Choriocarcinomas- revealed by brain
metastasis are quite rare; we report the case of a patient with a history of
abortion; she is admitted for a disorder of consciousness. CT scan and magnetic
resonance imaging of the brain denoted several haemorragic lesions that looked
suspicious, biological tests revealed an elevated blood level of beta human
chorionic gonadotropin (β-hCG), and pelvic ultrasound showed the presence of a
choriocarcinome. The evolution was not favorable and led to the death of the
patient after the 2nd cure of chemotherapy. Choriocarcinoma is
a malignant and very aggressive form of gestational trophoblastic diseases characterized
by a highly metastatic potential; brain metastasis is associated with poor
prognosis. In this case report, we show the importance of early diagnosis of
choriocarcinoma to limit dramatic complications.
A 19-year-old
woman, married, on oral contraception, having a history of an abortion 6 months
ago, admitted for a sudden consciousness disorder. The patient had had
progressive worsening headaches over 2 weeks, resistant to analgesic treatment. The clinical
examination denoted a GCS of 9, a temperature at 37°C, a heart rate at 105
beats / minute, a respiratory rate at 25 cycles/minute, a blood pressure at
170/100 and an oxygen saturation at 90% in ambient air.A cerebral computed
tomography (CT) showed the presence of multiple hemorrhagic localizations in
both sides of the frontal and parietal lobes; and the right occipital lobe; all
of them are surrounded by significant peri-lesional edema.
Cerebral Magnetic
Resonance Imaging (MRI) showed that these hemorrhagic localizations
corresponded to heterogeneous hyper signal in T1, T2, FLAIR and diffusion
(Figure 1), (Figure 2a,c,d); surrounded by a hypo-signal corona on T2 sequences
with peripheral enhancement after gadolinium injection (Figure 2b). The results of the
MRI suspected secondary brain lesions that led us to perform a pelvic
ultrasound and a thoraco-abdomino-pelvic CT scan which showed a globular uterus
with the presence of a partitioned mass.
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