Title: Rare Occurrence of Concomitant Brain Tumor Hemorrhages and Infarctions in a Patient with Metastatic Testicular Choriocarcinoma: A Case Report and Review of Literature

Bernadeth Lyn C. Piamonte

University of the Philippines, Philippines


Bernadeth Lyn C. Piamonte is an adult neurology resident at the University of the Philippines – Philippine General Hospital. She graduated cum laude at the University of the Philippines College of Medicine. She takes special interest in particular fields in neurology such as dementia and interventional neuroradiology


Background: Among tumors of germ cell origin, the pure variant of testicular choriocarcinoma is extremely rare, accounting for 0.3% of testicular germ cell tumors and 0.19% of all testicular malignancies. About 10% of choriocarcinoma metastasizes to the brain, with tumor bleed being the most common cerebrovascular complication.
Case Presentation: We describe an unusual case of a 54-year-old male with pure testicular choriocarcinoma presenting not only with brain tumor hemorrhages, but also cerebral infarctions of varying ages on cranial imaging. Further workup also demonstrated metastatic lesions to the lungs and liver. Despite treatment with cisplatin-based systemic chemotherapy, he succumbed to febrile neutropenia and subsequently to septic shock.
Conclusion: The coexistence of brain tumor hemorrhages and infarctions in a patient with metastatic pure testicular choriocarcinoma is unusual and, to the best of our knowledge, the first report of this kind in the literature. Early recognition of metastatic testicular choriocarcinoma by knowing such varied presentations allows for timely workup and subsequent pursuance of potentially life-saving treatments.