Choriocarcinoma with cerebral metastasis presenting as a stroke-like lesion

Abstract

Choriocarcinoma is a very aggressive malignant variant of gestational trophoblastic disease characterized by malignant proliferation of trophoblastic tissues and absence of chorionic villi. We present a rare case of metastatic choriocarcinoma presenting with a stroke-like lesion. A 40-year old multiparous woman that presented with bleeding per vaginam, right-sided facial nerve palsy and hemiparesis following eight weeks of amenorrhea. Serum β-hCG was elevated and urine pregnancy test was positive in neat and in serial dilution. She was managed as a case of metastatic choriocarcinoma and had five courses of the EMA-CO drug regimen. She made rapid neurological recovery and was discharged in good condition. We conclude that metastatic choriocarcinoma may present in bizarre forms. It should be suspected in any woman presenting with abnormal vaginal bleeding, unusual systemic physical features and raised serum β-hCG. We conclude that combination chemotherapy is usually effective even in metastatic choriocarcinoma.