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Stains

hCG


Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 11 August 2012, last major update August 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

Definition
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human Chorionic Gonadotrophin
● Glycoprotein with alpha and beta subunits (Wikipedia)
● May cause low TSH levels during early pregnancy because of TSH-like effects of hCG, which has similar alpha subunit as TSH

Uses by pathologists
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● Cytoplasmic stain; relatively specific for choriocarcinoma or syncytiotrophoblasts
● Serum levels of beta subunit used to detect pregnancy
● Serum levels also used to stage germ cell tumors and gestational trophoblastic tumors

Micro images
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Normal placenta: third trimester


Bladder: urothelial carcinoma with trophoblastic differentiation; giant cells (arrows) are hCG+
Note that many hcG+ cells are not multinucleated and cannot be distinguished from other anaplastic cells without hCG staining (AFIP image courtesy of Dr. Jonathan I. Epstein, Baltimore, Maryland)



Breast: invasive ductal carcinoma with choriocarcinomatous features


Choriocarcinoma


Choriocarcinoma: metastatic


Choriocarcinoma in 8 year old girl: mixed with mature teratoma

   
Pleural fluid: reactive mesothelium (left) versus lung carcinoma (right)

Positive staining - normal
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● Placenta (syncytiotrophoblasts)

Positive staining - disease
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Choriocarcinoma > complete mole > partial mole
● Syncytiotrophoblast cells in other tumors, including epithelioid trophoblastic tumors, carcinomas with trophoblastic differentiation, some carcinoids and other tumors
● Serous effusions with reactive mesothelium may be hCG+ (Mod Pathol 2004;17:701)

Negative staining
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● Giant cells other than syncytiotrophoblasts; early placenta, cytotrophoblast, intermediate villous trophoblast
Exaggerated placental site
Placental site nodule
Placental site trophoblastic tumor
● Dysgerminoma / seminoma, yolk sac tumor, but may have scattered hCG+ syncytiotrophoblasts

End of Stains > hCG


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