Case Report: Intracranial Hemorrhage as Initial Manifestation of Metastatic Trophoblastic Disease

Abstract

Background: Gestational trophoblastic disease is a heterogeneous group of epithelial tumors that arise in placental trophoblastic tissue following abnormal fertilization and are related to a pregnancy event (miscarriage, extrauterine or term/preterm pregnancy). Choriocarcinoma is the most aggressive histologic type, as it shows early vascular invasion and blood metastases. It can manifest itself through hemorrhages originating in the most frequent metastatic foci of choriocarcinoma, which are usually the lung (80%), vagina (30%), brain and liver (10%).

Clinical Case: 22-year-old female patient, who presented to the emergency department secondary to neurological deterioration with initial evaluation Glasgow 3 points, with presentation of Fisher IV subarachnoid hemorrhage, which merited neurosurgical treatment (decompressive craniectomy), with diagnosis of choriocarcinoma, with result of chorionic gonadotropin beta fraction 91114 mIU/ml, uterine choriocarcinoma in posterior wall of uterus, metastasis to lung and splenic and right renal infarction.

Conclusion: Choriocarcinoma is a highly aggressive trophoblast pathology, due to its great capacity for angioinvasion, which facilitates its dissemination and favours the development of pulmonary, cerebral, hepatic and other organ metastases. This increases mortality, since diagnosis and treatment is usually not carried out early, or is incomplete.