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Gestational Choriocarcinoma Presenting with Lacrimal Gland Metastasis: A First Reported Case.

Ahamed NA, Sait K, Anfnan N, Farwan K, Nizamuddin SH, Baeesa SS - Case Rep Obstet Gynecol (2015)

Bottom Line: Case Presentation.At two-year follow-up, serum b-HCG level was with normal limits; imaging surveillance was uneventful.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia.

ABSTRACT
Background. Gestational choriocarcinoma (GC) is a recognized clinicopathological subtype of gestational trophoblastic neoplasia that usually metastasizes hematogenously to highly vascular organs like the lung, liver, and brain. However, orbital metastasis to the choroid and lacrimal gland is a rare occurrence. Case Presentation. A 21-year-old female presented with headache and left orbital swelling one year after resection of a complete hydatidiform mole followed by adjuvant methotrexate chemotherapy. A metastatic imaging screening revealed multiple metastases in the lungs, brain, and adrenal gland, in addition to the choroid and lacrimal gland. Based on her modified WHO risk factors scoring she was started on chemotherapy and whole brain radiotherapy, which resulted in a complete response. At two-year follow-up, serum b-HCG level was with normal limits; imaging surveillance was uneventful. Conclusion. We present the first case of lacrimal gland metastasis in a young girl from GC relapse.

No MeSH data available.


Related in: MedlinePlus

Axial T2-FLAIR MRI image showing that the lesion appears hypointense to gray matter with typical signal intensities of the optic nerve.
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fig5: Axial T2-FLAIR MRI image showing that the lesion appears hypointense to gray matter with typical signal intensities of the optic nerve.

Mentions: Orbital MRI scan demonstrated a marginally exophytic lesion in the left eye at the level of choroid adjacent to the optic disc appearing hyperintense to gray matter on T1-weighted images (Figure 4). There was no calcification seen in the slice-matched CT images, thus helping in distinguishing between possible synchronous choroidal pathologies like retinoblastoma. The lesion was hypointense on T2-FLAIR images (Figure 5). The high-resolution axial 3D- constructive interference in steady state (CISS) images showed the full extent of the lesion, which was confined to the retinal choroid with normal appearances of the vitreous chamber of the globe (Figure 6). On imaging, after intravenous gadolinium, the lesion demonstrated homogenous enhancement in keeping with a vascular tumor. Another focal lesion was seen centered in the left lacrimal gland distorting the lacrimal contour (Figure 7). The dark periosteum of the superior orbital ridge was lost in the MRI study, which showed an amorphous enhancement, and a comparison with the CT study revealed faint periosteum thickening (Figure 8). Both findings were in keeping with bone infiltration.


Gestational Choriocarcinoma Presenting with Lacrimal Gland Metastasis: A First Reported Case.

Ahamed NA, Sait K, Anfnan N, Farwan K, Nizamuddin SH, Baeesa SS - Case Rep Obstet Gynecol (2015)

Axial T2-FLAIR MRI image showing that the lesion appears hypointense to gray matter with typical signal intensities of the optic nerve.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4446461&req=5

fig5: Axial T2-FLAIR MRI image showing that the lesion appears hypointense to gray matter with typical signal intensities of the optic nerve.
Mentions: Orbital MRI scan demonstrated a marginally exophytic lesion in the left eye at the level of choroid adjacent to the optic disc appearing hyperintense to gray matter on T1-weighted images (Figure 4). There was no calcification seen in the slice-matched CT images, thus helping in distinguishing between possible synchronous choroidal pathologies like retinoblastoma. The lesion was hypointense on T2-FLAIR images (Figure 5). The high-resolution axial 3D- constructive interference in steady state (CISS) images showed the full extent of the lesion, which was confined to the retinal choroid with normal appearances of the vitreous chamber of the globe (Figure 6). On imaging, after intravenous gadolinium, the lesion demonstrated homogenous enhancement in keeping with a vascular tumor. Another focal lesion was seen centered in the left lacrimal gland distorting the lacrimal contour (Figure 7). The dark periosteum of the superior orbital ridge was lost in the MRI study, which showed an amorphous enhancement, and a comparison with the CT study revealed faint periosteum thickening (Figure 8). Both findings were in keeping with bone infiltration.

Bottom Line: Case Presentation.At two-year follow-up, serum b-HCG level was with normal limits; imaging surveillance was uneventful.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia.

ABSTRACT
Background. Gestational choriocarcinoma (GC) is a recognized clinicopathological subtype of gestational trophoblastic neoplasia that usually metastasizes hematogenously to highly vascular organs like the lung, liver, and brain. However, orbital metastasis to the choroid and lacrimal gland is a rare occurrence. Case Presentation. A 21-year-old female presented with headache and left orbital swelling one year after resection of a complete hydatidiform mole followed by adjuvant methotrexate chemotherapy. A metastatic imaging screening revealed multiple metastases in the lungs, brain, and adrenal gland, in addition to the choroid and lacrimal gland. Based on her modified WHO risk factors scoring she was started on chemotherapy and whole brain radiotherapy, which resulted in a complete response. At two-year follow-up, serum b-HCG level was with normal limits; imaging surveillance was uneventful. Conclusion. We present the first case of lacrimal gland metastasis in a young girl from GC relapse.

No MeSH data available.


Related in: MedlinePlus