Pulmonary arteriovenous malformations as an unusual initial manifestation of gestational trophoblastic neoplasia: a case report from Saudi Arabia.

Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between an artery and a vein without an intervening capillary component. Most PAVMs are congenital, caused by hereditary hemorrhagic telangiectasia, but around 20% are acquired. The most common presenting symptom is dyspnoea on exertion, but patients can be completely asymptomatic. Furthermore, Gestational trophoblastic neoplasia (GTN) is a group of rare tumors that arise from abnormal growth of trophoblastic tissue which includes invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor can progress, invade, metastasize, and lead to death if left untreated. In the majority of GTNs, the disease is limited to the uterus where the abnormal trophoblast proliferation and localized hCG production may lead to focal vascular changes, including the formation of AVMs. Most patients with GTN present with abnormal vaginal bleeding but they can also present with bleeding from metastatic sites. Symptoms of pulmonary metastasis from GTN often include cough, hemoptysis, and chest pain. However, PAVMs are not typically listed as a direct consequence of this metastatic spread. Here, we report a rare case of metastatic GTN initially presented with pulmonary vascular malformation.