Metastatic Choriocarcinoma Without a Uterine Focus Presenting as an Intracranial Hemorrhage A Case Report

Abstract

Choriocarcinoma is an aggressive subtype of gestational trophoblastic disease.  It is composed of a dimorphic trophoblast pattern and lacks chorionic villi (Baergen, 2005). Grossly, it is seen as a well-defined hemorrhagic or necrotic focus, which is variable in size within the myometrium or extending into the endometrial cavity. This tumor has the potential to metastasize early (Baergen, 2005). We report a 24 year old female presenting with headache revealed as a hemorrhagic focus in a non-contrast cranial computed tomography (CT) scan. Work-up revealed elevated beta-human chorionic gonadotropin hormone (beta-HCG), pulmonary metastases in chest CT, but without a uterine focus in transvaginal ultrasound.  The patient was treated with EMACO protocol and whole brain radiation therapy.  The patient is now asymptomatic with a normal beta-HCG level and is on regular follow-up.