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Elevated HCG and retroperitoneal adenopathy after clomiphene therapy for infertility
  1. Raj Vikesh Tiwari1,
  2. Maria Di Jiang2,
  3. Keith Jarvi3 and
  4. Robert Hamilton4
  1. 1Urology, University of Toronto, Toronto, Ontario, Canada
  2. 2Medical Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
  3. 3Division of Urology, Sinai Health System, Toronto, Ontario, Canada
  4. 4Division of Urology, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Dr Raj Vikesh Tiwari; raj.tiwari{at}


In the context of an elevated human chorionic gonadotropin (HCG) with enlarged retroperitoneal nodes and absent testicular tumours, clinicians will consider a diagnosis of extragonadal germ cell tumours. We report the case of a man in his thirties who while on treatment for subfertility with clomiphene citrate was noted to have enlarged retroperitoneal nodes and elevated HCG levels of 75 IU/L. Chemotherapy with bleomycin, etoposide and cisplatin originally planned was deferred when two separate retroperitoneal nodal biopsies returned as benign fibroadipose tissue and HCG levels spontaneously down-trended to 4 IU/L within 4 months of clomiphene citrate discontinuation. Follow-up imaging revealed regression of the retroperitoneal nodes.

  • Obstetrics, gynaecology and fertility
  • Urinary and genital tract disorders
  • Drugs: endocrine system
  • Urological cancer
  • Surgical oncology

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  • Contributors RVT the clinical fellow summarised the case, reviewed the images and was the primary author under the supervision of MDJ, KJ and RH who are managing staff medical oncologists and urologists who assisted with revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.