Primary pulmonary choriocarcinoma: a diagnostic dilemma

We present a case of a 25-year-old Hispanic woman who presented to emergency department with chief complaint of left lower quadrant abdominal pain. Initial workup revealed positive pregnancy test. Serum human chorionic gonadotropin was 36,478 (normal range, 0 to 8.0) IU/mL. She underwent diagnostic laparoscopy with dilatation and curettage, which did not reveal any evidence of intrauterine or extrauterine pregnancy. Chest and abdomen radiographic findings were significant for a heterogenously enhancing 2.2×1.7×1.6 cm nodule in superior segment of the right lower lobe of the lung and a large perinephric hematoma. We performed radial endobronchial ultrasound-guided transbronchial biopsies of the right lower lobe lesion. Pathologic specimen revealed choriocarcinoma.