PMC8381407_01
(a) Abdomen CT scan with contrast shows large retroperitoneal soft tissue mass lesion
associated with right psoas muscle involvement consistent with the known
choriocarcinoma, (b) CT-scan shows a right dorsal skin metastatic nodule, (c) chest CT
scan with contrast shows metastatic pulmonary, pleural based, and right skin dorsal
nodules, and (d) brain MR scan, T1-weighted images with contrast show hemorrhagic
heterogeneous contrast enhancing metastatic lesion in the right parieto-occipital
region.
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The patient underwent computed tomography (CT) scan that showed a retroperitoneal mass (Figure 1(a)) involving the psoas muscle with liver and lung lesions. Radiological examination showed a skin nodule that was suspicious for metastasis (Figure 1(b)). A progression of his bilateral metastatic pulmonary nodules was also seen (Figure 1(c)). MRI imaging of the brain showed right parieto-occipital brain metastasis (Figure 1(d)).
(a) The tumor is composed of hyperchromatic mono- and multinuclear cells surrounding a
large area of necrosis (H&E X20), (b) a higher power magnification of both
components, in which the mononuclear cytotrophoblasts interweave with the multinucleated
syncytiotrophoblasts (H&E X40), (c) lymphatic invasion is seen (H&E X40), and
(d) beta-HCG immunostain is positive in the tumor cells (X40).
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Microscopically, there was a biphasic tumor composed of hyperchromatic mononuclear cells that interweaved with multinuclear cells surrounding a large area of necrosis (Figure 2(a) and (b)). Lymphovascular invasion was also seen (Figure 2(c)). Immunostain for Beta-HCG was positive in the tumor cells (Figure 2(d)), supporting the diagnosis of metastatic choriocarcinoma to the skin.