Peter E.Stoemmer
Anja Meyer and Thomas Pusl Pathologie Augsburg Hermanstrasse 1 and Intensive care unit, ZK Augsburg, Germany
Title: An unusual case of Gynecomastia and Urothelial Bladder Cancer
Biography
Biography: Peter E.Stoemmer
Abstract
A 29-year old patient was referred to the medical clinics of ZK Augsburg; he complained of bilateral rather indolent asymmetric enlargement of his breasts: the left mamma being larger. Few small nodal consistences in the left breast was palpated; no nipple discharges were found. Ultrasonics and mammography showed a gynecomastia without features of a malignant tumor.
Anamnestically, the patient practiced bodybuilding (and denied the use of androgenic steroidal anabolics); erectile functions were normal; undescended testes were corrected by surgery in childhood., the left testis was atrophic.
Hormonal studies showed testosteron in the high-normal range and his estradiol and HCG were elevated, while the gonadotropins were suppressed; normal fetoprotein.
Cranial MRI and Chest-CT-Scan were normal; the bladderwall in abdominal CT thickened.
Cystoscopy, performed due to painless macrohematuria showed a small unifocal papillary tumor in the bladderwall followed by transurethral resection.
Histology: Multiple particles of a soft, grey focal hemorrhagic tissue together 0.5g with up to 10 layers of atypical urothelia; some preserved umbrella cells.No invasion into the muscularis. IHC: ectopic expression of HCG.
Diagnosis: Papillary urothelial carcinoma of the bladder with no invasion into the lamina propria (pTa G1 cN0 cM0)
In the following weeks, HCG was no longer detectable, his sex hormones returned to normal, and gynecomastia completely regressed.
HCG-producing tumors of the bladder are known since 1904 (1), but these were ectopic choriocarcinomas. In our case, the tumorcells are typical urothelia with ectopic HCG-production; we assume that this is the cause of estrogen- induced proliferation of male mammary glands.