Kew M C, Kirschner M A, Abrahams G E, Katz M
N Engl J Med. 1977 May 12;296(19):1084-8. doi: 10.1056/NEJM197705122961903.
Primary liver cancer occasionally presents with feminization. The mechanism is unknown. We studied a young man with primary liver cancer associated with feminization that disappeared after removal of the tumor. Before operation, the serum estrone level was markedly (1113 pg per milliliter) and estradiol and estriol levels were slightly elevated. Human placental lactogen was also increased (0.52 microng per milliliter). Luteinizing hormone, follicle-stimulating hormone and prolactin levels were normal, and testosterone reduced. Beta subunits of human chorionic gonadotropin were not detected in the serum. In vitro assay of tumor tissue showed estrogenic activity and high levels of these subunits. With a reversed isotope dilution technic with crystallization to constant specific activity, we showed the tumor tissue to convert dehydroepiandrosterone sulfate and dehydroepiandrosterone to estrone and estradiol. Production of beta subunits of chorionic gonadotropin and raised serum levels of placental lactogen provided further evidence that the tumor was functioning as trophoblastic tissue.
原发性肝癌偶尔会出现女性化表现。其机制尚不清楚。我们研究了一名患有原发性肝癌并伴有女性化的年轻男性，肿瘤切除后女性化表现消失。术前，血清雌酮水平显著升高（每毫升1113皮克），雌二醇和雌三醇水平略有升高。人胎盘催乳素也升高（每毫升0.52微克）。促黄体生成素、促卵泡生成素和催乳素水平正常，睾酮降低。血清中未检测到人绒毛膜促性腺激素的β亚基。肿瘤组织的体外检测显示有雌激素活性以及这些亚基的高水平。通过反向同位素稀释技术结合结晶至恒定比活性，我们发现肿瘤组织可将硫酸脱氢表雄酮和脱氢表雄酮转化为雌酮和雌二醇。绒毛膜促性腺激素β亚基的产生以及血清中胎盘催乳素水平的升高进一步证明该肿瘤具有滋养层组织的功能。
