Primary Intracranial Choriocarcinoma: Neurorradiological Features

Objective: The purpose of this study is to describe and review CT and MR imaging findings in a very rare case of a patient with pathologically proved Primary Intracranial Choriocarcinoma treated at our institution – Unimed-BH Hospital.

Patient/Methods: A 36-year-old woman presented to the emergency department with an acute change in her headache pattern. Brain CT scan without contrast revealed a hyperdense expansive lesion within the left temporal lobe parenchyma. Following MRI study showed a single heterogeneous (hypo- and hyperintese) intrinsic tumoral lesion in the posterior aspect of the left temporal lobe surrounded by pronounced vasogenic edema on T2-W images. Intratumoral hemorrhage was remarkably appreciated. Enhancement was very heterogeneous on T1-W with gadolinium. The patient was operated on and the immunohistochemical and pathological studies revealed a choriocarcinoma.

Results/Discussion: Primary intracranial choriocarcinoma (PIC) is the rarest and most malignant primary intracranial germ cell tumor. The most common sites of occurrence of PIC are the pineal and suprasellar regions. Intratumoral hemorrhage and extraneural/CSF metastasis are common manifestations of PIC, which are responsible for its poor prognosis. Complete resection is the first line therapy followed by adjuvant treatment. Very few studies have described the radiologic findings of PIC.

Conclusion: This case illustrates the relevance of recognizing the typical CT and MRI features of intracranial choriocarcinomas.