1
|
Wilkinson BM, Duncan MA, Draytsel DY, Babu H. Metastatic choroid plexus papilloma presenting as a sellar mass: A case report and literature review. Surg Neurol Int 2024; 15:140. [PMID: 38742015 PMCID: PMC11090562 DOI: 10.25259/sni_847_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/03/2024] [Indexed: 05/16/2024] Open
Abstract
Background Choroid plexus papillomas (CPPs) are rare neoplasms arising from choroid plexus epithelium representing <1% of all intracranial tumors. Symptoms vary based on location and regional mass effect; however, hydrocephalus is common due to cerebrospinal fluid flow obstruction and/or overproduction. Distant site metastasis or de novo formation in extraventricular sites is rare. Case Description A 57-year-old female with a history of a 4th ventricular CPP status post resection in 2004 and 2018 with subsequent gamma knife therapy in 2019 presented with increased thirst and urination. Since her initial surgery, she has experienced significant gait imbalance, diplopia, dysphagia, and right-sided hemiparesis and hemisensory loss. Magnetic resonance imaging revealed a new 1.5 × 1.8 cm suprasellar lesion. She underwent a left supraorbital craniotomy for tumor resection, with pathology revealing metastatic World Health Organization grade II CPP. Conclusion Extraventricular manifestation of CPP is rare. De novo or metastatic involvement of the sella has seldom been reported. Treatment should target gross total surgical resection. Adjuvant chemotherapy and radiation may be useful in higher-grade lesions.
Collapse
|
2
|
Broekx S, De Praeter M. A rare trifocal presentation of a choroid plexus papilloma: Case report and review of the literature. BRAIN & SPINE 2024; 4:102774. [PMID: 38510631 PMCID: PMC10951795 DOI: 10.1016/j.bas.2024.102774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
Introduction CPP's present as slow-growing intraventricular neoplasms arising from epithelium of choroid plexus. They account for approximately 0.5-4% of intracranial neoplasms in adults and children, respectively. A trifocal presentation is exceedingly rare. Research question We describe the case of a trifocal presentation of a CPP and explored the importance of genetic analyses. Material and methods We present the case of an 18-year old adolescent who was treated for a fourth ventricular and suprasellar neoplasm. Brain MRI revealed an intraventricular lesion in the fourth ventricle, as well as a suprasellar lesion and a lesion located in the left internal auditory meatus. An adult-subtype CPP (WHO grade 1) was confirmed by means of histological and genetic analyses in the first two regions. Results Optimal treatment strategy remains controversial, although it is accepted that surgical resection alone remains the gold standard, whereas chemoradiotherapy is reserved for specific cases. There are only a few articles reporting on a multifocal presentation or the coexistence of synchronous histologically different primary brain neoplasms. Reports on genetic examination are scarce. Discussion and conclusion CPP's should be included in the differential diagnosis of posterior fossa tumors, both in children and adults. Genetic analyses (TP53/TERT mutations) should be considered, since they entail important diagnostic, prognostic and therapeutic implications. When a TERT mutation is present, adjuvant radiotherapy should be used with caution, since it plays a role in tumorigenesis, even when GTR could not be achieved. There is an association between TERT methylation status and malignant transformation, indicating that these patients should be followed more closely.
Collapse
Affiliation(s)
- Senne Broekx
- Department of Neurosurgery, Antwerp University Hospital, 2650, Edegem, Belgium
| | - Mania De Praeter
- Department of Neurosurgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Faculty of Medicine, Antwerp University, 2650, Edegem, Belgium
| |
Collapse
|
3
|
Rima S, Rao S, Nigam P, Kacchara R. Primary papillary epithelial tumor of the sella: a case report of an emerging tumor type. Brain Tumor Pathol 2024; 41:30-34. [PMID: 38091172 DOI: 10.1007/s10014-023-00472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024]
Abstract
Primary papillary epithelial tumor of the sella (PPETS) is a newly described tumor entity with prototypical location in the sella. Only two case series with ten cases have been described so far. These tumours have a typical papillary architecture with bland nuclear features, TTF-1 immunopositivity and low MIB-1-labelling index. Many of these tumours were previously assigned under the category of 'ectopic choroid plexus papilloma'. PPETS expands the group of TTF-1 positive tumours of the central nervous system. Histomorphology plays an essential role in making this diagnosis. We report a case of 44-year-old female with a sellar mass lesion, who presented with progressive loss of vision and diagnosed as primary papillary epithelial tumor.
Collapse
Affiliation(s)
- S Rima
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
| | - Pulak Nigam
- Institute of Neurosciences, Medanta Super Speciality Hospital, Indore, Madhya Pradesh, India
| | - Rajneesh Kacchara
- Institute of Neurosciences, Medanta Super Speciality Hospital, Indore, Madhya Pradesh, India
| |
Collapse
|
4
|
Singh SK, Patra S, Shirazi N, Gupta G. Extracerebral choroid plexus papilloma in a newborn: a rare presentation. BMJ Case Rep 2023; 16:e256794. [PMID: 37996145 PMCID: PMC10668134 DOI: 10.1136/bcr-2023-256794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Choroid plexus papillomas (CPPs) are extremely rare lesions that originate in the central nervous system. Still rarely, these can occur in heterotopic locations. We report a case of aneonate who presented at fourth week of life with a small swelling in the left side of the oropharynx. There were no other symptoms. MRI scan revealed a cystic lesion with the possibility of lymphatic malformation or teratoma. Swelling which was gradually increasing in size was electively excised. Histopathological examination revealed it to be an extracerebral CPP. Postoperative period was uneventful, and baby had no further complications. CPP is a rare lesion and, almost always, cannot be anticipated before surgery. Imaging only helps in surgical planning. Complete excision is curative.
Collapse
Affiliation(s)
- Santosh Kumar Singh
- Paediatric Surgery, Himalayan Institute of Medical Sciences, Dehradun, India
| | - Saikat Patra
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, India
| | - Nadia Shirazi
- Pathology, Himalayan Institute of Medical Sciences, Dehradun, India
| | - Girish Gupta
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, India
| |
Collapse
|
5
|
Azab WA, Khan T, Alqunaee M, Al Bader A, Yousef W. Endoscopic Endonasal Surgery for Uncommon Pathologies of the Sellar and Parasellar Regions. Adv Tech Stand Neurosurg 2023; 48:139-205. [PMID: 37770685 DOI: 10.1007/978-3-031-36785-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Endoscopic skull base surgery has become an integral part of the present neurosurgical armamentarium. The pioneering efforts in which the purely endoscopic transsphenoidal approach was introduced have triggered a growing tide of using the endoscopic endonasal procedures for a large variety of skull base lesions. Because of their anatomical peculiarities, lesions of the sellar and parasellar regions lend themselves very well to the endoscopic endonasal approaches. Apart from the common pathological entities, many other less frequent pathologies are encountered in the sellar and parasellar area. In this chapter, we review the surgical technique of the endoscopic endonasal transsphenoidal approach and its extensions applied to a variety of rare and uncommon pathological entities involving the sella turcica and clivus. An overview of these pathological entities is also presented and exemplified.
Collapse
Affiliation(s)
- Waleed A Azab
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Tufail Khan
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Marwan Alqunaee
- Rhinology - Endoscopic Sinus and Skull Base Surgery, Zain Hospital, Kuwait City, Kuwait
| | - Abdullah Al Bader
- Rhinology - Endoscopic Sinus and Skull Base Surgery, Jaber Al Ahmad Hospital, Kuwait City, Kuwait
| | - Waleed Yousef
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
| |
Collapse
|
6
|
Lee N, Bae MH, Han YM, Park KH, Hwang JY, Hwang CS, Lee JC, Byun SY. Extracerebral choroid plexus papilloma in the pharynx with airway obstruction in a newborn: a case report. BMC Pediatr 2020; 20:336. [PMID: 32635904 PMCID: PMC7339594 DOI: 10.1186/s12887-020-02234-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022] Open
Abstract
Background Choroid plexus papillomas (CPPs) are rare, usually benign, neoplasms originating in the central nervous system. In this study, we present the first case of a giant airway-obstructing CPP in the pharynx of a newborn. Case presentation A cystic mass located in the pharynx was noted in a fetus at the 29th week of gestation. Elective cesarean section was performed at the 38th week of gestation with successful intubation and ex utero intrapartum treatment. On computed tomography, there was a huge airway-obstructing cystic mass in the choana and pharynx. Elective surgery with total excision was performed, and histological examination confirmed the diagnosis of CPP. Conclusion We report the first case of an extracerebral airway-obstructing CPP in the pharynx of a newborn. Radiologic examinations are not enough for the diagnosis of CPPs, and complete excision of the tumor with histological confirmation is indispensable for accurate diagnosis and treatment.
Collapse
Affiliation(s)
- Narae Lee
- Department of Pediatrics, Pusan National University School of Medicine, 20 Geumo-ro, Yangsan, 50612, Republic of Korea
| | - Mi Hye Bae
- Department of Pediatrics, Pusan National University School of Medicine, 20 Geumo-ro, Yangsan, 50612, Republic of Korea
| | - Young Mi Han
- Department of Pediatrics, Pusan National University School of Medicine, 20 Geumo-ro, Yangsan, 50612, Republic of Korea
| | - Kyung Hee Park
- Department of Pediatrics, Pusan National University School of Medicine, 20 Geumo-ro, Yangsan, 50612, Republic of Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Cheong-Soo Hwang
- Department of Pathology, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jin-Choon Lee
- Department of Otorhinolaryngology and Head-neck surgery, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Shin Yun Byun
- Department of Pediatrics, Pusan National University School of Medicine, 20 Geumo-ro, Yangsan, 50612, Republic of Korea.
| |
Collapse
|
7
|
Roncaroli F, Chatterjee D, Giannini C, Pereira M, La Rosa S, Brouland JP, Gnanalingham K, Galli C, Fernandes B, Lania A, Radotra B. Primary papillary epithelial tumour of the sella: expanding the spectrum of TTF-1-positive sellar lesions. Neuropathol Appl Neurobiol 2020; 46:493-505. [PMID: 32311761 DOI: 10.1111/nan.12622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 12/11/2022]
Abstract
AIM To describe four novel primary epithelial tumours of the sella with papillary architecture and Thyroid Transcription Factor 1 (TTF-1) expression. METHODS Paraffin-embedded tissue from the four cases and recurrence of patient 1 was investigated with haematoxylin-eosin, special histochemical stains, immunohistochemistry with a broad panel of antibodies and next-generation sequencing. The ultrastructure of one tumour was studied in tissue retrieved from paraffin. RESULTS The lesions occurred in three females aged 20, 26 and 42 years and a male aged 49 years. They presented with signs and symptoms secondary to pituitary stalk compression. Preoperative neuroimaging documented mixed solid and cystic, enhancing sellar masses with suprasellar extension. Histologically, the tumours showed thin papillae lined by a single layer of cytokeratin and TTF-1-positive cuboidal and cylindrical cells with mildly atypical nucleus. Next-generation sequencing performed in three cases did not identify any mutations. The main differential diagnosis included metastasis from lung or thyroid carcinoma, extraventricular choroid plexus papilloma and sellar ependymoma. CONCLUSION We suggest the descriptive term of primary papillary epithelial tumour of the sella (PPETS) for this entity and propose that it could represent the intracranial equivalent of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma. The cell of origin of PPETS remains undetermined although the intense and ubiquitous expression of TTF-1 may suggest a derivation from the infundibulum or ventricular recess. Our study expands the spectrum of sellar TTF-1-positive tumour and challenges the view that they all derive from pituicytes.
Collapse
Affiliation(s)
- F Roncaroli
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biology, University of Manchester, Manchester, UK
| | - D Chatterjee
- Deparment of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - C Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Pereira
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Division of Evolution and Genomic Science, University of Manchester, Manchester, UK
| | - S La Rosa
- Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - J P Brouland
- Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - K Gnanalingham
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Foundation Trust, Salford, Manchester, UK
| | - C Galli
- Department of Histopathology, Humanitas University, Milan, Italy
| | - B Fernandes
- Department of Histopathology, Humanitas University, Milan, Italy
| | - A Lania
- Department of Endocrinology, Humanitas University, Milan, Italy
| | - B Radotra
- Deparment of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
8
|
TTF1-positive Papillary Epithelial Tumor of Pituitary: An Epithelial Variant of Pituicytoma? Appl Immunohistochem Mol Morphol 2020; 28:e1-e5. [DOI: 10.1097/pai.0000000000000532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Varshney K, Epari S, Sahay A, Gupta T, Shetty P, Moiyadi A. Pigmented primary epithelial tumor of the sella: A report of an intriguing case. Neuropathology 2019; 39:378-381. [PMID: 31373070 DOI: 10.1111/neup.12584] [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: 03/26/2019] [Revised: 06/13/2019] [Accepted: 06/16/2019] [Indexed: 11/30/2022]
Abstract
This is a report of an uncommon primary pigmented papillary epithelial tumor of the sella in a 38-year-old man, who presented with clinicoradiological features of pituitary adenoma. Histologically, the tumor showed features reminiscent of choroid plexus papilloma, that is, conspicuous papillary epithelial morphology with presence of intacytoplasmic melanin and no mitotic activity. Immunohistochemically, the tumor was positive for pancytokeratin (AE1/AE3), S-100 protein and CD56, while it was negative for glial fibrillary acid protein, thyroid transcription factor-1, epithelial membrane antigen, other cytokeratins and pituitary hormones. These findings were not typical of any WHO-defined entity and is thus best regarded as a pigmented papillary epithelial tumor of sella of uncertain histogenesis. The present case is a valuable addition to the spectrum of primary pigmented papillary epithelial tumors originating at an unusual location.
Collapse
Affiliation(s)
- Konil Varshney
- Department of Pathology, Tata Memorial Centre, Homi Baba National Institute, Mumbai, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Centre, Homi Baba National Institute, Mumbai, India
| | - Ayushi Sahay
- Department of Pathology, Tata Memorial Centre, Homi Baba National Institute, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Baba National Institute, Mumbai, India
| | - Prakash Shetty
- Neurosurgery Division of Department of Surgical Oncology, Tata Memorial Centre, Homi Baba National Institute, Mumbai, India
| | - Aliasgar Moiyadi
- Neurosurgery Division of Department of Surgical Oncology, Tata Memorial Centre, Homi Baba National Institute, Mumbai, India
| |
Collapse
|
10
|
Abushamat LA, Kerr JM, Lopes MBS, Kleinschmidt-DeMasters BK. Very Unusual Sellar/Suprasellar Region Masses: A Review. J Neuropathol Exp Neurol 2019; 78:673-684. [PMID: 31233145 DOI: 10.1093/jnen/nlz044] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/15/2019] [Accepted: 05/10/2019] [Indexed: 12/18/2022] Open
Abstract
The cause of sellar region masses in large retrospective series is overwhelmingly pituitary adenomas (84.6%), followed by craniopharyngiomas (3.2%), cystic nonneoplastic lesions (2.8%), inflammatory lesions (1.1%), meningiomas (0.94%), metastases (0.6%), and chordomas (0.5%) (1). While other rare lesions were also identified (collectively 6.0%), single unusual entities in the above-cited series numbered <1-2 examples each out of the 4122 cases, underscoring their rarity. We searched our joint files for rare, often singular, sellar/suprasellar masses that we had encountered over the past several decades in our own specialty, tertiary care specialty pituitary center practices. Cases for this review were subjectively selected for their challenging clinical and/or histological features as well as teaching value based on the senior authors' (MBSL, BKD) collective experience with over 7000 examples. We excluded entities deemed to be already well-appreciated by neuropathologists such as mixed adenoma-gangliocytoma, posterior pituitary tumors, metastases, and hypophysitis. We identified examples that, in our judgment, were sufficiently unusual enough to warrant further reporting. Herein, we present 3 diffuse large cell B cell pituitary lymphomas confined to the sellar region with first presentation at that site, 2 sarcomas primary to sella in nonirradiated patients, and 1 case each of granulomatosis with polyangiitis and neurosarcoidosis with first presentations as a sellar/suprasellar mass. Other cases included 1 of chronic lymphocytic leukemia within a gonadotroph adenoma and 1 of ectopic nerve fascicles embedded within a somatotroph adenoma, neither of which impacted patient care. Our objective was to share these examples and review the relevant literature.
Collapse
Affiliation(s)
- Layla A Abushamat
- Department of Endocrinology, University of Colorado Health Sciences Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Janice M Kerr
- Department of Endocrinology, University of Colorado Health Sciences Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - M Beatriz S Lopes
- Department of Pathology (Neuropathology) and Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Bette K Kleinschmidt-DeMasters
- Department of Pathology
- Department of Neurology
- Department of Neurosurgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|
11
|
Kuo CH, Yen YS, Tu TH, Wu JC, Huang WC, Cheng H. Primary Choroid Plexus Papilloma over Sellar Region Mimicking with Craniopharyngioma: A Case Report and Literature Review. Cureus 2018; 10:e2849. [PMID: 30140600 PMCID: PMC6103389 DOI: 10.7759/cureus.2849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Choroid plexus papillomas (CPPs) are slow-growing and benign tumors, representing less than 1% of all intracranial neoplasms. They are predominantly located in the lateral ventricles in children, and in the fourth ventricle in adults. Primary CPP over sellar regions is extremely rare. There was previously only one case reported in men. We report the case of a 43-year-old male who initially presented with bilateral temporal hemiapnosia. A brain magnetic resonance imaging (MRI) revealed heterogenous enhanced mass lesion with cyst component compressing upward onto the optic chiasm. A craniopharyngioma was initially suspected. Further endoscopic trans-sphenoidal surgery (ETS) was performed for total tumor resection. After surgery, the patient had visual field improved without tumor recurrence on post-operative MRI in clinical follow-up. Histopathological examination of the lesion confirmed the diagnosis of CPP, with fibrovascular cores covered by a single layer of cuboidal to columnar epithelial cells. CPP is a rare tumor without specific clinical patterns or imaging findings. Therefore, pre-operative differential diagnosis is difficult for this kind of tumor with complete separation from ventricular system. An ETS for total tumor resection provided effective treatment.
Collapse
Affiliation(s)
- Chao-Hung Kuo
- Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN
| | - Yu-Shu Yen
- Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN
| | - Tsung-Hsi Tu
- Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN
| | - Jau-Ching Wu
- Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN
| | | | - Henrich Cheng
- Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN
| |
Collapse
|
12
|
A Primary Pigmented Choroid Plexus Papilloma Located Within the Sella Turcica: Case Report and Literature Review. World Neurosurg 2017; 105:1039.e13-1039.e18. [DOI: 10.1016/j.wneu.2017.06.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 11/21/2022]
|
13
|
Luo W, Liu H, Li J, Yang J, Xu Y. Choroid Plexus Papillomas of the Cerebellopontine Angle. World Neurosurg 2016; 95:117-125. [PMID: 27506402 DOI: 10.1016/j.wneu.2016.07.094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/23/2016] [Accepted: 07/27/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Choroid plexus papillomas (CPPs) of the cerebellopontine angle (CPA) are extremely rare. We present a series of 21 cases operated on in the last 7 years at our institution. METHODS During the period from January 2008 to October 2015, we encountered 102 histologically established cases of CPPs, of which 21 were located in the CPA region. Clinical profiles, radiologic features, surgical procedures, intraoperative findings, and outcomes were extracted from the patient records and neuroimaging data. RESULTS The 21 CPPs in the CPA region accounted for 20.5% of all CPPs. Two of the tumors occurred in pediatric patients. Tumor size was 2.5-4.7 cm. The rate of calcification was higher in the CPPs in the CPA region. Peritumoral cysts and cysts with small nodules were observed in our cases. A far lateral suboccipital approach was chosen for CPPs protruding inferiorly into the foramen magnum region (n = 14), and a suboccipital retrosigmoid approach was chosen for the other tumors. Total resection was achieved in 18 patients, and subtotal resection was achieved in 3 patients. During the follow-up period, only 1 patient experienced recurrence 32 months after the first operation. The recurrence turned out to be an atypical CPP. CONCLUSIONS CPPs in the CPA region cannot be easily differentiated from other tumors preoperatively. Cysts and calcifications appear on neuroimaging. CPPs in the CPA region usually protrude inferiorly into the foramen magnum region. As much tumor should be removed as possible to avoid recurrence and malignant transition.
Collapse
Affiliation(s)
- Wei Luo
- Department of Neurosurgery, Capital Institute of Pediatrics, Chaoyang District, Beijing, China
| | - Hai Liu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, China.
| | - Jiaxin Li
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, China
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, China
| |
Collapse
|
14
|
Keskin F, Erdi F, Kaya B, Toy H. Sellar-Suprasellar Extraventricular Choroid Plexus Papilloma : A Case Report and Review of the Literature. J Korean Neurosurg Soc 2016; 59:58-61. [PMID: 26885287 PMCID: PMC4754588 DOI: 10.3340/jkns.2016.59.1.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/18/2014] [Accepted: 12/05/2014] [Indexed: 11/30/2022] Open
Abstract
Choroid plexus papillomas (CPPs) are relatively rare neuroectodermal tumors that develop from choroid plexus epithelial cells and are usually restricted to the ventricles. Extraventricular CPPs are very unusual and can be difficult to diagnose and treat. A 50-year-old male patient was admitted to our clinic complaining of headache and visual deterioration. Neurological examination found no abnormalities except decreased light perception and secondary optic atrophy in the left eye. Endocrine testing revealed normal levels of hormones produced by the pituitary and target glands. Magnetic resonance imaging of the brain revealed a huge regular-shaped lesion in the sellar-suprasellar region occupying the sella turcica and extending into the suprasellar cistern and planum sphenoidale. The lesion was completely excised by microsurgery via an ordinary left-sided pterional approach. Histopathology identified the lesion as a choroid plexus papilloma. Following the case report, literature on the origin, differential diagnosis, and treatment of this rare tumor is reviewed.
Collapse
Affiliation(s)
- Fatih Keskin
- Department of Neurosurgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Fatih Erdi
- Department of Neurosurgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Bülent Kaya
- Department of Neurosurgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hatice Toy
- Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| |
Collapse
|
15
|
Qi Q, Ni S, Zhou X, Huang B, Li X. Extraventricular Intraparenchymal Choroid Plexus Tumors in Cerebral Hemisphere: A Series of 6 Cases. World Neurosurg 2015; 84:1660-7. [PMID: 26171890 DOI: 10.1016/j.wneu.2015.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Extraventricular intraparenchymal choroid plexus tumors (CPTs) in the cerebral hemisphere are extremely rare. The aim of this study was to investigate the clinical characteristics, radiologic findings, and surgical outcomes of this atypical type of CPT. METHODS The study comprised 6 patients with pathologically proven extraventricular intraparenchymal CPTs who were surgically treated at Qilu Hospital of Shandong University. The PubMed database was searched for similar cases published before January 2015, and these cases were reviewed. RESULTS Patients were 5 (83.3%) men and 1 (16.7%) woman with an average age of 46.5 years. Symptoms and signs of CPT were usually associated with increased intracranial pressure and invasion of functional areas by tumor. Magnetic resonance imaging commonly demonstrated a contrast-enhancing intraparenchymal mass with cysts; hydrocephalus was not observed in any cases. Subtotal resection and gross total resection were achieved in 1 (16.7%) and 5 (83.3%) cases, respectively. There were 3 cases (50.0%) of choroid plexus papilloma, 2 cases (33.3%) of atypical choroid plexus papilloma, and 1 case (16.7%) not otherwise specified. There was a low incidence of postoperative complications, and surgical outcomes of CPTs were satisfactory. CONCLUSIONS In contrast to typical lesions, extraventricular intraparenchymal CPTs in the cerebral hemisphere are rarely associated with hydrocephalus. Magnetic resonance imaging features are key in preoperative diagnosis; nevertheless, it is difficult to distinguish this atypical type of CPT from other lesions. Surgical removal of the tumor is safe and efficacious.
Collapse
Affiliation(s)
- Qichao Qi
- Department of Neurosurgery, Qilu Hospital of Shandong University, Shandong, China; Brain Science Research Institute, Shandong University, Shandong, China
| | - Shilei Ni
- Department of Neurosurgery, Qilu Hospital of Shandong University, Shandong, China
| | - Xudong Zhou
- Department of Neurosurgery, Qilu Hospital of Shandong University, Shandong, China
| | - Bin Huang
- Brain Science Research Institute, Shandong University, Shandong, China
| | - Xingang Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Shandong, China; Brain Science Research Institute, Shandong University, Shandong, China.
| |
Collapse
|
16
|
Kulwin C, Chan D, Ting J, Hattab EM, Cohen-Gadol AA. Endoscopic endonasal transplanum transtuberculum resection of a large solid choroid plexus papilloma of the third ventricle. J Clin Neurosci 2013; 21:1263-6. [PMID: 24480582 DOI: 10.1016/j.jocn.2013.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 09/29/2013] [Indexed: 10/25/2022]
Abstract
Choroid plexus papilloma (CPP) is a highly vascular solid or mixed solid-cystic tumor. Previously described resection techniques for the more common solid CPP in the third ventricle have all been through the transcranial route. The authors review the literature and describe a patient who, to their knowledge, is the first successful resection of a large, completely solid CPP of the third ventricle through an entirely endoscopic, extended transphenoidal approach. Using modern neuroendoscopic methods and closure techniques, a gross total resection was accomplished and a successful closure without postoperative cerebrospinal fluid leak was achieved despite the presence of preoperative hydrocephalus. For appropriately selected lesions, an extended endonasal skull base resection can be performed successfully for vascular tumors despite the presence of preoperative hydrocephalus.
Collapse
Affiliation(s)
- Charles Kulwin
- Indiana University, Department of Neurological Surgery and Goodman Campbell Brain and Spine, 355 W. 16th Street, Suite 5100, Indianapolis, IN 46202, USA
| | - David Chan
- Indiana University, Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Jonathan Ting
- Indiana University, Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Eyas M Hattab
- Indiana University, Department of Pathology and Laboratory Medicine, Indianapolis, IN, USA
| | - Aaron A Cohen-Gadol
- Indiana University, Department of Neurological Surgery and Goodman Campbell Brain and Spine, 355 W. 16th Street, Suite 5100, Indianapolis, IN 46202, USA.
| |
Collapse
|
17
|
Maimone G, Ganau M, Nicassio N, Paterniti S. Paratrigonal choroid plexus papilloma presenting with satellite multiple supra- and infratentorial hemorrhages. Neuroanatomical basis and pathological hypothesis. Int J Surg Case Rep 2013; 4:239-42. [PMID: 23333804 DOI: 10.1016/j.ijscr.2012.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/19/2012] [Accepted: 11/25/2012] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Choroid plexus papillomas (CPP) are rare tumors arising from the neuroepithelium of the choroid plexus. PRESENTATION OF CASE We report a case of a patient operated for a paratrigonal hemorrhagic WHO class I CPP presenting with multiple satellite supra- and infratentorial hemorrhages. Clinical presentation was characterized by sudden hemiparesis, speech impairment and consciousness deterioration; neuroradiological imaging showed a huge contrast-enhanced solid hemorrhagic left paratrigonal lesion along with others multifocal right occipital and vermian hemorrhages. The patient underwent urgent intervention for excision of the paratrigonal lesion, whose histological analysis led to the diagnosis of CPP. A few days later due to failure of conservative treatment of the satellite hemorrhages the patient underwent a second-time surgery for their evacuation; interestingly histological examination of the tissue probe did not reveal any neoplastic features confirming their sole hemorrhagic nature. Patient's conditions slowly improved despite severe neurological deficits, without any further tumor recurrence. DISCUSSION A thorough revision of the literature is provided including previous reported cases of spontaneous bleeding CPPs and other underlying causes that could lead to multifocal hemorrhages. CONCLUSION Due to the rarity of these events, this case remains still open to speculative hypotheses drawn to explain the neuroanatomical and pathogenetic basis behind this case report.
Collapse
Affiliation(s)
- G Maimone
- Department of Neurosurgery, Policlinic University of Messina, 98126 Messina, Italy.
| | | | | | | |
Collapse
|