Background: Choriocarcinoma is a highly malignant trophoblastic tumor. However, the awareness surrounding its atypical clinical presentation is insufficient. The presence of a solitary lung lesion without uterine lesions often leads to misdiagnosis or missed diagnosis, which in turn causes delayed treatment or even multiple metastases throughout the body.
Case Presentation: We present the case of a 36-year-old female patient who was misdiagnosed with a lung abscess and received suboptimal anti-infective treatment. She then underwent left upper lobectomy and was misdiagnosed with lung cancer by abscess incision and drainage in thoracic surgery, however, the results after pleural effusion removal were suboptimal. During this time a breast nodule was found, and a large segment of the right breast was excised and misdiagnosed as breast cancer but was finally diagnosed as choriocarcinoma with multiple metastases of lung and breast. Multiple metastases were also detected in the head, liver, kidney, and bones. The patient underwent multiple adjuvant chemotherapies. The blood β-hCG level gradually declined to normal. When we reported this case, that is, seven months after the diagnosis, the patient was still alive, and the disease was stable without progress.
Conclusion: Choriocarcinoma with a solitary lung lesion as the first presentation and no lesions in the uterus is clinically rare. This may lead to a delay in diagnosis due to poor awareness of the disease and the appearance of multiple metastases throughout the body. Clinicians should be more aware of choriocarcinoma with an atypical presentation to reduce misdiagnosis and missed diagnosis.



中文翻译：

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伪装成肺脓肿或肺癌的绒毛膜癌：影像学表现不典型的病例

背景：绒毛膜癌是一种高度恶性的滋养细胞肿瘤。然而，对其非典型临床表现的认识不足。没有子宫病变的孤立性肺部病变的存在往往导致误诊或漏诊，进而导致治疗延误甚至全身多发转移。
案例介绍：我们介绍了一名 36 岁女性患者的病例，她被误诊为肺脓肿并接受了次优的抗感染治疗。随后，她接受了左上肺叶切除术，并在胸外科手术中因脓肿切开引流而误诊为肺癌，但胸腔积液清除后的结果并不理想。在此期间发现了一个乳腺结节，切除了大部分右侧乳房，误诊为乳腺癌，最终被诊断为绒癌，肺和乳房多发转移。在头部、肝脏、肾脏和骨骼中也检测到多处转移。患者接受了多种辅助化疗。血β-hCG水平逐渐下降至正常。当我们报告这个病例时，也就是确诊后七个月，病人还活着，
结论：以单发肺部病变为首发且子宫内无病变的绒毛膜癌临床罕见。由于对疾病的认识不足和全身多处转移的出现，这可能导致诊断延迟。临床医生应更多地了解具有非典型表现的绒毛膜癌，以减少误诊和漏诊。