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Vol. 26. Num. 3.May - June 2015
Pages 105-156
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Vol. 26. Num. 3.May - June 2015
Pages 105-156
Case Report
DOI: 10.1016/j.neucir.2014.08.001
Histology of a cerebral hemorrhage: AVM as a seat of a metastatic choriocarcinoma
Histología de un hematoma cerebral: MAV como asiento de una metástasis de coriocarcinoma
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Noemí Morollóna, Ignacio Arreseb, Tomas Zamorac, Rosario Sarabiab,
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rsarabia@saludcastilayleon.es

Corresponding author.
a Servicio de Neurología, Complejo Hospitalario de Segovia, Segovia, Spain
b Unidad Neurovascular Río Hortega, Hospital Universitario Río Hortega, Valladolid, Spain
c Servicio de Anatomía Patológica, Hospital Universitario Río Hortega, Valladolid, Spain
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Abstract
Introduction

There are published cases of cerebral hemorrhage secondary to vascular alterations caused by choriocarcinoma metastases. However, it is extremely rare to find this type of bleeding secondary to an association of such a metastasis with a brain arteriovenous malformation (AVM).

Clinical case

We present the case of a 19-year-old male who came to the Emergency Department complaining of intense headache of abrupt onset. His physical examination revealed a striking increase in size of the right testicle of tumoral origin. Chest X-ray evidenced metastasis to the lungs and a brain CT showed a frontal hemorrhage of probably metastatic origin. The latter eventually progressed to cause the death of the patient. Pathology of the brain hematoma disclosed a choriocarcinoma within the brain AVM nidus.

Conclusions

The case presented is an extremely rare confluence of choriocarcinoma brain metastasis within an AVM. The hemorrhagic onset could have been secondary to bleeding from either of the two histological components of the subjacent mixed pathological lesion.

Keywords:
Brain arteriovenous malformation
Choriocarcinoma
Brain metastases
Brain hemorrhage
Resumen
Introducción

Aunque se han descrito casos de hemorragia cerebral secundaria a anomalías vasculares inducidas por metástasis de coriocarcinomas, es excepcional el que una hemorragia cerebral se deba a una asociación de malformación arteriovenosa con metástasis de coriocarcinoma.

Caso clínico

Presentamos el casos de un paciente varón de 19 años que acudió a urgencias por cefalea brusca, intensa. Su exploración física demostró un tumor testicular de gran tamaño. El estudio radiológico mostró metástasis pulmonares, y la TC cerebral evidenció un hematoma frontal sospechoso de tener origen metastásico. La evolución de este hematoma fue eventualmente la causa de la muerte del paciente. La anatomía patológica del hematoma demostró una metástasis de coriocarcinoma en el seno del nidus de una MAV.

Conclusiones

Se trata de un caso extremadamente infrecuente de colisión de una metástasis de coriocaricnoma en el seno de una MAV cerebral. El debut hemorrágico pudo deberse a sangrado de cualquiera de los dos componentes patológicos de esta lesión mixta.

Palabras clave:
Malformación ateriovenosa cerebral
Coriocarcinoma
Metástasis cerebral
Hematoma cerebral

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