VIRILIZATION ASSOCIATED WITH CHORIOCARCINOMA

We demonstrate here two autopsy-proven cases of virilization associate d with choriocarcinoma. The first patient was a 27-year-old woman with a 7-year history of metastatic choriocarcinoma who presented with lef t hemiparesis and virilization. Serum testosterone concentration was 1 8 nmol/l, free testosterone 471 pmol/l, dehydroepiandrosterone sulphat e (DHEA-sulphate) 1.7 mu mol/l, sex hormone binding globulin 12.3 nmol /l, estradiol (E(2)) 1,843 pmol/l, and hCG 1.6 x 10(5) IU/I. The secon d patient was a 21-year-old virilized woman with metastatic choriocarc inoma who presented in semicomatose state. Limited endocrine investiga tion revealed serum testosterone 27 nmol/l and hCG 2.7 x 10(5) IU/I. B oth patients died despite chemotherapy and radiation therapy. Autopsy findings revealed choriocarcinoma with brain and multiple organ metast asis in both. Pathology of the ovaries of both patients demonstrated h yperplasia of luteinized theca cells and lutein cells. We postulate th at an association of virilization and choriocarcinoma resulted from lo ng-standing stimulation of ovary by hCG causing theca cell hyperplasia with subsequent hypertestosteronemia and virilization.