J Korean Neurosurg Soc.  2012 Mar;51(3):141-143. 10.3340/jkns.2012.51.3.141.

Intramedullary Spinal Cord Metastasis of Choriocarcinoma

• Ko JK
• Cha SH
• Lee JH
• Choi CH

• KMID: 2018186
• DOI: http://doi.org/10.3340/jkns.2012.51.3.141

Abstract

The authors describe a case of choriocarcinoma that metastasized to the cerebral cortex, vertebral body, and intramedullary spinal cord. A 21-year-old woman presented with sudden headache, vomiting and a visual field defect. Brain computed tomography and magnetic resonance examinations revealed an intracranial hemorrhage in the left temporo-parietal lobe and two enhancing nodules in the left temporal and right frontal lobe. After several days, the size of the hemorrhage increased, and a new hemorrhage was identified in the right frontal lobe. The hematoma and enhancing mass in the left temporo-parietal lobe were surgically removed. Choriocarcinoma was diagnosed after histological examination. At 6 days after the operation, her consciousness had worsened and she was in a state of stupor. The size of the hematoma in the right frontal lobe was enlarged. We performed an emergency operation to remove the hematoma and enhancing mass. Her mental status recovered slowly. Two months thereafter, she complained of paraplegia with sensory loss below the nipples. Whole spine magnetic resonance imaging revealed a well-enhancing mass in the thoracic intramedullary spinal cord and L2 vertebral body. Despite chemotherapy and radiotherapy, the patient died 13 months after the diagnosis.

Keyword

Choriocarcinoma; Intracerebral hematoma; Intramedullary spinal cord metastasis; Spinal metastasis

MeSH Terms

Brain
Cerebral Cortex
Choriocarcinoma
Consciousness
Emergencies
Female
Frontal Lobe
Headache
Hematoma
Hemorrhage
Humans
Intracranial Hemorrhages
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Neoplasm Metastasis
Nipples
Paraplegia
Pregnancy
Spinal Cord
Spine
Stupor
Visual Fields
Vomiting
Young Adult

Figure

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  Fig. 1 Preoperative brain MRI scan showing a hematoma in the left temporo-parietal region and two enhancing nodular lesions in the right frontal and left temporal regions.

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  Fig. 2 Histologic section of the enhancing mass showing trophoblastic cells (H&E, original magnification ×200).

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  Fig. 3 A : Sagittal T2-weighted MRI of the thoracic spine, showing the edematous swelling of the spinal cord. B : Axial T2-weighted MRI showing an intramedullary high-signal intensity lesion. C : Sagittal T1-weighted MRI obtained after Gd injection. The tumor appears heterogeneously hyperintense. D : Axial Gd-enhanced T1-weighted MRI showing a well-enhancing intramedullary mass.

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  Fig. 4 Sagittal Gd-enhanced T1-weighted MRI showing rim-enhancing mass in the L2 vertebral body.

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