Choriocarcinoma metastasis in the left atrium

A 36-year-old woman was transferred to our hospital with dizziness and headache for 10 days and had left-side hemiparesis for 1 day. Head computed tomography suggested multiple intracerebral haemorrhages. Digital subtraction angiography showed that the right internal carotid artery was occluded (Panel A, Video S1). During angiography, a mass in the right lung was observed by accident (Panel B). Chest-enhanced computed tomography revealed a solid 35-mm × 32-mm mass in the right lung with intermediate bronchus stenosis (Panel C). Additionally, the left atrium and pulmonary vein showed tumour invasion (Panels C and D). The patient had no respiratory system symptoms. However, she complained of a 6-month history of irregular vaginal bleeding after full-term delivery of a baby. Blood tests revealed a β-human chorionic gonadotropin (HCG) concentration of 3.5 × 105 mIU/mL but vaginal ultrasound suggested no abnormalities. On the basis of the patient’s history of irregular vaginal bleeding after delivery, level of β-HCG, right lung mass and multiple intracerebral haemorrhages, the diagnosis of choriocarcinoma with lung and brain metastasis was made. The diagnosis was confirmed by pathological assessment of the chest tumour biopsy (Panel E). Immunohistochemical analysis showed positivity for HCG (Panel F). This diagnosis indicated that the cause of the right internal carotid artery occlusion was tumour embolism. Choriocarcinoma is a rare and aggressive gynaecological cancer. Early diagnosis and chemotherapy lead to a high long-term survival rate. The main treatment of cases presenting with a cardiac intracavitary mass is surgery to prevent organ embolization. Supplementary material is available at European Heart Journal online.