Background: Gestational trophoblastic neoplasia are malignancies arising from the placenta which usually arise from molar pregnancy but can follow any gestation. Choriocarcinoma is a subset of these which is highly invasive and frequently metastasizes, most commonly in the lungs and to the brain. These tumors frequently present with bleeding. This case report tackles metastatic choriocarcinoma presenting as intracranial hemorrhage.
Case Description: This is a case of a 25-year-old female with no known comorbidities, recently delivered 4 months prior, who presented with recurrent intracranial hemorrhage. She was managed conservatively with no surgical intervention and underwent digital subtraction angiography, revealing findings consistent with vasculitis, and treated with intravenous corticosteroids. She was readmitted 2 weeks after discharge and during admission was found to have decreasing sensorium. Repeat CT scan revealed multiple new intracranial hemorrhages mostly located in the right parietal lobe. Incidentally, whole abdominal CT revealed multiple hepatic nodules for which biopsy was requested. Patient deteriorated and expired before the final reading of metastatic choriocarcinoma was given.
Discussion and Conclusions: With the diagnosis of metastatic choriocarcinoma to the liver proven with biopsy and due to the nature of this tumor, we surmise that the cause of her intracranial hemorrhage is a metastatic disease to the brain. Choriocarcinoma with liver and brain metastasis occurs in patients with antecedent non-molar pregnancy and delay of diagnosis. This disease is highly responsive to chemotherapy but is invariably fatal if unrecognized. Early recognition is key as this disease is highly responsive to chemotherapy. In the demographics of a young female presenting with intracranial hemorrhage, AV malformation and vasculitis are more commonly considered. However, bleeding metastatic choriocarcinoma warrants consideration especially in peripartum women presenting with intracranial hemorrhage.