Primary gestational choriocarcinoma of the vagina: magnetic resonance imaging findings

Abstract

A 33-year-old nulligravid Filipino woman was admitted to the gynaecology ward of Princess Margaret Hospital in April 2014, with lower abdominal pain and recurrent retention of urine. Her pregnancy test was positive. Per-vaginal examination revealed a 4-cm firm, fixed, and wide-based vaginal mass with smooth wall over the upper anterior vagina. Bedside transabdominal ultrasonography confirmed a 4.5-cm solid mass in the anterior vagina and a 3. <5.0 IU/L for non-pregnant women), and repeated checking 3 days later was 253 957 IU/L. Alphafetoprotein, carcinoembryonic antigen, and Ca-125 were negative. A urologist was consulted and the patient underwent flexible cystoscopy that revealed indentation of the urinary bladder by an external mass. Mild erythematous changes were visualised at the right urinary bladder base. Biopsy revealed inflammation but no malignant cells.Magnetic resonance imaging (MRI) of the pelvis revealed a 4.8 cm x 5.2 cm x 4 cm (craniocaudal x anteroposterior x transverse) mass located at the anterior aspect of the vagina. It was hypointense with a faint hyperintense rim on T1-weighted images (Fig 1a) and heterogeneously hyperintense CASE REPORT

Magnetic Resonance Imaging of a Rare Case of Primary Choriocarcinoma of the Vulva

“…On T2 weighted images, they are heterointense with a hypointense rim. On contrast administration, they exhibit peripheral enhancement with non-enhancing areas indicating necrosis (7,8). The imaging features in our case are similar to all the features thus described.…”

“…Extrauterine choriocarcinoma is extremely rare and the cervix is the commonest site (2). Only four cases of primary vulvovaginal choriocarcinoma and two cases of primary vaginal choriocarcinoma are found in literature, with imaging features described only for purely vaginal lesions (3,4,5,6,7,8). The commonest presenting feature is abnormal vaginal bleeding with elevated β-hCG, as seen in our case (2).…”

MRI of rare vaginal tumors: Report of two cases

“…Wong et al described a case of primary vaginal choriocarcinoma in which MRI showed a T1 hypointense mass with hyperintense rim and peripheral rim enhancement. [4] In our case also, we noted the T1 hyperintense rim and peripheral enhancement. However, we also saw heterogeneous hyper and hypointensity on T2, which was not described earlier.…”