Metastatic choroidal choriocarcinoma : a clinicopathological study

A previously healthy 33-year-old woman presented with decreased vision and pain in her left eye. Funduscopic examination revealed a mass in the posterior pole of the eye, and chest radiography showed a lesion in the lower lobe of her left lung. The eye became painful and blind over 12 days and was enucleated. The tumour had the typical histopathological and immunohistochemical features of choriocarcinoma: sheets of cytotrophoblasts with pleomorphic nuclei and lacy cytoplasm intermingled with multinucleated syncytiotrophoblasts. The neoplastic cells stained positively for cytokeratin and the beta subunit of human chorionic gonadotropin (beta-HCG). The serum beta-HCG level was markedly elevated, at 82,000 (normally less than 5) IU/L. The patient was treated with combination chemotherapy, and normal serum beta-HCG levels were obtained. Thirty months after presentation the serum beta-HCG level was normal and there had been no clinical evidence of recurrence. To our knowledge this is the second case of metastatic choriocarcinoma in the eye in which the ocular tumour caused the presenting symptom.