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Vol. 28. Núm. 1.Enero - Febrero 2017Páginas 1-50
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Vol. 28. Núm. 1.Enero - Febrero 2017Páginas 1-50
Letter to the Editor
DOI: 10.1016/j.neucir.2016.10.002
The question of double identity
La cuestión de la doble identidad
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Pratyush Shrestha
Autor para correspondencia
pratyush_shrestha@yahoo.com

Corresponding author.
, Upendra Prasad Devkota
National Institute of Neurological and Allied Sciences, Basbari, Kathmandu, Nepal
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We found it interesting to go through the case report “Histology of a cerebral hemorrhage: AVM as a seat of a metastatic Choriocarcinoma” published in the Neurocirugia (Volume 26, Issue 3, 2015). We had published a similar incidence in a 22 year-old girl who had presented with an intracerebral bleed, which was characterized to be an arteriovenous malformation angiographically and proven to be metastatic Choriocarcinoma by histopathology.1

The question raised in the case report is which entity bled – the AVM or the metastatic Choriocarcinoma? The case further highlights an extremely rare confluence of Choriocarcinoma brain metastasis within an AVM.

We beg to defer and are of the opinion that the Choriocarcinoma that metastasizes to the brain and the neovascularization of the malignant mass, gives it the appearance of a vascular malformation. The AVM and the metastatic mass of Choriocarcinoma are not two different entities.

Metastatic cells embolizing through hematogenous route anchor and proliferate in normal capillaries and venules at a distance. In an AVM there is lack of intervening capillary network. This state of high-flow shunting leads to gliosis of the adjacent brain parenchyma; hence implantation of metastatic cells within or close to the AVM is highly unlikely.2

References
[1]
P. Shrestha,U.P. Devkota,R. Panth
Metastatic Choriocarcinoma masquerading as an intracerebral arteriovenous malformation bleed
Internet J Neurosurg, 7 (2011),
[2]
S.L. Robbins,V. Kumar,R.S. Cotran
Robbins and Cotran pathologic basis of disease
8th ed., Saunders/Elsevier, (2010)
Copyright © 2016. Sociedad Española de Neurocirugía
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Neurocirugía

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