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Human Chorionic Gonadotropin (hCG) and Its Free Subunits in Hydrocele Fluids and Neoplastic Tissue of Testicular Cancer Patients: Insights into the in Vivo hCG Secretion Pattern¹

Department of Urology, University of Vienna [S. M., C. K.]; Institute for Biomedical Aging Research of the Austrian Academy of Sciences, Rennweg 10, A-6020 Innsbruck [R. G., S. D., P. B.]; and Institute for General and Experimental Pathology, University of Innsbruck [P. B.], Austria

To obtain insight into the secretion pattern of human chorionic gonadotropin (hCG) and its free subunits, hCG and hCGß, in vivo, we analyzed hydrocele fluids of 13 patients with testicular cancer and correlated the respective values to those of cubital vein and testicular vein serum. As a control population, patients with nonmalignant hydroceles (n = 11) were studied. Analyses were performed with a set of highly sensitive and specific time-resolved fluoroimmunoassays based on our own panel of monoclonal antibodies. In the collective of testicular cancer patients, increased hydrocele levels of either hCG or free hCG or free hCGß were observed in 77, 54, and 92% of cases; the corresponding percentages for cubital vein serum were 62, 23, and 31%. The cubital vein ratio of hCG:hCG (546:1) and hCG:hCGß (51:1) decreased to 64:1 and to 7:1 in the hydrocele fluids. Surprisingly, hydrocele fluids of five patients with pure seminoma, who were negative for the three markers in the periphery, revealed an elevation of free hCGß in all cases, while hCG and holo-hCG were elevated twice. Final proof that hCGß and hCG are indeed produced by these previously termed "marker negative" seminomas has been achieved by reverse transcriptase-polymerase chain reaction with primers specific for the -subunit and the four most abundantly transcribed hCGß genes 3, 5, 7, and 8. From these data, we conclude that: (a) seminomatous and nonseminomatous testicular cancers, irrespective of histology, secrete hCG and its free subunits; (b) the amount of free subunits being secreted in vivo by these tumors has been underestimated; and (c) the classification in marker-positive and marker-negative testicular cancer should be reconsidered.

¹ Supported by the Tuba Foundation.

² To whom requests for reprints should be addressed.

Received 6/21/94. Accepted 8/18/94.

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