Choriocarcinoma Presenting as Recurrent Intracranial Hemorrhage in an Adolescent Patient

Due to its highly metastatic and invasive nature, choriocarcinoma may affect other organ systems and mimic conditions not typical of gynecologic cancers. Recurrent intracranial hemorrhage secondary to rupture of multiple oncotic aneurysms is one of its rare initial presentations.

We report a 2-month postpartum, 16-year old girl who initially presented with sudden-onset left-sided weakness. Her plain cranial computed tomography scan showed a 16-mL hematoma in the right parietal area, and her 4-vessel angiogram (4VA) disclosed 4 saccular aneurysms in bilateral distal middle cerebral arteries (MCA). The β-human chorionic gonadotrophin (β-hCG) done 2 weeks later was 356,684.5 mIU, and her transvaginal ultrasound showed an ill-defined heterogenous myometrial mass measuring 1.6 × 1.3 × 1.2 cm. Due to the multiplicity of aneurysms and the patient's young age, surgical excision and brain irradiation were deferred. Nonetheless, she received chemotherapy with a regimen of etoposide, methotrexate, actinomycin-D, cyclophosphamide, and vincristine/oncovin.

Early consideration of oncotic aneurysm secondary to choriocarcinoma in a postpartum presenting with multiple intracranial hemorrhages may lead to earlier administration of proper chemotherapy and, in turn, to a better prognosis. Age and the number of aneurysms should be considered in choosing the appropriate therapy.