DECEMBER 2012
An 18-year-old girl was admitted to the emergency department for headache and acute right hemiparesis. Clinical history was marked by persistent metrorrhagia after a normal childbirth six months ago.
Metastatic Choriocarcinoma
- Choriocarcinoma is a malignant proliferation of trophoblasts that complicates a normal or abnormal pregnancy.
- Intraparenchymal brain metastases from choriocarcinoma occur in 10-20 % of the cases and are often haemorrhagic.
- Endovascular metastases may lead to aneurysms by cell invasion of the vessel wall, with resultant progressive weakening and deformation.
- Neoplastic aneurysms have poor prognosis, with a mortality rate of 50%.
- Key Diagnostic Features: Hemorrhagic metastases with aneurysms. Elevated β-HCG in patients with diagnosis of choriocarcinoma should raise a red flag for associated complications (such as metastatic choriocarcinoma).
- DDx: Mycotic aneurysms
- Rx: Chemotherapy for metastatic disease. Aneurysms: endovascular or surgery
