Metastatic Choriocarcinoma Presents Challenge in Addressing Intracranial Pressure
Keti Gvazava1, Nihal Satyadev1, Jeffrey Peel1, Christopher Kramer1, Lauren Ng1, Gabriel Bendfeldt2, Ahmed Ombada Mutaz1, Johnny Cebak1, Danelia Martinez Narvaez3, Nikki Matos3, Ansley Madala1, William Freeman2
1Neurology, 2Neurosurgery, Mayo Clinic, 3Mayo Clinic
Objective:
The objective is to present a case of postpartum choriocarcinoma with multifocal bilateral hemorrhagic brain metastases, where the time from diagnosis to death was six days. The case posed significant challenges in managing intracranial pressure (ICP) despite the use of multimodal therapy.
Background:
Choriocarcinoma is a subtype of gestational trophoblastic neoplasia, with a prevalence of around one in 50,000 pregnancies. It commonly metastasizes to the lungs, liver, and pelvic cavity, but in rare cases, it can metastasize to the brain. The response to chemotherapy is well-documented; however, our case this was influenced by poor prognostic factors such as antecedent term pregnancy and location of metastasis. Our case presents a challenging diagnosis and explores management considerations for ICP in the setting of multifocal hemorrhage.
Design/Methods:
Case report
Results:
A 34-year-old woman with a history of lupus presented on postpartum day 4 with severe headache, right-sided weakness, and a one-month history of blurry vision. Upon admission, Stage IV metastatic choriocarcinoma was diagnosed. Neuroimaging revealed nine hemorrhagic metastatic brain lesions with necrotic cores and intraventricular hemorrhage. Metastases were also present in the liver and lungs. Progressive hemorrhagic expansion of intracranial lesions occurred on days three, five, and six, accompanied by seizures on days four and six, leading to decreased consciousness and necessitating intubation. Despite aggressive interventions, including corticosteroids, chemotherapy, and whole-brain radiation, the patient succumbed to tonsillar herniation on day six, culminating in the patient's death.
Conclusions:
This case highlights the clinical challenges of metastatic choriocarcinoma involving the CNS and emphasizes the need for early ICP monitoring and management. While chemotherapy is the standard of care for choriocarcinoma, neurosurgical and radiosurgery intervention could offer potential benefits in selected cases to optimize outcomes and reduce mortality risks.
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