Presentation
History of gestational trophoblastic disease on chemotherapy. Status post total abdominal hysterectomy and bilateral salpingectomy with pathology consistent with choriocarcinoma. Status post peripherally inserted central catheter placement.
Patient Data
1. The right upper extremity peripherally inserted central catheter terminates in the distal superior vena cava.
2. Innumerable metastatic nodules in the lungs are consistent with choriocarcinoma metastasis in this patient with history of gestational trophoblastic disease.
3. No discrete focal pneumonic consolidation, effusion or pneumothorax.
4. The heart and central pulmonary vascularity are normal.
5. No discrete focal suspicious osseous lesions. No free air in the upper abdomen.
Case Discussion
Gestational choriocarcinoma is a type of malignant gestational trophoblastic disease which commonly arise after fertilization and implantation of the egg. Most cases of gestational choriocarcinoma are preceded by hydatidiform mole, miscarriage, ectopic pregnancy, or normal pregnancy. However, non-gestational choriocarcinoma arises from pluripotent germ cells. Choriocarcinoma is characterized by the malignant transformation of the cytotrophoblastic and syncytiotrophoblastic tissue that grows into the myometrium without a chorionic villi. Choriocarcinoma commonly metastasizes early to the lungs, vagina, brain, and liver with a risk of hemorrhage due to its hypervascularity.
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Health Sciences Clinical Professor,
Department of Radiological Sciences,
David Geffen School of Medicine at UCLA.
Attending Radiologist,
Olive View - UCLA Medical Center.
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