In Search of a Cancer

Abstract

Abstract In a 22-year-old man, who had minimal gynecomastia, serum immunoassayable luteinizing hormone activity was 500 to 1000 mIU per milliliter. A gonadotropin secreting neoplasm was diagnosed, but in spite of a thorough search over eight months' time, none was found. The search included all routine x-ray procedures, catheterization and measurement of gonadotropin concentrations in samples from femoral, inferior and superior vena caval veins and systemic arteries, abdominal arteriograms, measurement of testicular-vein gonadotropin concentrations, and surgical exploration of both testes and the mediastinum. Production rate of gonadotropin, estimated with radioiodinated chorionic gonadotropin, was sufficiently low that it would have been unlikely to detect differences between tumor venous concentrations and peripheral vein concentrations. One year after onset of symptoms, pulmonary metastases suddenly appeared, and within a few weeks he died with widespread metastases. At post-mortem examination, the lik...