PMC5538038_01
Clinical image showing bilateral sixth nerve palsy in the patient.
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Scale of E4V1M3, with bilateral pupils equal and reacting. She had bilateral sixth nerve palsies (left >> right; Figure 1).
CT head images showing multiple hemorrhagic lesions within the brain.
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CT and MRI images of the head revealed multiple hemorrhagic lesions both in the supra and the infra-tentorial compartment with evidence of effacement of the forth ventricle and evolving hydrocephalus ( Figure 2 and Figure 3).
MRI images showing multiple lesions within the brain at different phase of resolution.
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CT and MRI images of the head revealed multiple hemorrhagic lesions both in the supra and the infra-tentorial compartment with evidence of effacement of the forth ventricle and evolving hydrocephalus ( Figure 2 and Figure 3).
MRI angiography showing absence of any vascular blush or major arterial feeder to the lesions.
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There was no vascular blush seen within the brain in the MR angiography ( Figure 4).
Chest X-ray revealing right sided apical lung lesion.
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Routine chest X-ray revealed the presence of a right lung mass ( Figure 5).
Post-operative CT image showing complete excision of the lesion in the posterior fossa.
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The patient immediately underwent sub-occipital craniactomy and excision of the well capsulated hemorrhagic lesion from the left cerebellar hemisphere ( Figure 6).
Histology image confirming the diagnosis of invasive choriocarcinoma.
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Histopathological study of the excised lesion showed diffuse cohesive sheets of trimorphic malignant trophoblasts, consisting of intermediate trophoblasts and cytotrophoblast, and rimmed with syncytiotrophoblast with the presence of a central hemorrhage and necrosis ( Figure 7).
CT chest confirming presence of an enhanced and highly vascular lesion in the upper lobe of the right lung.
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