case_images: PMC10989191_01
case_images: Computed tomography (CT) images of male choriocarcinoma with multiple systemic metastases (December 15, 2018). (A) The transverse image reveals bilaterally enlarged breasts (long arrows). (B) The transverse image displays empty scrotums bilaterally, with the testes not visualized (long arrows). (C) A roundish mass with heterogeneous density is observed in the pelvis, featuring eggshell-like calcifications at its margins (long arrows). (D) The transverse image in the arterial phase shows heterogeneous mild enhancement of the lesion, with evident thickening of blood-supplying arteries, areas of necrotic cystic degeneration in the interior, and tortuous, dilated veins in the surrounding area (long arrows). (E) The coronal image in the venous phase reveals multiple enlarged lymph nodes in the retroperitoneum, merging with one another (dashed arrows). (F) The transverse image in the venous phase exhibits multiple hypodense foci in the liver, characterized by ring-shaped and mild enhancement (arrowheads). (G) The transverse image depicts multiple rounded hyperdense nodules in both lungs (arrowheads).
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case_images: PMC10989191_01_fmed-11-1382672-g001.jpg
case_images: fig1
case_images: The patient underwent an enhanced CT examination, revealing bilateral enlarged breasts (Figure 1A), empty scrotums bilaterally, with the testes not visualized (Figure 1B). A roundish mass with heterogeneous density was observed in the pelvis, post-enhancement, the mass exhibited heterogeneous mild enhancement (Figures 1C,D). Multiple enlarged lymph nodes were identified in the retroperitoneum, merging with one another, encircling the abdominal aorta and vessels, resulting in displacement of surrounding organs (Figure 1E). Additionally, multiple hypodense foci, characterized by ring-shaped and mild enhancement, were detected in the liver (Figure 1F). Furthermore, multiple rounded hyperdense nodules were observed in both lungs (Figure 1G).
case_images: 18F-FDG PET/CT images of male choriocarcinoma with multiple systemic metastases (December 20, 2018). (A) The anteroposterior 3-dimensional maximum intensity projection (MIP) image demonstrates increased metabolic activity in the both lungs, abdominal cavity, and pelvic cavity. (B) The sagittal fusion image demonstrates increased metabolic activity in the liver, retroperitoneum and pelvis. (C) Transverse images reveal multiple soft tissue nodules in both lungs with significantly increased 18F-FDG uptake (SUVmax = 12.7). (D) Transverse images reveal the liver exhibiting multiple slightly hypodense nodules and masses, characterized by markedly increased 18F-FDG uptake (SUVmax = 38.6). (E) Transverse images depict, in the retroperitoneum, numerous intermingled soft tissue masses with markedly increased 18F-FDG uptake (SUVmax = 13.1). (F) Transverse images identify a soft tissue mass of irregular shape in the right pelvis, displaying unevenly increased 18F-FDG uptake (SUVmax = 19.5). The maximum dimensions of this mass are approximately 12.0 cm x 15.2 cm, with areas of cystic necrosis and calcifications noted. (G) Transverse images reveal markedly increased 18F-FDG uptake at the thoracic 11 vertebral attachments (SUVmax = 11.8). (H) Transverse images show the bilateral breast glands exhibiting thickening with a slight increase in 18F-FDG uptake (SUVmax = 1.2).
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case_images: PMC10989191_01_fmed-11-1382672-g002.jpg
case_images: fig2
case_images: For staging, the patient underwent further 18F-FDG PET/CT (Figures 2A,B). Truepoint 64 PET/CT machine, was conducted 60 min after the intravenous administration of 18F-FDG (6.1 mCi), revealing multiple soft tissue nodules in both lungs with significantly increased 18F-FDG uptake (SUVmax = 12.7, Figure 2C). The liver exhibited multiple slightly hypodense nodules and masses, characterized by markedly increased 18F-FDG uptake (SUVmax = 38.6). The larger liver mass measured approximately 3.6 cm x 2.1 cm (Figure 2D). Additionally, patchy calcifications were evident within this area (Figure 2E). The maximum dimensions of this mass were approximately 12.0 cm x 15.2 cm, with areas of cystic necrosis and calcifications noted (Figure 2F). Markedly increased 18F-FDG uptake (SUVmax = 11.8) was detected at the thoracic 11 vertebral attachments (Figure 2G). The bilateral breast glands exhibited thickening with a slight increase in 18F-FDG uptake (SUVmax = 1.2, Figure 2H).
case_images: Histopathological and immunohistochemical images of choriocarcinoma (December 22, 2018). (A,B) Hematoxylin-eosin (HE) staining (magnification x200 and 400) showed extensive hemorrhage and characteristic features indicative of choriocarcinoma. (C,D) Immunohistochemistry showed that the tumor cells were positive for HPL and beta-HCG (magnification x200).
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case_images: PMC10989191_01_fmed-11-1382672-g003.jpg
case_images: fig3
case_images: The tumor consists of mononuclear cytotrophoblasts and multinucleated syncytiotrophoblasts (Figures 3A,B). Immunohistochemistry showed positive expression of HPL (Figure 3C), beta-HCG (Figure 3D), CD34 (vascular), CK7, CK19 and SALL-4.
case_images: CT images and magnetic resonance images after treatment for choriocarcinoma (May 5 & 14, 2020). (A) The sagittal bone window CT image reveals multiple metastases in the vertebral body. (B,C) The T2-weighted imaging (T2WI) and enhanced images indicate the development of brain metastases in the patient. (D,E) Subsequent scans after 9 days demonstrate an enlargement and increased size of the patient's brain metastatic lesions compared to the previous images in both T2WI and enhanced sequences.
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case_images: PMC10989191_01_fmed-11-1382672-g004.jpg
case_images: fig4
case_images: At the conclusion of the Avelumab treatment, follow-up CT scans revealed an increase in size of metastatic lesions in both lungs and liver, accompanied by the emergence of multiple metastases in the vertebral body (Figure 4A). A cranial MRI disclosed a rounded lesion in the left frontal lobe with high signal on T2WI (Figure 4B), measuring approximately 1.7 cm in diameter, and exhibiting inhomogeneous annular enhancement (Figure 4C). Nine days later, the patient's secondary epileptic symptoms exacerbated, with a repeat MRI showing an enlarged frontal lobe lesion surpassing its previous size (Figure 4D). Additionally, new bilateral occipital lobe metastases were evident (Figure 4E).