case_images: PMC8381407_01
case_images: (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.
case_images: 10.1177_20363613211039724-fig1.jpg
case_images: PMC8381407_01_10.1177_20363613211039724-fig1.jpg
case_images: fig1-20363613211039724
case_images: 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)).
case_images: (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).
case_images: 10.1177_20363613211039724-fig2.jpg
case_images: PMC8381407_01_10.1177_20363613211039724-fig2.jpg
case_images: fig2-20363613211039724
case_images: 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.