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Mathkour M, Michael A, Scullen T, Carsky K, Hage M, Werner C, Carr C, Keen JR, Ware ML. Symptomatic xanthogranuloma of the lateral ventricle in a pregnant patient treated with delayed resection: A case report and systematic review. Clin Neurol Neurosurg 2020; 198:106143. [PMID: 32810760 DOI: 10.1016/j.clineuro.2020.106143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
Intracranial xanthogranulomas (XG) are a rare benign histiocytic neoplasm and most often within the choroid. The majority are asymptomatic and are found incidentally on imaging or post-mortem examination or autopsy. We present a case of symptomatic XG in a pregnant patient who underwent a delayed transcortical, transventricular approach for lateral ventricle XG resection following the completion of her pregnancy. Four years post-operatively, the patient is neurologically intact and without recurrence. Our review of the literature showed differences among XG depending on location. The clinical and radiological features of XG are often indistinguishable from tumors arising from the choroid plexus and should be considered as a rare etiology in the differential of newly diagnosed intraventricular lesions.
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Affiliation(s)
- Mansour Mathkour
- Ochsner Medical Center, Department of Neurosurgery, New Orleans, United States; Tulane University, School of Medicine, New Orleans, United States.
| | - Abenet Michael
- Tulane University, School of Medicine, New Orleans, United States.
| | - Tyler Scullen
- Ochsner Medical Center, Department of Neurosurgery, New Orleans, United States; Tulane University, School of Medicine, New Orleans, United States.
| | - Katherine Carsky
- Tulane University, School of Medicine, New Orleans, United States.
| | - Madeleine Hage
- Tulane University, School of Medicine, New Orleans, United States.
| | - Cassidy Werner
- Tulane University, School of Medicine, New Orleans, United States.
| | - Christopher Carr
- Ochsner Medical Center, Department of Neurosurgery, New Orleans, United States; Tulane University, School of Medicine, New Orleans, United States.
| | - Joseph R Keen
- Ochsner Medical Center, Department of Neurosurgery, New Orleans, United States.
| | - Marcus L Ware
- Ochsner Medical Center, Department of Neurosurgery, New Orleans, United States.
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Lu JQ, Fong C, Attar A. Levodopa-responsive parkinsonism in a patient with corticobasal degeneration and bilateral choroid plexus xanthogranulomas. J Clin Neurosci 2019; 71:286-289. [PMID: 31537463 DOI: 10.1016/j.jocn.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/05/2019] [Indexed: 11/26/2022]
Abstract
Corticobasal degeneration (CBD) has substantial overlap of clinical features with other neurodegenerative diseases including Parkinson's disease (PD). Its clinical diagnostic accuracy is the lowest among the common neurodegenerative diseases, and its antemortem diagnosis is more challenging when CBD is comorbid with another brain disease. We report an elderly male patient with multiple medical conditions and a family history of essential tremor. He presented with progressive tremor that was initially thought to be essential tremor and later diagnosed as PD despite head computerized tomography showing bilateral intraventricular masses and other minor changes. The clinical diagnosis of PD was supported by his responsiveness to low-dose levodopa. However, postmortem neuropathological examination revealed CBD and bilateral choroid plexus xanthogranulomas with mild ventricular enlargement and multifocal ependymal lining injury presumably due to mild hydrocephalus. CBD is typically levodopa-unresponsive, but hydrocephalus-associated parkinsonism is commonly levodopa-responsive. We raise awareness of the present comorbidity and atypical parkinsonism due to the choroid plexus xanthogranuloma-induced hydrocephalus for the clinical diagnosis and management of parkinsonism.
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Affiliation(s)
- Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, Neuropathology, McMaster University, Hamilton, Ontario, Canada.
| | - Crystal Fong
- Department of Diagnostic Imaging, Neuroradiology, McMaster University, Hamilton, Ontario, Canada
| | - Ahmed Attar
- Department Medicine, Neurology, McMaster University, Hamilton, Ontario, Canada
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Yan C, Zhu S, Sun H, (Jenn) WTL, Zhang X, Xu Z, Kong X, Chen X. Neuronavigator-guided ventriculoscopic approach for symptomatic xanthogranuloma of the choroid plexus in the lateral ventricle. Medicine (Baltimore) 2019; 98:e14718. [PMID: 31008920 PMCID: PMC6494259 DOI: 10.1097/md.0000000000014718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Xanthogranuloma of choroid plexus is an extremely rare, benign, and mostly asymptomatic intracranial lesion. We report a case of symptomatic lateral ventricular xanthogranuloma resected via a neuronavigator-guided ventriculoscopic approach. Then we review recent English medical literature and notice that craniotomies have been the most popular treatment. But our choice of a ventriculoscopic approach possesses unique advantages such as minimized neural tissue damage, shortened operative time, less blood loss, and safer access to central structures over conventional open surgeries. Informed consent has been obtained from the patient and his immediate family regarding this case report.
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Affiliation(s)
- Chengrui Yan
- Department of Neurosurgery, Peking University International Hospital
| | - Shan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical Collage Hospital, Chinese Academy of Medical Sciences
| | - Haitao Sun
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wan-Ting Lee (Jenn)
- Mater Hospital Brisbane Queensland Medical Program, The University of Queensland, Brisbane, Australia
| | - Xiaoying Zhang
- Department of Pathology, Peking University International Hospital
| | - Zongsheng Xu
- Department of Neurosurgery, Peking University International Hospital
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xiaolin Chen
- Department of Neurosurgery, Peking University International Hospital
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Abstract
Abstract
This article reviews symptomatic intraventricular xanthogranulomas, based on a case presentation. Bilateral xanthogranulomas of the choroid plexus were removed surgically from the lateral ventricles of a 12-year-old boy. At 9 years of age, he had evidence of increased intracranial pressure and was hospitalized. Dense enhancing masses were detected in computerized tomogram (CT) brain scan. The lesions were in the region of trigones with extension into the temporal horns and into the right occipital horn. The masses were brightly yellow and greasy. They measured 8.5 x 5.5 x 3.5 cm and 10 x 6.5 x 4.5 cm, respectively, and proved to be xanthogranulomas. Review of 35 reported symptomatic intraventricular xanthogranulomas revealed 11 lesions in the lateral ventricles in which six of them were bilateral. Twenty-two lesions were in the third ventricle, and two lesions were in the fourth ventricle. The lesion shows no significant sexual predilection. The patients’ average age is 37.6 years for males, 32.4 years for females, and 34.3 years for both sexes. The size of symptomatic lesions ranged from 1 to 3 cm in diameter but a few were large, up to 8 to 10 cm. The origin of foamy (xanthoma) cells in the xanthogranulomas arising in the choroid plexus is thought to be multicentric including the choroidal epithelium and stromal arachnoidal cells that have undergone xanthomatous changes. Increased intracranial pressure is the significant clinical feature of the intraventricular xanthogranulomas as in other mass lesions within the skull. Surgical extirpation is the treatment of choice if the lesion is accessible and the patient’s general condition is suitable.
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Kasliwal MK, Suri A, Rishi A, Suri V, Sharma BS, Sarkar C. Symptomatic bilateral cerebellar mass lesions: an unusual presentation of intracranial xanthogranuloma. J Clin Neurosci 2008; 15:1401-4. [PMID: 18952438 DOI: 10.1016/j.jocn.2007.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 09/06/2007] [Accepted: 09/16/2007] [Indexed: 10/21/2022]
Abstract
Xanthogranulomas are a group of benign lesions with an incidence of 1.6-7.0% in various autopsy series. Although the lateral ventricle is the most frequent intracranial site involved, most symptomatic cases occur in the choroid plexus, involving the third ventricle. Multicentric bilateral symptomatic cerebellar xanthogranuloma has not been reported previously. We describe a 35-year-old man who presented with a complaint of vertigo, with nystagmus and left-side cerebellar signs found on clinical examination. Radiological evaluation revealed bilateral cerebellar lesions abutting the cerebellopontine angle cistern. The left-side lesion was excised and diagnosed as xanthogranuloma up on histopathological examination. The right-side lesion was subsequently excised 4 years later when it became symptomatic. The role of histopathology cannot be overemphasized in the diagnosis of this rare lesion and long-term follow-up is advised in cases managed conservatively owing to the propensity of this tumor to grow over time.
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Affiliation(s)
- Manish K Kasliwal
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Miranda P, Lobato RD, Ricoy JR, Lagares A, Ramos A. Xanthogranuloma of the choroid plexus of the third ventricle: case report and literature review. Neurocirugia (Astur) 2005; 16:518-22. [PMID: 16378134 DOI: 10.1016/s1130-1473(05)70381-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Xanthogranulomas of the choroids plexus (XG) are benign tumours of debatable etiology which become rarely symptomatic. Only few cases have been studied with MRI. A new case of xanthogranuloma of the third ventricle showing unusual features in the CT and MRI studies in a 47-year-old man with a 2-month history of gait and urinary disturbances and cognitive impairment is reported. The literature concerning clinical and neuroradiological presentation of intracranial xanthogranulomas is reviewed.
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Boulos AS, Deshaies EM, Qian J, Popp AJ. Preoperative stent placement for intradural vertebral artery stenosis from a rare xanthogranuloma. J Neurosurg 2004; 101:864-8. [PMID: 15540929 DOI: 10.3171/jns.2004.101.5.0864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ In this report, the authors discuss a novel use of intradural vertebral artery (VA) stent placement to protect a tumor-encased vessel from injury during lesion resection. The tumor was a rare foramen magnum region xanthogranuloma and a component of Erdheim—Chester disease (ECD). This 64-year-old man presented with large masses encasing and compressing the intracranial segments of each VA. Preoperatively, a left VA stent was placed to protect the arterial wall during resection of the tumor. Histopathological study results on the subtotally resected mass were consistent with xanthogranuloma, a rare benign histiocytic tumor frequently occurring in patients with ECD. Further radiographic evaluation in the patient revealed an osteolytic lesion of the eleventh thoracic vertebra supporting the diagnosis of ECD disease. Based on this case study, the authors recommend the following: 1) tumor-encased vessels can be protected preoperatively by stent placement to assist with tumor debulking; and 2) patients diagnosed with a xanthogranuloma should be evaluated for multisystem involvement consistent with ECD.
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Affiliation(s)
- Alan S Boulos
- Department of Surgery, Division of Neurosurgery Albany Medical Center, Albany, New York 12208, USA.
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Shah KC, Poonnoose SI, George R, Jacob M, Rajshekhar V. Necrobiotic xanthogranuloma with cutaneous and cerebral manifestations. J Neurosurg 2004; 100:1111-4. [PMID: 15200133 DOI: 10.3171/jns.2004.100.6.1111] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ Necrobiotic xanthogranuloma (NXG) is a rare inflammatory histiocytic disease of the skin. Xanthogranuloma of the central nervous system is rare and few cases have been reported. To the authors' knowledge, there has been no previously reported case of NXG in which an intracranial lesion was found.
This 52-year-old man, in whom NXG with all its cutaneous manifestations had been diagnosed, presented with three episodes of generalized tonic—clonic seizures. A contrast-enhanced computerized tomography scan of his brain revealed a bifrontal, dura-based mass lesion. The lesion was excised and reported to be an NXG that was similar, but not identical to the skin lesions. The patient was placed on a regimen of antiepileptic drug and chlorambucil after surgery.
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Domínguez J, Castro V, Rivas JJ, Fenández LM, Lorenzo JN, Bravo P. [Symptomatic xanthograuloma of the lateral ventricle]. Neurocirugia (Astur) 2001; 12:525-8. [PMID: 11787403 DOI: 10.1016/s1130-1473(01)70672-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Xanthogranulomas of the choroid plexus in the lateral ventricle are usually asymptomatic lesions found incidentally at autopsy. Symptomatic cases are rare. We present the case of a 30-year-old woman with a xanthogranuloma of the right lateral ventricle who showed intracranial hypertension and visual disturbance. Plain T1-weighted magnetic resonance images disclosed a isointense right temporal lesion in the ventricular horn which showed decreased signal intensity on T2-weighted images and massive enhancement on T1-weighted images after gadolinium injection. She was operated on through a right temporal craniotomy with total excision. We review the literature and discuss radiological findings on MRI.
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Affiliation(s)
- J Domínguez
- Servicio de Neurocirugía, Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife
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Abstract
Disorders of the choroid plexus, a central nervous system structure, are rare, but can pose diagnostic difficulties. The purpose of this review is to illustrate the computed tomography and magnetic resonance imaging findings of a wide spectrum of lesions that affect the choroid plexus. The areas covered include (1) neoplasms (papilloma, leukaemia, meningioma, lymphoma and metastases); (2) infections (bacterial, fungal and viral); (3) cysts; (4) haemorrhage; (5) congenital abnormalities (Sturge-Weber syndrome, Klippel-Trenaunay-Weber syndrome and vascular malformations); and (6) non-infectious inflammatory disorders (xanthogranulomas, inflammatory pseudotumour, neurosarcoidosis, rheumatoid nodule and villous hypertrophy). Few of the patterns of choroid plexus involvement are specific for a particular pathological process. Guermazi, A. (2000) Clinical Radiology 55, 503-516.
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Affiliation(s)
- A Guermazi
- Department of Radiology, Saint-Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France
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Tomita H, Tamaki N, Korosue K, Kokunai T. Xanthogranuloma with Massive Hematoma in the Third Ventricle: Case Report. Neurosurgery 1996. [DOI: 10.1227/00006123-199609000-00032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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13
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Tomita H, Tamaki N, Korosue K, Kokunai T. Xanthogranuloma with massive hematoma in the third ventricle: case report. Neurosurgery 1996; 39:591-4. [PMID: 8875492 DOI: 10.1097/00006123-199609000-00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE Symptomatic xanthogranulomas of the ventricular system are rare entities. No case of a massive hematoma in the xanthogranuloma, which may cause sudden deterioration, has been reported. This is the first report of a massive hematoma arising from a xanthogranuloma in the third ventricle. CLINICAL PRESENTATION A 35-year-old woman was referred to our hospital with a 1-month history of progressively deteriorating consciousness. Neuroradiological findings revealed a mass in third ventricle and obstructive hydrocephalus. INTERVENTION Bilateral external ventricular drainage was performed as an emergency treatment. Two weeks later, the mass was removed totally via the transcallosal-transforaminal approach. The disturbance of consciousness completely disappeared 2 weeks after the second operation. The pathological diagnosis was xanthogranuloma causing massive hematoma. CONCLUSION The pathogenesis, clinical and radiological features, differential diagnosis, and treatment of this rare benign tumor are discussed. The hypothalamic dysfunction caused by a massive hematoma in the lesion of the third ventricle may cause sudden deterioration and death, whether the obstructive hydrocephalus exists. The risk of hemorrhage and hydrocephalus still remains after aspiration alone because of the presence of the cyst wall. Radical extirpation should be the choice of treatment for xanthogranulomas or colloid cysts of the third ventricle.
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Affiliation(s)
- H Tomita
- Department of Neurosurgery, Kobe University School of Medicine, Japan
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Kim EY, Choi JU, Kim TS, Kim DI, Kim KY. Huge Langerhans cell histiocytosis granuloma of choroid plexus in a child with Hand-Schüller-Christian disease. Case report. J Neurosurg 1995; 83:1080-4. [PMID: 7490625 DOI: 10.3171/jns.1995.83.6.1080] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the literature, only two previous cases of presumed Langerhans cell histiocytosis (LCH) granuloma involving choroid plexus have been reported in patients with Hand-Schüller-Christian (HSC) disease, but those cases were not verified by immunohistochemistry or electron microscopy. The authors report a case of LCH granuloma of the choroid plexuses of bilateral lateral ventricles and the fourth ventricle in a child affected by HSC disease. This disease was confirmed by the presence of Birbeck granules on electron microscopy and positive reactivity to S-100 protein. Clinical, radiographic, and histological features are discussed. This case illustrates that LCH granuloma should be considered in the differential diagnosis of intraventricular masses.
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Affiliation(s)
- E Y Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
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Gaskill SJ, Saldivar V, Rutman J, Marlin AE. Giant bilateral xanthogranulomas in a child: case report. Neurosurgery 1992; 31:114-7. [PMID: 1641088 DOI: 10.1227/00006123-199207000-00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Symptomatic xanthogranulomas are rare lesions that most commonly occur in adults. A case of giant bilateral xanthogranulomas in a 6-year-old boy, who remains without tumor recurrence 9 years after resection, is presented. The operative management of these unusually large lesions is discussed. The pathogenesis of xanthogranulomas is reviewed as it relates to the presentation of these lesions in the pediatric population.
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Affiliation(s)
- S J Gaskill
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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Brück W, Sander U, Blanckenberg P, Friede RL. Symptomatic xanthogranuloma of choroid plexus with unilateral hydrocephalus. Case report. J Neurosurg 1991; 75:324-7. [PMID: 2072175 DOI: 10.3171/jns.1991.75.2.0324] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Xanthogranulomas involving the choroid plexus of the lateral ventricles are generally asymptomatic lesions. The case is reported of a 50-year-old man in whom a xanthogranuloma of the choroid plexus had occluded the left trigone, causing unilateral hydrocephalus of the left temporal horn and neurological symptoms. A review of the literature shows that xanthogranulomas of the glomus of the lateral ventricles differ from the xanthomatous cystic lesions of the third ventricle, which are probably akin to colloid cysts.
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Affiliation(s)
- W Brück
- Department of Neuropathology, University of Göttingen, Germany
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