title: Metastatic bronchogenic carcinoma with human chorionic gonadotropin production manifesting as cerebellar hemorrhage--case report.
abstract: A 58-year-old male presented with a rare case of brain metastatic bronchogenic carcinoma with human chorionic gonadotropin (hCG) production causing cerebellar hemorrhage with symptoms of nausea, vomiting, and headache. Bronchogenic carcinoma manifesting as gynecomastia had been resected a few months previously. Neurological examination revealed left cerebellar ataxia. Neuroimaging showed multiple cerebellar metastases with cerebellar hemorrhage adjacent to the tentorium. Angiography demonstrated tumor staining fed by the hemispheric branch of the left posterior inferior cerebellar artery. Suboccipital craniectomy was performed. The left cerebellar hematoma was evacuated and the tumor was partially removed to prevent massive intraoperative hemorrhage and avoid brain stem injury. Histological examination showed the resected tumor was large cell carcinoma. hCG was detected in the cerebrospinal fluid and was identified by immunohistochemical staining in tumor cells. The primary lesion of bronchogenic carcinoma showed choriocarcinomatous change because the tumor could produce hCG. The choriocarcinomatous cells with higher metastatic potential formed lesions in the brain, and finally intratumoral hemorrhage occurred producing the rapid development of symptoms.
authors.affiliation: Department of Neurosurgery, Hyogo Medical Center for Adults, Akashi, Hyogo.
authors.forename: H
authors.initials: H
authors.lastname: Sawa
authors.forename: K
authors.initials: K
authors.lastname: Taomoto
authors.forename: N
authors.initials: N
authors.lastname: Tamaki
authors.forename: C
authors.initials: C
authors.lastname: Obayashi
authors.forename: R
authors.initials: R
authors.lastname: Nishimura
mesh_terms: D002283:Carcinoma, Bronchogenic / Q000175:diagnosis / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D018287:Carcinoma, Large Cell / Q000175:diagnosis / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D002526:Cerebellar Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D002528:Cerebellar Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D002531:Cerebellum / Q000473:pathology / Q000601:surgery; D006063:Chorionic Gonadotropin / Q000378:metabolism*; D003937:Diagnosis, Differential; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D006063:Chorionic Gonadotropin