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Garrido E, Alqahtani K, Lozouet M, Derrey S, Gilard V. Metastasis of the choroid plexuses: A systematic review of the literature and case illustration. Neurochirurgie 2023; 69:101412. [PMID: 36649887 DOI: 10.1016/j.neuchi.2023.101412] [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: 12/05/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Choroid plexus (CP) metastases are an extremely rare condition accounting for less than 1% of brain metastases. Due to its scarcity, little is known about this pathology and its management. Herein, we propose a review of the current literature to help its diagnosis and management. METHODS Through a literature review based on PubMed/MEDLINE database, we reviewed 94 cases of intraventricular metastasis of solid cancer in 28 full-text articles in English from 1980 to 2010. We have reported epidemiological, clinical, radiological, histological data, as well as management strategies and outcomes. A case report of fourth ventricular pulmonary metastasis illustrates this review. RESULTS Intraventricular metastases are most often reported in patients in their 6th decade. The clinical presentation is marked by acute hydrocephalus, more rarely lesional bleeding. Three-quarters of intraventricular metastases develop in lateral ventricle, then respectively in the fourth and third ventricles. Kidney cancer accounts for 45% of the cases. The treatment modalities are surgical removal in case of a single lesion and adjuvant radiotherapy and chemotherapy depending on the primary cancer. The prognosis remains poor due to dissemination via the cerebrospinal fluid. CONCLUSION Multiple choroid plexus metastasis is a rare diagnosis, affecting patients with a specific clinical presentation and a misleading radiological appearance. There is no standard of care for the management of these lesions and surgical approach can be challenging.
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Affiliation(s)
- E Garrido
- Department of neurosurgery, Rouen university hospital, Rouen, France.
| | - K Alqahtani
- Department of neurosurgery, Rouen university hospital, Rouen, France
| | - M Lozouet
- Department of neurosurgery, Rouen university hospital, Rouen, France
| | - S Derrey
- Department of neurosurgery, Rouen university hospital, Rouen, France
| | - V Gilard
- Department of neurosurgery, Rouen university hospital, Rouen, France; UNIROUEN, Inserm U1245, laboratory of microvascular endothelium and neonate brain lesions, Normandie university, Rouen, France
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Radiologic and Clinical Outcomes of Stereotactic Radiosurgery for Intraventricular Metastases. World Neurosurg 2021; 157:e333-e341. [PMID: 34653703 DOI: 10.1016/j.wneu.2021.10.083] [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: 09/17/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The optimal management of intraventricular metastases remains debatable. The aim of this study is to define the safety and efficacy of Gamma-Knife radiosurgery in the treatment of intraventricular metastases. METHODS This retrospective, single-center study involved patients that were treated with stereotactic radiosurgery (SRS) for intraventricular metastases. The study end points included SRS-related toxicity, local and distal intracranial tumor control, as well as the incidence of post-treatment hydrocephalus and leptomeningeal dissemination. Factors associated with radiologic and clinical outcomes were also analyzed. RESULTS The cohort included 17 consecutive patients who underwent stereotactic radiosurgery for treatment of 41 intracranial metastases, of which 23 were primary intraventricular (intraventricular metastasis). Median overall survival from primary tumor diagnosis and from SRS treatment were 28 and 5 months, respectively. With a median radiological follow-up of 3 (interquartile range 3) months, 7 patients (41.18%) experienced overall intracranial disease progression, whereas 7 (27.27%) intraventricular metastases progressed radiologically. Four (23.53%) and 3 (17.65%) patients developed hydrocephalus and leptomeningeal dissemination post-SRS, respectively. Four patients (23.53%) died due to intracranial disease progression. CONCLUSIONS SRS offers a reasonable chance of local tumor control for patients with intraventricular brain metastasis. However, the risk of hydrocephalus and leptomeningeal spread of disease is not inconsequential and merits close follow-up for patients with brain metastasis involving the ventricular system.
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Beach IR, Olszewski AM, Thomas AA, DeWitt JC, Liebelt BD. Multifocal metastases to choroid plexus from papillary thyroid carcinoma: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21436. [PMID: 35855300 PMCID: PMC9265197 DOI: 10.3171/case21436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Choroid plexus metastases are extremely rare from all types of malignancy, with only 42 cases reported in the literature thus far. Most of these originate from renal cell carcinoma and present as a solitary choroid plexus lesion; only two cases of multifocal choroid plexus metastases have been reported to date.
OBSERVATIONS
The authors report the third case of multifocal metastases to the choroid plexus, that of a 75-year-old man who developed three measurable choroid plexus lesions approximately 3.5 years after undergoing total thyroidectomy and chemotherapy for papillary thyroid carcinoma. He underwent intraventricular biopsy of the largest lesion and subsequently died of hydrocephalus after opting for comfort care only.
LESSONS
This is the third case of multifocal choroid plexus metastasis in the literature and the second case of multifocal metastasis from thyroid carcinoma. As such, the natural disease course is not well characterized. This case is compared with the previous eight reports of choroid plexus metastases from thyroid carcinoma, seven of which involved solitary lesions. The eight prior cases are evaluated with attention to treatment modalities used and factors potentially influencing prognosis, specifically those that might contribute to hydrocephalus, a reported complication for this pathology.
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Affiliation(s)
- Isidora R. Beach
- Larner College of Medicine, University of Vermont, Burlington, Vermont; and
| | | | | | - John C. DeWitt
- Pathology & Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont
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Lopes Rufino EP, Ribeiro da Costa Gomes ES, Silva Loureiro LM, Oliveira Eugenio P, Vaz-Guimaraes F. Brain Metastasis of Follicular Thyroid Carcinoma in Pregnancy: A Case Report and Literature Review. Cureus 2020; 12:e9337. [PMID: 32850211 PMCID: PMC7445421 DOI: 10.7759/cureus.9337] [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: 11/10/2022] Open
Abstract
Brain metastases (BMs) related to cancer are quite common and represent the most common brain cancer. We present a rare case of a 32-year-old female, 36 weeks pregnant, admitted to the emergency with complaints of severe headache, vomiting, and left hemiparesis associated with drowsiness. Cranial tomography showed an image suggestive of an expansive lesion in the right front-temporo-insular region with an important mass effect. The result of biopsy with immunohistochemistry was compatible with metastasis of follicular thyroid carcinoma (FTC). The knowledge of neurological characteristics in the clinical analysis of patients with thyroid carcinoma must be highly valued, both in the correct interpretation of the signs and in the early investigation through skull imaging exams.
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Affiliation(s)
| | | | - Lucas M Silva Loureiro
- Faculty of Medical Sciences of the University of Pernambuco, Hospital Universitário Oswaldo Cruz, Recife, BRA
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Sharifi G, Bakhtevari MH, Alghasi M, Nosari MA, Rahmanzade R, Rezaei O. Bilateral Choroid Plexus Metastasis from Papillary Thyroid Carcinoma: Case Report and Review of the Literature. World Neurosurg 2015; 84:1142-6. [DOI: 10.1016/j.wneu.2015.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022]
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Umehara T, Okita Y, Nonaka M, Mori K, Kanemura Y, Kodama Y, Mano M, Kudawara I, Nakajima S. Choroid Plexus Metastasis of Follicular Thyroid Carcinoma Diagnosed due to Intraventricular Hemorrhage. Intern Med 2015; 54:1297-302. [PMID: 25986274 DOI: 10.2169/internalmedicine.54.3560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Choroid plexus metastasis (CPM) is extremely rare and originates most frequently from renal cell carcinoma (RCC). We herein report the case of a 58-year-old man who developed a solitary CPM lesion derived from follicular thyroid carcinoma in addition to intraventricular hemorrhage. Computed tomography revealed acute hydrocephalus as a result of the hemorrhage, and we planned endoscopic hematoma evacuation. Since it was too difficult to reach the hematoma, we considered the possibility of a neoplasm and performed a biopsy of the lesion, the results of which led to an accurate diagnosis of CPM in this case. We also review previous reports of CPM originating from thyroid carcinoma compared with RCC.
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Affiliation(s)
- Toru Umehara
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Japan
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Healy AT, Otvos B, Schroeder J, Hamrahian AH, Angelov L, Kamian K. Hurthle cell carcinoma presenting as a single choroid plexus metastasis. J Clin Neurosci 2014; 21:1448-50. [PMID: 24656751 DOI: 10.1016/j.jocn.2013.12.012] [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: 12/19/2013] [Accepted: 12/24/2013] [Indexed: 11/24/2022]
Abstract
Choroid plexus masses represent approximately 0.3-0.8% of intracranial tumors. Herein we present, to our knowledge, the first reported patient with an isolated Hurthle cell papillary thyroid carcinoma metastasis to the choroid plexus of the lateral ventricle. Unresponsive to iodine ablation and refusing surgery, the patient underwent Gamma Knife radiosurgery (Elekta AB, Stockholm, Sweden), receiving 15Gy to the 50% isodose line. The lesion regressed until 5years later at which time it was unresponsive to 18Gy and required surgical resection. Although extraneural metastatic cancers are recognized as potential sources for the single choroid plexus mass, we must consider even the unusual culprit in patients with a history of cancer.
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Affiliation(s)
- Andrew T Healy
- Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Balint Otvos
- Case Western Reserve University, Lerner College of Medicine, Cleveland, OH, USA
| | - Jason Schroeder
- Department of Neurosurgery, University of Toledo, Toledo, OH, USA
| | - Amir H Hamrahian
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - Lilyana Angelov
- Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Kambiz Kamian
- Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Kitagawa Y, Higuchi F, Abe Y, Matsuda H, Kim P, Ueki K. Metastasis to the choroid plexus from thyroid cancer: case report. Neurol Med Chir (Tokyo) 2013; 53:832-6. [PMID: 24162238 PMCID: PMC4508725 DOI: 10.2176/nmc.cr2012-0238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Thyroid cancer is not a common primary cancer causing intracranial metastasis. Here we report a 74-year-old woman with magnetic resonance imaging (MRI) demonstrating a 4 cm round, heterogeneously enhancing mass in the trigone of the right lateral ventricle. Systemic screening by computed tomography (CT) examination detected a 20 mm nodule with calcification in the thyroid, multiple well circumscribed nodules in bilateral lung filed, and a bone metastasis to the right dorsal rib. Cerebral angiography demonstrated a hypervascular mass fed from anterior and posterior choroidal arteries. Tumor biopsy via parietal transcortical approach confirmed a thyroid carcinoma metastasis to the choroid plexus. Of the 33 reported cases of choroid plexus metastasis, 14 (42%) are from kidney and 3 (9%) from thyroid cancer, which appears to be overrepresented considering their prevalence among all brain metastasis. There may be seed-and-soil relationship between thyroid cancer and choroid plexus.
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Evaluation of rare choroid plexus metastasis from papillary thyroid carcinoma with multimodality imaging. Clin Nucl Med 2013; 39:551-3. [PMID: 23877529 DOI: 10.1097/rlu.0b013e31829f913d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Papillary thyroid carcinoma (PTC) is the most common malignancy of thyroid gland. Though it metastasizes primarily through lymphatics, hematogenous spread is not infrequent. We report the case of a 62-year-old male patient with intraventricular choroid plexus metastasis from PTC, incidentally detected on post-high-dose radioiodine therapy whole-body I scan, which is an extremely rare presentation. Only 3 cases of choroid plexus metastasis from thyroid carcinoma have been reported. Further multimodality radiological investigations confirmed diagnosis and helped in assessing treatment response. The patient received gamma-knife stereotactic radiosurgery, and follow-up radiological imaging suggested improvement of intracranial metastasis.
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Modern management of rare brain metastases in adults. J Neurooncol 2011; 105:9-25. [DOI: 10.1007/s11060-011-0613-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 05/22/2011] [Indexed: 12/13/2022]
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Wasita B, Sakamoto M, Mizushima M, Kurosaki M, Watanabe T. Choroid Plexus Metastasis From Papillary Thyroid Carcinoma Presenting With Intraventricular Hemorrhage. Neurosurgery 2010; 66:E1213-4. [DOI: 10.1227/01.neu.0000369193.03305.00] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Metastases to the choroid plexus from extracranial tumors are rare. Kidney, lung, and colon are the common primary origins of choroid plexus metastases. Choroid plexus metastases from thyroid carcinoma are very rare, with only 2 cases reported thus far. We report the third case of choroid plexus metastasis from thyroid carcinoma.
CLINICAL PRESENTATION
A 75-year-old man presented with severe headache, nausea, and vomiting. He had a history of thyroid carcinoma, which had metastasized to the lymph nodes and lung. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography revealed right intraventricular hemorrhage with mild hydrocephalus, without evidence of a bleeding source. The bleeding source was assumed to be the choroid plexus metastasis in the trigone of the right lateral ventricle (following second admission).
INTERVENTION
Surgery was performed using a navigation-assisted system. The tumor was entirely removed, including some choroid plexus tissue. A ventriculoperitoneal shunt was also performed to treat the hydrocephalus. Histopathological examination revealed brain metastasis from papillary thyroid carcinoma. Postoperatively, the patient showed good recovery, with nausea and vomiting improved, and gait disturbance diminished. The patient was discharged from the hospital one month later.
CONCLUSION
Choroid plexus metastasis from papillary thyroid carcinoma is very rare, and this is the first case of intraventricular hemorrhage reported.
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Affiliation(s)
- Brian Wasita
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan; on leave from Department of Anatomical Pathology, Faculty of Medicine, Sebelas Maret University, Indonesia
| | - Makoto Sakamoto
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan
| | - Minoru Mizushima
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan
| | - Masamichi Kurosaki
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan
| | - Takashi Watanabe
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan
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Hassaneen W, Suki D, Salaskar AL, Wildrick DM, Lang FF, Fuller GN, Sawaya R. Surgical management of lateral-ventricle metastases: report of 29 cases in a single-institution experience. J Neurosurg 2010; 112:1046-55. [PMID: 19663549 DOI: 10.3171/2009.7.jns09571] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The aim of this study was to review the outcome of patients undergoing surgery for treatment of lateral-ventricle metastases. METHODS Imaging information and chart reviews of operative reports were used to conduct a retrospective analysis in 29 patients who underwent resection of lateral-ventricle metastases at the authors' institution between 1993 and 2007. Clinical and neurosurgical outcomes and recurrence rates were studied. RESULTS The mean patient age was 56 years (range 20-69 years); 66% of patients were male. Single intraventricular metastases occurred in 69% of patients, and 55% of them had systemic metastases. The 30-day postoperative mortality rate was 7%. There was intracerebral tumor recurrence in 41% of patients, with 1 patient undergoing a second operation for this. The median postoperative survival duration for 28 patients (excluding 1 patient with preoperative leptomeningeal disease) was 11.7 months; the 3- and 5-year survival rates were 17 and 11%, respectively. Univariate analysis identified factors significantly influencing survival, including the preoperative Karnofsky Performance Scale (KPS) score (p = 0.02), the number of cerebral metastases (p = 0.02), the presence of primary renal cell carcinoma (RCC) (p = 0.02), and the resection method (en bloc vs piecemeal; p = 0.05). The presence of extracranial metastases did not significantly influence survival. Multivariate analysis showed that the preoperative KPS score (p = 0.002), the presence of primary RCC (p = 0.039), and the resection method (en bloc vs piecemeal; p = 0.008) correlated significantly with survival time. CONCLUSIONS Surgery is an important component in the management of intraventricular metastases. To the authors' knowledge, this is the first study focusing totally on resection of lateral-ventricle metastases. The authors found that patients with primary RCC, those with a favorable preoperative KPS score, and those who underwent en bloc resection had a better outcome than others.
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Affiliation(s)
- Wael Hassaneen
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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