Case Study: Non-gestational ovarian choriocarcinoma in a young female

By Dr. Moushumi Lodh, Dr. Abhishek Mukherjee and Dr. Ratnadeep Ganguly

Summary

We describe a case of non-gestational ovarian carcinoma with omental and central nervous system metastasis in a twenty-two year old woman.

Background

The symptoms of extra-uterine choriocarcinoma mimic common disorders of young women, such as an ovarian cyst, abscess, torsion, or ectopic pregnancy. It is imperative then, that it is considered a differential diagnosis when the patient presents with clinical findings of ectopic pregnancy, especially with elevated β human chorionic gonadotropin.

Case Presentation

Choriocarcinoma commonly metastasizes to the lungs, brain and liver. Non-gestational choriocarcinoma constitutes 0.6% or less of all ovarian neoplasms. (1) Ovarian choriocarcinoma is an extremely rare tumor arising from germ cells, accounting for fewer than 5% of all ovarian cancers diagnosed in Western countries. (2)

The diagnostic criteria for non-gestational choriocarcinoma of the ovary include exclusion of molar pregnancy, intrauterine pregnancy, intrauterine disease and pathological confirmation of the disease. (3) The central nervous system metastases of the choriocarcinoma are seen in 10-20% of cases, (4) and may present as arteriovenous malformation bleed, parenchymal or subarachnoid hemorrhage from rupture of neoplastic aneurysms, carotid cavernous fistula, infarct due to tumor embolus or a subdural hematoma. (5)

Our patient, a twenty-two-year-old was brought to the emergency department of our hospital with a history of unconsciousness and sudden fall. Her pupils were responding sluggishly, and she was not able to move her right limbs when she arrived in the emergency department, although her left limbs were showing spontaneous movements. There was no external injury and no history of convulsions. For the last four days, she had been complaining to her family of a persistent headache with intermittent vomiting. For the last four months, she had irregular periods and lower abdominal pain. The patient had delivered a healthy baby five years ago, by normal vaginal delivery.

No complaints of lethargy, poor appetite, or marked weight loss existed. There was no history of prolonged oral contraceptive use, or any prolonged medication or surgery for any other ailment. There was no family history of molar pregnancy, abortion or consanguineous marriage.

Her blood pressure was 120/60 mm Hg, heart rate was 68/minute, respiratory rate was 24/minute, and oxygen saturation in room air was 94%. Heart sounds were normally audible, and breath sounds were bilateral and vesicular. Her abdomen was soft but had a firm, mobile mass of about 10x7 cm, in the right adnexal region. The ultrasound confirmed the mass to be an 11x7 cm solid lesion, probably arising from the ovary. The other pelvic organs, including the uterus, were found to be normal, and there was no gestational sac or evidence of hydatidiform mole.

Investigations

Her laboratory tests were as follows: hemoglobin level 9.3 grams/dl, total WBC count 18,900/cu mm associated with ...

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