Primary intracranial choriocarcinoma presenting as a ring-enhancing lesion: A case report and review of literature

We report here a rare case of primary intracranial choriocarcinoma without evidence of tumor elsewhere, presenting as a ring-enhancing lesion managed successfully in our institute (Grant Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India). A 22-year-old, right-handed housewife presented with complaints of headache, vomiting, generalized tonic–clonic seizures, and right upper limb weakness of short duration. On neurological examination, the patient was conscious, cooperative, well-oriented in time, place, and person. Visual acuity was 6/9 in both eyes. Fundus was showing grade 1 papilledema. Tone was increased on the right side. Power was decreased in the right upper limb as compared to the left. Reflexes were brisk in the right upper limb. Imaging was suggestive of a thick ring-enhancing lesion in the left parietal region suggestive of glioma or tuberculosis. Complete excision of the lesion was achieved. The diagnosis was confirmed by histopathologic examination of the lesion and β-human chorionic gonadotropin (β-HCG) levels. The patient recovered well postoperatively without neurological deficit. She was relieved of headache completely and there were no further episodes of vomiting or seizures. The right upper limb weakness improved to 4+/5. Choriocarcinoma is the most malignant lesion of all the gestational trophoblastic diseases. Primary brain choriocarcinoma presenting as a ring-enhancing lesion has not been reported in the literature. This diagnosis should be kept in mind, especially in young females of child-bearing age group. Complete surgical excision with adjunctive treatment is required to achieve prolonged remissions.