A Delayed Metastatic Storm after Molar Pregnancy: CT Chest and Brain Findings of Choriocarcinoma with Life- Threatening Hemoptysis

Abstract

Choriocarcinoma is a highly aggressive form of gestational trophoblastic neoplasia that may develop years after a molar pregnancy. We report a 22-year-old woman with severe hemoptysis and a history of molar pregnancy two years prior. Her ?-hCG level was 225,000 mIU/mL. Chest CT showed a hypervascular right lung mass with arterial supply from multiple systemic vessels, suggestive of arteriovenous shunting. Brain MRI revealed hemorrhagic occipital metastasis. No uterine lesion was found. Metastatic choriocarcinoma was diagnosed. She underwent arterial embolization followed by systemic chemotherapy with etoposide–cisplatin and EMA-CO. Her ?-hCG level declined to 10,090.15 mIU/mL. This case illustrates an atypical, delayed metastatic presentation of choriocarcinoma. In women of reproductive age with a prior gestational event, hypervascular pulmonary and cerebral lesions with elevated ?-hCG should prompt consideration of metastatic choriocarcinoma.