Epidural dorsolumbar spinal metastasis of choriocarcinoma a rare case report

Aims: To present and review a rare case of metastatic choriocarcinoma in the dorsolumbar spine. Methods: A 21-year-old woman presented with complains of acute sudden onset paraplegia since 15 days with past history of uterine dilatation and curettage before 1 month for abnormal products in uterus and vaginal bleeding and laparotomy for uterine perforation before 20 days. No report of biopsy was available. Dorsolumbar magnetic resonance examinations revealed epidural lesion at the level from D5 to L1 on posterior and right lateral side which was hypointense on T1 weighted image, hyperintense on T2 weighted image and shows post contrast enhancement with compression of spinal cord. Patient was operated for D5 to L1 laminotomy and biopsy from that lesion which was very vascular. Results: Biopsy report revealed infiltration of invasive hydatidiform mole. Serum level of βHCG was 242958 miu/ml. Patient was further investigated for contrast enhanced computer tomography of thorax and abdomen showed nodular metastasis of lung with pleural effusion and ascites. Despite of chemotherapy and radiotherapy patient has paraplegia at present. Conclusion: We have reported a rare case of dorsolumbar epidural metastasis and pulmonary metastasis of choriocarcinoma. Choriocarcinoma is a highly anaplastic malignancy derived from trophoblastic cells characterized by the secretion of human chorionic gonadotropin (βHCG) and early hematogenous metastasis. However, metastatic choriocarcinoma in the spine is extremely rare. Very few cases of metastasis in lumbar and/or sacral vertebra have been reported. Chemotherapy is treatment of choice for metastatic choriocarcinoma.