title: Histology of a cerebral hemorrhage: AVM as a seat of a metastatic choriocarcinoma.
abstract: BACKGROUND
  There are published cases of cerebral hemorrhage secondary to vascular alterations caused by choriocarcinoma metastases. However, it is extremely rare to find this type of bleeding secondary to an association of such a metastasis with a brain arteriovenous malformation (AVM).
  
  
  METHODS
  We present the case of a 19-year-old male who came to the Emergency Department complaining of intense headache of abrupt onset. His physical examination revealed a striking increase in size of the right testicle of tumoral origin. Chest X-ray evidenced metastasis to the lungs and a brain CT showed a frontal hemorrhage of probably metastatic origin. The latter eventually progressed to cause the death of the patient. Pathology of the brain hematoma disclosed a choriocarcinoma within the brain AVM nidus.
  
  
  CONCLUSIONS
  The case presented is an extremely rare confluence of choriocarcinoma brain metastasis within an AVM. The hemorrhagic onset could have been secondary to bleeding from either of the two histological components of the subjacent mixed pathological lesion.
authors.affiliation: Servicio de Neurología, Complejo Hospitalario de Segovia, Segovia, Spain.
authors.forename: Noemí
authors.initials: N
authors.lastname: Morollón
authors.affiliation: Unidad Neurovascular Río Hortega, Hospital Universitario Río Hortega, Valladolid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Arrese
authors.affiliation: Servicio de Anatomía Patológica, Hospital Universitario Río Hortega, Valladolid, Spain.
authors.forename: Tomas
authors.initials: T
authors.lastname: Zamora
authors.affiliation: Unidad Neurovascular Río Hortega, Hospital Universitario Río Hortega, Valladolid, Spain. Electronic address: rsarabia@saludcastilayleon.es.
authors.forename: Rosario
authors.initials: R
authors.lastname: Sarabia
mesh_terms: D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000473:pathology; D002822:Choriocarcinoma / Q000150:complications* / Q000556:secondary*; D017809:Fatal Outcome; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications*; D008297:Male; D013736:Testicular Neoplasms / Q000150:complications / Q000473:pathology; D019043:Vascular Neoplasms / Q000150:complications* / Q000556:secondary*; D055815:Young Adult
keywords: Brain arteriovenous malformation; Brain hemorrhage; Brain metastases; Choriocarcinoma; Coriocarcinoma; Hematoma cerebral; Malformación ateriovenosa cerebral; Metástasis cerebral