Article
Brain metastasis in the precentral region due to choriocarcinoma – mimicking an acute cavernoma haemorrhage with recurrent seizures
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Authors
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Stefanie Hammersen
- Vivantes-Klinikum im Friedrichshain Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Michèle Simon
- Vivantes-Klinikum im Friedrichshain Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Dag Moskopp
- Vivantes-Klinikum im Friedrichshain Berlin, Klinik für Neurochirurgie, Klinik für Neurochirurgie, Berlin, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Choriocarcinoma is a rare female disease of childbearing age. An early diagnosis, especially of intraplacental metastatic spreaded choriocarcinoma is often aggravated due to separation from the primary tumour with delivery. The first clinical presentation of metastatic disease often is associated with respiratory symptoms due to pulmonary metastases. Brain metastasis are rarely reported.
Method: We report a case of a 31-year old female patient with a cerebral metastatic spreaded choriocarcinoma and try to elucidate this rare, untreated usually rapidly spreading fatal disease.
Results: This case report describes a 31 year old female patient 6 months after delivery, who presented in our hospital with a single seizure and subsequent postictal Todd’s paralysis. On admission to our emergency department we observed an alert and fully oriented patient with a right-sided pure motor hemiparesis. A cranial CT scan with angiography showed an atypical nodular haemorrhage. MRI verified the “popcorn” pattern of the haemorrhage. A venous malformation adjacent to the lesion strengthened the diagnosis of a present cerebral cavernous malformation with acute bleeding. Based on clinical worsening we decided to perform surgery. Histopathological findings revealed a metastasis of an adenocarcinoma of unknown primary origin by the time. The most common primary sites for brain metastasis in women – breast, kidney and melanoma – were ruled out by dermatological, gynacological as well as urological examinations. Screening by 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) depicted no tumour. Merely a subsisted increase in serum hCGß level gave a constructive hint for choriocarcinoma. The patient underwent subsequent chemotherapy analogous to the EMA/CO-scheme. Eight months following surgery the patient is assessed as cured.
Conclusion: In conclusion highlights this case of a 31 year old female patient with intraplacental metastatic spreaded choriocarcinoma the nessecity to consider also uncommon entities for intracranial tumours in female patients of childbearing age. Otherwise profound consequences are threatend. It also points out the not rarely delicate distinction between haemorrhagic and tumoural lesions solitary based on radiologic imaging. Likewise nodular non-hypermetabolic lesions in FDG-PET aren’t in principle non-malignant.
