PMC5738576_01
T1 weighted MRI of brain showing right cerebellar lesion.
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CT scan of her head demonstrated a right sided inferior cerebellar lesion with minimal hemorrhage which was confirmed on the MRI of the brain (Figure 1).
Brain biopsy. (a) Histologic examination of the biopsy reveals a sheet of syncytiotrophoblastic cells characterized by multilobulated to multinucleated and spindle shaped cells with a moderate amount of eosinophilic cytoplasm (H&E x20). (b) Immunohistochemical stain for beta-hCG shows moderate to strong cytoplasmic staining of the syncytiotrophoblastic cells (x20).
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Immunohistochemical stains were positive for cytokeratin 5.2, AE1/AE3, EMA, and CK7 and strongly positive for beta-hCG supportive for choriocarcinoma differentiation (Figure 2).
CT chest showing right upper lobe mass with emphysema.
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Metastatic workup which included CT chest, abdomen, and pelvis and PET scan showed a right upper lobe (RUL) mass (Figure 3).
RUL mass biopsy. (a) Touch imprint cytology from core needle biopsy demonstrates bizarre, pleomorphic cells arranged in a dissociative fashion. Some of the tumor cells are multilobulated to multinucleated with pleomorphic, hyperchromatic nuclei (Diff-Quik stain x20). (b) Core needle biopsy reveals bizarre syncytiotrophoblasts characterized by pleomorphic cells, including some that are multilobulated to multinucleated. The cells have a moderate amount of surrounding eosinophilic cytoplasm. Extensive necrosis is noted in the cores (H&E x20). (c) Immunohistochemical stain for beta-hCG shows intense strong positive cytoplasmic staining (x40). (d) Strong diffuse positive cytoplasmic and membranous staining for PLAP (x40).
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The negative staining for TTF-1, Napsin-A, CK 5/6, and p63 supports that the poorly differentiated malignancy is neither a conventional adenocarcinoma nor squamous cell carcinoma, respectively (Figure 4).