Retroperitoneal leiomyosarcoma and enlarged epididymis associated with a positive pregnancy test

A 57-year-old man presented with a 1-month history of progressive abdominal pain and weight loss. A palpable, nonpulsatile, firm abdominal mass was felt below the xiphisternum down to the pelvis. A pregnancy test performed on a urine sample was positive. Testicular examination and testicular ultrasound were normal. Computerized tomography of the abdomen revealed a retroperitoneal mass measuring 30 × 21 × 13 cm. Serum β-human chorionic gonadotropin (β-HCG) was serially increased (19.71-22.71 mlU/mL). Results of histopathology tests confirmed the diagnosis of leiomyosarcoma. The level of serum β-HCG decreased to < 0.2 mlU/mL after chemotherapy. β-HCG is usually increased in germ-cell tumors but few reports in the literature describe β-HCG-secreting leiomyosarcomas. The incidence of increased levels of β-HCG in sarcomas in general, and its potential role as a tumor marker, is not known. A simple urine pregnancy test may be done in the work-up of abdominal masses.