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Johnson GW, Mian AY, Dahiya S, Rich KM, Chicoine MR, Limbrick DD. Cystic dissemination of choroid plexus papilloma: illustrative cases. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22360. [PMID: 36377129 PMCID: PMC9664240 DOI: 10.3171/case22360] [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: 09/06/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Choroid plexus papillomas are benign tumors of the choroid plexus. Although typically focal, they can metastasize. Rarely, patients may present with numerous cystic lesions throughout the craniospinal axis. OBSERVATIONS The authors present three cases of pathologically confirmed fourth ventricular World Health Organization (WHO) grade 1 choroid plexus papillomas presenting with numerous cystic lesions throughout the craniospinal axis. Two cases were treated with only resection of the fourth ventricular mass; one was treated with a partial cyst fenestration. During follow-up, there was only mild interval growth of the cystic lesions over time, and all patients remained asymptomatic from their cystic lesions. The authors summarize five additional cases of cystic dissemination in the published literature and discuss hypotheses for the pathophysiology of this rare presentation. LESSONS Choroid plexus papillomas may present with numerous, widely disseminated cystic lesions within the craniospinal axis. Thus, the authors recommend preoperative and routine imaging of the entire neuroaxis in patients with choroid plexus tumors, regardless of WHO grade. Although the role of adjuvant therapy and cyst fenestration in the treatment of these lesions remains unclear, watchful waiting may be indicated, especially in asymptomatic patients, because the lesions often demonstrate slow, if any, growth over time.
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Affiliation(s)
| | | | - Sonika Dahiya
- Pathology, Washington University School of Medicine, St. Louis, Missouri; and
| | | | - Michael R. Chicoine
- Department of Neurosurgery, University of Missouri School of Medicine, Columbia, Missouri
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2
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Saitoh Y, Aikawa T, Miyazaki Y, Nishimura M. Long-Term Outcome After Surgical Resection of a Spinal Choroid Plexus Tumor in a Dog. J Am Anim Hosp Assoc 2021; 57:37-41. [PMID: 33260214 DOI: 10.5326/jaaha-ms-6982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 11/11/2022]
Abstract
A 6 yr old castrated male Clumber spaniel was referred for evaluation of acute paraplegia. MRI of the thoracolumbar spine demonstrated an intradural-extramedullary mass lesion at the level of T12 and extradural spinal cord compression at L1-L2. A hemilaminectomy was performed to achieve gross total resection of the mass lesion and removal of extruded disc material. A diagnosis of spinal choroid plexus tumor (CPT) and intervertebral disc extrusion was made. At 4 mo postoperatively, MRI demonstrated a mass lesion at the right lateral aperture of the fourth ventricle. Spinal drop metastasis from a primary intracranial CPT was suspected. The dog was ambulating independently and neurologically normal at that time. At 17 mo postoperatively, a third MRI was performed owing to decreased postural reactions in both hind limbs and vision loss in the right eye, and it demonstrated an increase in size of the intracranial mass lesion. These two additional MRI studies of the entire central nervous system showed no other metastatic lesions nor any evidence of local recurrence. At 25 mo postoperatively, the dog died at home. This is the first case report of surgical intervention and antemortem histopathological diagnosis of a spinal CPT in a dog.
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Affiliation(s)
- Yuya Saitoh
- From Department of Surgery, Aikawa Veterinary Medical Center, Tokyo, Japan
| | - Takeshi Aikawa
- From Department of Surgery, Aikawa Veterinary Medical Center, Tokyo, Japan
| | - Yuta Miyazaki
- From Department of Surgery, Aikawa Veterinary Medical Center, Tokyo, Japan
| | - Masaaki Nishimura
- From Department of Surgery, Aikawa Veterinary Medical Center, Tokyo, Japan
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3
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Ochoa-Cacique D, Córdoba-Mosqueda M, Aguilar-Calderón JR, Sánchez-Silva MC, Vicuña-González RM, la Torre AID, Reyes-Rodríguez VA, Lomelí-Ramírez JDJ, Medina-Carrillo Ó, Sánchez-Calderón MD, Castañeda-Ramírez EA, García-González U. Spinal drop of atypical choroid plexus papilloma in an adult patient: A case report and literature review. Surg Neurol Int 2020; 11:409. [PMID: 33365172 PMCID: PMC7749967 DOI: 10.25259/sni_649_2020] [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: 09/16/2020] [Accepted: 10/22/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Choroid plexus papillomas (CPPs) are benign extra-axial tumors that originate from the choroid plexus; these tumors rarely have metastases, being at the spinal level the location with few reported cases. Case Description: We report the case of a 48-year-old man with a history of atypical fourth ventricular CPP and gross total resection (GTR) in 2008. In 2015, he presented with radicular pain, decreased strength, and paresthesia in the left leg. Magnetic resonance imaging revealed a well-defined intradural ovoid lesion in the vertebral canal at the level of the L3-L4 intersomatic space. Subtotal resection of the tumor was performed. The patient recovered well, with relief of pain and no neurological deficit. A literature research few cases of CPP metastasis in adults. We describe here a fifth-decade male patient with a lumbar neoplasm, which according to the histopathologic characteristics and location is the first case of an atypical papilloma implant of the choroid plexus at this spinal level. Conclusion: GTR of primary lesions and associated implants remains the gold standard for surgical treatment of CPP. Radiotherapy, stereotactic radiosurgery, and chemotherapy are adjuvant therapies for CPP but there is no definitive protocol for the management of implants. Proper follow-up of these patients is essential since spinal drop can appear many years after the initial presentation of CPP.
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Affiliation(s)
- Diego Ochoa-Cacique
- Department of Neurosurgery, Hospital Central Sur de Alta Especialidad PEMEX, Tlalpan, Ciudad de Mexico, Mexico
| | - María Córdoba-Mosqueda
- Department of Neurosurgery, Hospital Central Sur de Alta Especialidad PEMEX, Tlalpan, Ciudad de Mexico, Mexico
| | - José Ramón Aguilar-Calderón
- Department of Neurosurgery, Hospital Central Sur de Alta Especialidad PEMEX, Tlalpan, Ciudad de Mexico, Mexico
| | | | - Rosa María Vicuña-González
- Department of Anatomical Pathology, Hospital Central Sur de Alta Especialidad PEMEX, Tlalpan, Ciudad de Mexico, Mexico
| | - Abraham Ibarra-de la Torre
- Department of Neurosurgery, Hospital Central Sur de Alta Especialidad PEMEX, Tlalpan, Ciudad de Mexico, Mexico
| | | | | | - Óscar Medina-Carrillo
- Department of Neurosurgery, Hospital Central Sur de Alta Especialidad PEMEX, Tlalpan, Ciudad de Mexico, Mexico
| | | | | | - Ulises García-González
- Department of Neurosurgery, Hospital Central Sur de Alta Especialidad PEMEX, Tlalpan, Ciudad de Mexico, Mexico
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Puerta Roldán P, Santa-María López V, Morales La Madrid A, Cruz O, Muchart J, Thomas C, Guillén Quesada A. Vanishing diffuse leptomeningeal contrast enhancement in an infant with choroid plexus papilloma. Acta Neurochir (Wien) 2019; 161:351-354. [PMID: 30617713 DOI: 10.1007/s00701-018-03781-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/18/2018] [Indexed: 11/24/2022]
Abstract
Choroid plexus tumors (CPT) can present in the baseline magnetic resonance imaging (MRI) with lesions compatible with leptomeningeal dissemination. Therapeutic strategy in this condition is controversial. We present a case of an infant with CPP and significant diffuse leptomeningeal contrast enhancement at diagnosis, which spontaneously resolved after removal of the primary tumor. In these challenging cases, several aspects, such as histopathological/molecular diagnosis and close radiological follow-up, should be taken into account to avoid unnecessary treatments.
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Affiliation(s)
- Patricia Puerta Roldán
- Department of Pediatric Neurosurgery, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain.
| | - Vicente Santa-María López
- Neuro-Oncology Unit. Department of Pediatric Oncology, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Andrés Morales La Madrid
- Neuro-Oncology Unit. Department of Pediatric Oncology, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Ofelia Cruz
- Neuro-Oncology Unit. Department of Pediatric Oncology, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Jordi Muchart
- Department of Diagnostic Imaging, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Christian Thomas
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Antonio Guillén Quesada
- Department of Pediatric Neurosurgery, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
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5
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Ruggeri L, Alberio N, Alessandrello R, Cinquemani G, Gambadoro C, Lipani R, Maugeri R, Nobile F, Iacopino DG, Urrico G, Battaglia R. Rapid malignant progression of an intraparenchymal choroid plexus papillomas. Surg Neurol Int 2018; 9:131. [PMID: 30105129 PMCID: PMC6044141 DOI: 10.4103/sni.sni_434_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 05/29/2018] [Indexed: 01/05/2023] Open
Abstract
Background: Choroid plexus tumors (CPTs) are rare neoplasms accounting for only 0.3–0.6% of all brain tumors in adults and 2–5% in children. The World Health Organization (WHO) classification describes three histological grades: grade I is choroid plexus papilloma (CPP), grade II is atypical papilloma, and grade III is the malignant form of carcinoma. In adults, CPTs rarely have a supratentorial localization. Case Description: Here we report a very rare case of an intraparenchymal parietal CPP with a rapid histological transition from grade I to grade III WHO in a 67-year-old man, in <7 months. Conclusion: Because of the rarity of these oncotypes, descriptions of each new case are useful, mostly to consider this diagnostic entity in extraventricular brain tumors of adults, despite an unusual location.
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Affiliation(s)
- Luca Ruggeri
- Unit of Neurosurgery, S. Elia Hospital, Caltanissetta, Italy
| | - Nicola Alberio
- Unit of Neurosurgery, S. Elia Hospital, Caltanissetta, Italy
| | | | | | | | - Rita Lipani
- Unit of Neurosurgery, S. Elia Hospital, Caltanissetta, Italy
| | - Rosario Maugeri
- Unit of Neurosurgery, S. Elia Hospital, Caltanissetta, Italy
| | | | - Domenico Gerardo Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Italy
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Morshed RA, Lau D, Sun PP, Ostling LR. Spinal drop metastasis from a benign fourth ventricular choroid plexus papilloma in a pediatric patient: case report. J Neurosurg Pediatr 2017; 20:471-479. [PMID: 28841111 DOI: 10.3171/2017.5.peds17130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Choroid plexus papillomas (CPPs) are typically benign tumors that can occur in any age group but are more commonly found in pediatric patients. Although these tumors are benign, there are several reports in adult patients of distant metastases present either at the time of diagnosis or occurring months to years after initial resection. Here, the authors report the case of a 14-year-old boy who presented with symptoms of elevated intracranial pressure due to obstructive hydrocephalus that was caused by a large fourth ventricular mass. Preoperative imaging included a full MRI of the spine, which revealed an intradural lesion that encased the distal sacral nerve roots at the tip of the thecal sac and was concerning for a drop metastasis. The patient underwent gross-total resection of both the fourth ventricular and sacral tumors with histology of both lesions consistent with benign CPP (WHO Grade I). In addition, the authors review prior reports of both pediatric and adult patients in whom benign CPPs have metastasized with either benign or atypical pathology found at a distant site. Taking into account this unusual case and reports in the literature, patients with even benign CPPs may warrant initial and routine follow-up imaging of the total neural axis in search of the rare, but possible, occurrence of drop metastasis.
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Affiliation(s)
- Ramin A Morshed
- Department of Neurological Surgery, University of California, San Francisco; and
| | - Darryl Lau
- Department of Neurological Surgery, University of California, San Francisco; and
| | - Peter P Sun
- UCSF Benioff Children's Hospital Oakland, California
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7
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Scala M, Morana G, Milanaccio C, Pavanello M, Nozza P, Garrè ML. Atypical choroid plexus papilloma: spontaneous resolution of diffuse leptomeningeal contrast enhancement after primary tumor removal in 2 pediatric cases. J Neurosurg Pediatr 2017; 20:284-288. [PMID: 28686125 DOI: 10.3171/2017.2.peds16526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atypical choroid plexus papillomas can metastasize in the form of leptomeningeal seeding. Postoperative chemotherapy is the recommended first-line treatment when gross-total removal is not achieved or in cases of disseminated disease. Here the authors report on 2 children with atypical choroid plexus papillomas and MRI findings of diffuse leptomeningeal enhancement at diagnosis, later presenting with spontaneous resolution of the leptomeningeal involvement after removal of the primary lesions. Observations in this report expand our knowledge about the natural history and biological behavior of these tumors and highlight the role of close neuroimaging surveillance in the management of atypical choroid plexus papillomas in cases with MRI evidence of diffuse leptomeningeal enhancement at presentation.
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Affiliation(s)
| | | | | | | | - Paolo Nozza
- Pathology, Istituto Giannina Gaslini, Genova, Italy
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8
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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]
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9
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Abdulkader MM, Mansour NH, Van Gompel JJ, Bosh GA, Dropcho EJ, Bonnin JM, Cohen-Gadol AA. Disseminated choroid plexus papillomas in adults: A case series and review of the literature. J Clin Neurosci 2016; 32:148-54. [PMID: 27372242 DOI: 10.1016/j.jocn.2016.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
Choroid plexus papillomas (CPPs) are uncommon, usually intraventricular, low-grade tumors, accounting for less than 1% of all intracranial neoplasms and 2-4% of brain tumors in children. Dissemination of CPPs to multiple levels of the neuraxis has been seldom observed. Thus far, only 26 adult patients have been reported in the English language literature. With some exceptions, disseminated CPPs have been observed in adults and involved multiple sites along the cerebrospinal fluid pathways. Occasionally, intraparenchymal extension has been documented, and secondary involvement of the suprasellar region has been reported in only five patients. Postoperative treatment of CPPs has not been standardized. Most recommended therapies have been extrapolated from a series of atypical papillomas or carcinomas of the choroid plexus in children. We herein report a series of three patients of disseminated choroid plexus papillomas providing additional insights into this relatively rare entity.
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Affiliation(s)
- Marwah M Abdulkader
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Nassir H Mansour
- Department of Neurological Surgery, Indiana University School of Medicine, 340 W 10(th) Street #6200, Indianapolis, IN 46202, USA
| | - Jamie J Van Gompel
- Departments of Neurosurgery and Otolaryngology, Mayo Clinic, Rochester, MN 55905, USA
| | - Gregory A Bosh
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Edward J Dropcho
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Jose M Bonnin
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Aaron A Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, 340 W 10(th) Street #6200, Indianapolis, IN 46202, USA.
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10
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Tumores de plexo coroideo en la infancia: experiencia en el hospital Sant Joan de Déu. Neurocirugia (Astur) 2016. [DOI: 10.1016/j.neucir.2015.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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11
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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.
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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
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Abstract
This article provides an overview of the intra-axial tumors that affect the cerebellum, which can be categorized by location and age. For each tumor, we review conventional neuroimaging findings and discuss the value of more advanced neuroimaging techniques. Current management strategies are also briefly discussed. Finally, cerebellar paraneoplastic disorders and medication-induced cerebellar disorders are discussed.
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Affiliation(s)
- Thomas J Pfiffner
- DENT Neurologic Institute, 3980 Sheridan Drive, Amherst, NY 14226, USA
| | - Ronak Jani
- DENT Neurologic Institute, 3980 Sheridan Drive, Amherst, NY 14226, USA
| | - Laszlo Mechtler
- DENT Neurologic Institute, Roswell Park Cancer Institute, 3980 Sheridan Drive, Buffalo, NY 14226, USA.
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13
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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.
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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.
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Dhillon RS, Wang YY, McKelvie PA, O’Brien B. Progression of choroid plexus papilloma. J Clin Neurosci 2013; 20:1775-8. [DOI: 10.1016/j.jocn.2012.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 11/08/2012] [Accepted: 11/18/2012] [Indexed: 11/15/2022]
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Safaee M, Oh MC, Bloch O, Sun MZ, Kaur G, Auguste KI, Tihan T, Parsa AT. Choroid plexus papillomas: advances in molecular biology and understanding of tumorigenesis. Neuro Oncol 2012; 15:255-67. [PMID: 23172371 DOI: 10.1093/neuonc/nos289] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Choroid plexus papillomas are rare, benign tumors originating from the choroid plexus. Although generally found within the ventricular system, they can arise ectopically in the brain parenchyma or disseminate throughout the neuraxis. We sought to review recent advances in our understanding of the molecular biology and oncogenic pathways associated with this disease. A comprehensive PubMed literature review was conducted to identify manuscripts discussing the clinical, molecular, and genetic features of choroid plexus papillomas. Articles concerning diagnosis, treatment, and long-term patient outcomes were also reviewed. The introduction of atypical choroid plexus papilloma as a distinct entity has increased the need for accurate histopathologic diagnosis. Advances in immunohistochemical staining have improved our ability to differentiate choroid plexus papillomas from other intracranial tumors or metastatic lesions using combinations of key markers and mitotic indices. Recent findings have implicated Notch3 signaling, the transcription factor TWIST1, platelet-derived growth factor receptor, and the tumor necrosis factor-related apoptosis-inducing ligand pathway in choroid plexus papilloma tumorigenesis. A combination of commonly occurring chromosomal duplications and deletions has also been identified. Surgical resection remains the standard of care, although chemotherapy and radiotherapy may be considered for recurrent or metastatic lesions. While generally considered benign, these tumors possess a complex biology that sheds insight into other choroid plexus tumors, particularly malignant choroid plexus carcinomas. Improving our understanding of the molecular biology, genetics, and oncogenic pathways associated with this tumor will allow for the development of targeted therapies and improved outcomes for patients with this disease.
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Affiliation(s)
- Michael Safaee
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117, USA
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Stuivenvolt M, Mandl E, Verheul J, Fleischeuer R, Tijssen CC. Atypical transformation in sacral drop metastasis from posterior fossa choroid plexus papilloma. BMJ Case Rep 2012; 2012:bcr-01-2012-5681. [PMID: 22922909 DOI: 10.1136/bcr-01-2012-5681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Choroid plexus papillomas (CPP) are rare tumours and spinal metastases of CPP are even less common. We report a 50-year-old woman with spinal drop metastases at Th9 and S1-2 6 years after total resection of a posterior fossa CPP. The metastasis at S1-2 was resected and histological examination showed transformation to an atypical CPP. Atypical transformation in a metastasis years after resection of a benign posterior fossa CPP has been described once. We would like to advocate craniospinal MRI at the time of initial diagnosis as well as periodic follow-up after total and subtotal resection of a posterior fossa CPP in adults at least once in 1 or 2 years, depending on the histological grading of the primary CPP. In our case report, this could have resulted in earlier diagnosis of the locoregional recurrence or of the spinal drop metastasis.
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Affiliation(s)
- Mischa Stuivenvolt
- Department of Neurology, St Elisabeth Hospital, Tilburg, The Netherlands.
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17
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Multifocal choroid plexus papillomas: case report. Acta Neurochir (Wien) 2012; 154:295-9. [PMID: 21953479 DOI: 10.1007/s00701-011-1172-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 09/07/2011] [Indexed: 10/17/2022]
Abstract
Choroid plexus papillomas (CPP) are rare tumors of the central nervous system, usually occurring in the ventricular system. Apart from spinal drop metastases, CPPs are generally unique tumors. In this report, the authors present two exceptional adult cases involving multiple benign CPPs located in both intra- and extraventricular locations. The tumors were located in the fourth ventricle and Meckel's cave in one case and the cerebellopontine angle, the frontotemporal region and the fourth ventricle in the other. A review of the literature revealed that these two cases represent the first reported occurrences of multiple choroid plexus papillomas involving Meckel's cave and frontotemporal intraparenchymal locations.
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18
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Solís Muñiz I, López Pino MA, Tello Moreno M, Sirvent Cerdá SI. [Solution to case 30. Choroid plexus papilloma with meningeal enhancement]. RADIOLOGIA 2011; 53:278-80. [PMID: 21700064 DOI: 10.1016/j.rx.2010.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 03/03/2010] [Indexed: 11/18/2022]
Affiliation(s)
- I Solís Muñiz
- Servicio de Radiodiagnóstico, Hospital Infantil Universitario Niño Jesús, Madrid, España.
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Bian LG, Sun QF, Wu HC, Jiang H, Sun YH, Shen JK. Primary choroid plexus papilloma in the pituitary fossa: case report and literature review. Acta Neurochir (Wien) 2011; 153:851-7. [PMID: 21140177 DOI: 10.1007/s00701-010-0884-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 11/12/2010] [Indexed: 11/30/2022]
Abstract
Choroid plexus papillomas are rare tumors of the central nervous system and are usually confined to the ventricular system. We illustrated a primary choroid plexus papilloma in the pituitary fossa. A 31-year-old female presented with amenorrhea and intermittent galactorrhoea, with no visual complaints in the last 2 years. Endocrine testing showed no hormone excess or deficiency of the pituitary and target glands, except for a higher prolactin level (56 ng/ml). A sharply circumscribed regular mass in the sellar region occupying the entire sella turcica and extending into the suprasellar cistern was demonstrated on MR imaging with gadolinium diethylenetriamine pentaacetic acid. The patient underwent an endonasal trans-sphenoidal approach. Complete microsurgical excision and complete preservation of the normal pituitary gland was achieved, with normal prolactin level. The histopathology showed that the lesion was a choroid plexus papilloma. Theories of the origin, the differential diagnosis, and treatment of the rare tumor are discussed.
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Affiliation(s)
- Liu-Guan Bian
- Department of Neurosurgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, People's Republic of China.
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Savage NM, Crosby JH, Reid-Nicholson MD. The cytologic findings in choroid plexus carcinoma: Report of a case with differential diagnosis. Diagn Cytopathol 2010; 40:1-6. [DOI: 10.1002/dc.21478] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 06/03/2010] [Indexed: 11/06/2022]
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Al-Abdullah AA, Abu-Amero KK, Hellani A, Alkhalidi H, Bosley TM. Choroid plexus papilloma metastases to both cerebellopontine angles mimicking neurofibromatosis type 2. J Neurol 2010; 258:504-6. [DOI: 10.1007/s00415-010-5761-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/13/2010] [Accepted: 09/14/2010] [Indexed: 11/29/2022]
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Palmer C, Kalsi P, Scoones D, Bradey N, Strachan R. Recurrence of fourth ventricular choroid plexus papilloma with late occurrence of a spinal drop metastasis. Br J Neurosurg 2010; 24:482-4. [PMID: 20632883 DOI: 10.3109/02688697.2010.487135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Choroid plexus papillomas are rare tumours, which occasionally spread both intracranially and down the spinal canal. Spinal metastasis has been reported infrequently and only once many years since the initial diagnosis. This is the first reported case of late recurrence, metastasis and transformation of a benign to an atypical lesion.
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Affiliation(s)
- Christopher Palmer
- Department of Neurosurgery, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK.
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Congenital tumors of the central nervous system. Neuroradiology 2010; 52:531-48. [PMID: 20428859 DOI: 10.1007/s00234-010-0699-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 03/30/2010] [Indexed: 01/17/2023]
Abstract
Congenital tumors of the central nervous system (CNS) are often arbitrarily divided into "definitely congenital" (present or producing symptoms at birth), "probably congenital" (present or producing symptoms within the first week of life), and "possibly congenital" (present or producing symptoms within the first 6 months of life). They represent less than 2% of all childhood brain tumors. The clinical features of newborns include an enlarged head circumference, associated hydrocephalus, and asymmetric skull growth. At birth, a large head or a tense fontanel is the presenting sign in up to 85% of patients. Neurological symptoms as initial symptoms are comparatively rare. The prenatal diagnosis of congenital CNS tumors, while based on ultrasonography, has significantly benefited from the introduction of prenatal magnetic resonance imaging studies. Teratomas constitute about one third to one half of these tumors and are the most common neonatal brain tumor. They are often immature because of primitive neural elements and, rarely, a component of mixed malignant germ cell tumors. Other tumors include astrocytomas, choroid plexus papilloma, primitive neuroectodermal tumors, atypical teratoid/rhabdoid tumors, and medulloblastomas. Less common histologies include craniopharyngiomas and ependymomas. There is a strong predilection for supratentorial locations, different from tumors of infants and children. Differential diagnoses include spontaneous intracranial hemorrhage that can occur in the presence of coagulation factor deficiency or underlying vascular malformations, and congenital brain malformations, especially giant heterotopia. The prognosis for patients with congenital tumors is generally poor, usually because of the massive size of the tumor. However, tumors can be resected successfully if they are small and favorably located. The most favorable outcomes are achieved with choroid plexus tumors, where aggressive surgical treatment leads to disease-free survival.
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Galloway M, Thom M. Brain and cerebrospinal fluid. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Primary choroid plexus papilloma of the sellar region. J Neurooncol 2008; 88:51-5. [PMID: 18224277 DOI: 10.1007/s11060-008-9531-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Accepted: 01/11/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Choroid plexus papillomas are rare tumors of the central nervous system and are usually confined to the ventricle system. We describe a choroid plexus papilloma located in the sella turcica that was identified pathologically. CASE DESCRIPTION A 49-year-old woman with a 5-year history of progressive visual deterioration in the left eye was admitted to our hospital. Neurological examination found no abnormality except for the perception of light and secondary optic atrophy in her left eye. Careful endocrine testing did not show any hormone excess or deficiency of the pituitary and target glands. Magnetic resonance imaging demonstrated a hemorrhagic mass in the sellar region, which occupied the entire sella turcica and extended to the suprasellar cistern. The mass was excised via an endonasal trans-sphenoidal approach. Histologic examination proved that the lesion was a choroid plexus papilloma. CONCLUSION Choroid plexus papillomas arising in and occupying the sella are rare, although some radiographic patterns of ectopic choroid plexus papillomas have been reported. A review of the current literature revealed no similar cases of a choroid plexus papilloma. We discuss the different radiological appearances of choroid plexus papillomas, the differential diagnosis, and treatment.
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