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Rationale:Choriocarcinoma is the most malignant type of gestational trophoblastic neoplasia. Brain metastasis is the main cause of death and disability in choriocarc- inoma patients. Brain metastasis of choriocarcinoma easily invades the vessel wall to form microaneurysms, so we have reason to believe that multiple intracerebral hemorrhage is related to neoplastic intracranial microaneurysms.Patient concerns:We report a rare case of brain metastasis of choriocarcinoma that caused six hemorrhages in four lesions within 50 days and anterior cerebral artery aneurysm.Diagnoses:We diagnosed multiple intracerebral hematoma, choriocarcinoma and intracranial aneurysms.Interventions:Evacuation of hematoma by craniotomy.Outcomes:The patient finally asked to terminate the treatment and was discharged. One month later, the patient died of upper gastrointestinal bleeding.Lessons:more than 20 cases of oncotic aneurysm from choriocarcinoma have been reported in the English literature, but few had multiple hematomas. Therefore, this case is unique. Brain metastasis of choriocarcinoma should be considered when patients experience unexplained cerebral hemorrhage, especially repeated intracranial hemorrhage in women of childbearing age. Early and intensive treatment can help achieve a better prognosis and avoid a fatal outcome. Multiple intracranial hematomas are related to neoplastic intracranial microaneurysms.

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Introduction: Papillary meningioma is an extremely rare malignant lesion with high degree of invasiveness, high recurrence rate, and perivascular pseudopapillary structure. The incidence of cystic degeneration in papillary meningiomas is relatively low, and cystic papillary meningiomas growing in the ventricle are even rarer. Here, we present a case of cystic meningioma and review the literature to propose the diagnosis, treatment, immunohistochemical features, and prognosis of the same. Patient concerns: In July 2013, a 35-year-old male Chinese patient presented with dizziness that lasted for a week, without relief. Magnetic resonance imaging (MRI) revealed a 2.0 cm × 1.5 cm × 3.0 cm-sized mass located in the left lateral ventricle trigone. The tumor was small and likely non-malignant. Therefore, the patient received conservative treatment and regular follow-ups. In June 2017, the patient experienced sudden severe headache, dizziness, and vomiting. Diagnosis and intervention: MRI revealed that the mass in the left lateral ventricle trigone had increased to 5.0 cm × 7.0 cm × 8.0 cm over 4 years. The patient underwent surgical resection via the left parietal–occipital approach. Two months postoperatively, the patient received 60 Gy local radiotherapy. The postoperative histopathology suggested that the mass was a cystic papillary meningioma. Outcomes: Two years after the operation, the patient was asymptomatic, and no recurrence of the lesion was noted on MRI. Conclusion: The diagnosis of intraventricular cystic papillary meningioma depends mainly on its histology and imaging features. Total resection and adjuvant radiotherapy can result in a relatively good prognosis of patients with intraventricular cystic papillary meningiomas.