CHORIOCARCINOMA WITH METASTASES LEADING TO ARTERIOPORTAL FISTULA WITH PORTAL ANEURYSM

Abstract

Choriocarcinoma, a highly malignant neoplasm arising from synciotrophoblast, occurs as a rare condition in about 1 in 50,000 pregnancies. It tends to metastasize early, commonly to the lung, vulvovaginal region, brain, and liver.
A rare case is presented of a young female presenting with obstructive jaundice, vomiting, and diarrhea, that after clinical workup and CT scan, was traced to a large pseudoaneurysm in the pancreaticoduodenal region with possible intra-biliary rupture, causing mass effect on duodenum and ampulla resulting in obstructive jaundice. A large mass with a cystic component was also present in the uterus. A history of abortion two years back was obtained, and laboratory reports showed high β-HCG levels. Metastatic nodules were also present in the lungs and liver.
A diagnosis of choriocarcinoma with metastatic disease was made and the arterioportal fistula with portal aneurysm embolectomized surgically. She remained stable postoperatively and was further managed by the oncologist.