Isolated pulmonary artery choriocarcinoma masquerading as pulmonary embolism diagnosed by endovascular biopsy: A case report and systematic review

ABSTRACT: Choriocarcinoma is an aggressive malignant trophoblastic tumour of rare occurrence, which often presents with multiple metastases, including lungs, brain, liver, kidneys, and lymph nodes. However, primary choriocarcinoma of the pulmonary artery is an even rarer and highly malignant clinical entity that is difficult to diagnose and treat timely. Less than 15 cases have been reported so far in the literature. In this case report, a 38-year-old female presented with recurrent pulmonary thromboemboli despite being on adequate anticoagulation. Positron emission tomography/computed tomography (PET/CT) showed an abnormally hypermetabolic uptake in the pulmonary artery thrombi, suggesting tumour emboli. Catheter-guided aspiration thrombectomy followed by pathological examination confirmed non-gestational choriocarcinoma originating from the pulmonary arteries. The patient underwent treatment under a medical oncologist and responded well to the treatment. A literature search revealed only 12 reported cases. Diagnosis of primary pulmonary artery choriocarcinoma requires a high index of suspicion. Suspicion rises manifold when a reproductive age group female presents with recurrent pulmonary thromboembolism with raised serum βhCG levels.