Unusual Presentation of Non-Gestational Extragonadal Choriocarcinoma
Abstract
Non-gestational choriocarcinoma is an extremely rare and highly aggressive malignant tumor that arises independent of gestational events, making less than 0.6% of all ovarian germ cell tumors. Unlike the more common gestational choriocarcinoma, which is associated with pregnancy, non-gestational choriocarcinoma originates from germ cells within the ovary. It accounts for a small fraction of ovarian malignancies and is often characterized by elevated levels of serum beta-human chorionic gonadotropin (β-HCG). The rarity and clinical overlap with other ovarian tumors pose significant diagnostic challenges, necessitating a thorough histopathological and immunohistochemical examination for accurate diagnosis. A 39-year-old female presented with a two-week history of right-sided migraine and general malaise, followed by a three-day onset of vision loss in the right eye. Initial evaluation in the emergency department included a chest X-ray, which revealed a 10 cm rounded opacity in the upper lobe of the left lung. A CT scan of the head showed a 4.5 cm rim-enhancing lesion in the left occipital lobe, along with a left middle cerebral artery (MCA) aneurysm. Notably, her serum β-HCG levels were significantly elevated at 5,642 mIU/mL despite the absence of intrauterine or extrauterine pregnancy on abdominal and pelvic ultrasound. Further workup included a CT thorax and MRI of the brain, which confirmed the isolated lung mass and left occipital lobe mass with no other sites of disease,…
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