Intracerebral hemorrhage as initial presentation of gestational choriocarcinoma: A case report and literature review
Journal
International Journal of Gynecological Cancer
Journal Volume
17
Journal Issue
5
Pages
1166-1171
Date Issued
2007
Author(s)
Abstract
Choriocarcinoma is the most malignant tumor of gestational trophoblastic neoplasia. It grows rapidly and metastasizes to the lung, liver, and, less frequently, to the brain. One rare case of metastatic cerebral choriocarcinoma with initial presentation of intracerebral hemorrhage is reported. A 40-year-old woman initially presented sudden onset of headache. Intracerebral hemorrhage resulting from ruptured pseudoaneurysm was suspected. Emergent surgery with excision of the pseudoaneurysms was performed. Metastatic choriocarcinoma was accidentally found with positive immunohistochemical staining of cytokeratin and β subunit of human chorionic gonadotropin (β-HCG). Choriocarcinoma with brain metastases was diagnosed. She then received chemotherapy with regimen of etoposide, methotrexate, actinomycin-D, cyclophosphamide, and vincristine (EMACO). Elevated serum β-HCG (30.3 mIU/mL) and new pulmonary lesions were noted by computed tomography 4 months after completion of EMACO. Salvage chemotherapy with etoposide, methotrexate, actinomycin-D, etoposide, and cisplatin (EMAEP) regimen was given. Seven months later after completion of EMAEP, two new pulmonary lesions were detected by positron emission tomography (PET) scan. So she received video-assisted thoracoscopic surgery with tumor excision. Pathologic report confirmed the diagnosis of lung metastases. The patient recovered well. She is free of disease for 12 months. The diagnosis of metastatic cerebral choriocarcinoma was only made by histopathology after craniotomy. Metastatic choriocarcinoma should be always in the differential diagnosis for women at childbearing age presenting with unexplained stroke-like symptoms. In addition, PET scan may be valuable in detecting occult metastatic lesions of choriocarcinoma. ? 2007, IGCS and ESGO.
SDGs
Other Subjects
chorionic gonadotropin beta subunit; cisplatin; cyclophosphamide; cytokeratin; dactinomycin; etoposide; folinic acid; methotrexate; vincristine; adult; aneurysm rupture; article; brain hemorrhage; brain metastasis; cancer chemotherapy; cancer surgery; case report; choriocarcinoma; computer assisted tomography; craniotomy; endoscopic surgery; false aneurysm; female; gestation period; headache; histopathology; human; immunohistochemistry; lung injury; lung metastasis; positron emission tomography; priority journal; Adult; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Cerebral Hemorrhage; Choriocarcinoma; Chorionic Gonadotropin; Dactinomycin; Disease-Free Survival; Doxorubicin; Etoposide; Female; Gestational Trophoblastic Neoplasms; Humans; Leucovorin; Methotrexate; Positron-Emission Tomography; Pregnancy; Pregnancy Complications, Neoplastic; Vincristine
Type
journal article