Metastatic trophoblastic disease presenting as a subarachnoid hemorrhage: report of two cases and review of the literature.
Trophoblastic tumors may present as subarachnoid or intracerebral hemorrhages in women of childbearing age. Although uncommon in Western countries, they constitute a significant percentage of metastatic lesions to the nervous system among Oriental women and usually follow molar pregnancies. Malignant transformation may occur at any time, but most frequently within a year of pregnancy. For this reason, close follow-up of women with molar pregnancies and subsequent prevention of pregnancy for one year is mandatory. Persistent serum human chorionic gonadotropin elevations are seen at some stage. Eighty percent of hydatidiform moles remit spontaneously, and the prognosis for persistent molar disease treated with chemotherapy and irradiation is good. The prognosis for choriocarcinoma, however, is less favorable. Subarachnoid hemorrhage may be the first and only sign of intracerebral bleeding into a metastatic lesion or leakage from a damaged vessel in which trophoblastic tissue has lodged. The triad of menstrual abnormalities, recent or remote pregnancy or abortion, and an acute cerebrovascular event with evidence of a mass lesion should suggest the diagnosis of metastatic trophoblastic disease in a woman of childbearing age.
D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000556:secondary*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D011247:Pregnancy; D011859:Radiography; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000556:secondary; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D014328:Trophoblastic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000556:secondary; D014594:Uterine Neoplasms / Q000150:complications / Q000175:diagnosis*