Background

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.

Case

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.

Summary and Conclusion

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.

中文翻译：

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绒毛膜癌在青少年患者中表现为复发性颅内出血

背景

由于绒毛膜癌具有高度转移性和侵袭性，它可能会影响其他器官系统和类似妇科癌症的典型模拟疾病。继发于多个肿瘤动脉瘤破裂的颅内反复出血是其罕见的最初表现之一。

案件

我们报告了一个2个月的产后16岁女孩，她最初表现为突然发作的左侧无力。她的普通颅脑计算机断层扫描显示右顶壁区域有16 mL血肿，而她的4血管造影（4VA）显示双侧大脑中部远端动脉（MCA）出现了4个囊状动脉瘤。2周后完成的β-人绒毛膜促性腺激素（β-hCG）为356,684.5 mIU，她的经阴道超声检查显示出不明确的异肌肌层质量，大小为1.6×1.3×1.2 cm。由于动脉瘤的多样性和患者的年龄，推迟了手术切除和脑部放疗。尽管如此，她仍接受了依托泊苷，甲氨蝶呤，放线菌素-D，环磷酰胺和长春新碱/ oncovin方案的化疗。

总结与结论

产后出现多发颅内出血的产后绒毛膜癌继发的肿瘤性动脉瘤的早期考虑可能导致较早给予适当的化学疗法，进而改善预后。选择合适的治疗方法时应考虑年龄和动脉瘤的数量。