Xanthogranuloma of the choroid plexus of lateral ventricle, presenting with parosmia and parageusia

Symptomatic xanthogranuloma of the lateral ventricle in a pregnant patient treated with delayed resection: A case report and systematic review

Intracranial xanthogranulomas (XG) are a rare benign histiocytic neoplasm and most often within the choroid. The majority are asymptomatic and are found incidentally on imaging or post-mortem examination or autopsy. We present a case of symptomatic XG in a pregnant patient who underwent a delayed transcortical, transventricular approach for lateral ventricle XG resection following the completion of her pregnancy. Four years post-operatively, the patient is neurologically intact and without recurrence. Our review of the literature showed differences among XG depending on location. The clinical and radiological features of XG are often indistinguishable from tumors arising from the choroid plexus and should be considered as a rare etiology in the differential of newly diagnosed intraventricular lesions.

Neuronavigator-guided ventriculoscopic approach for symptomatic xanthogranuloma of the choroid plexus in the lateral ventricle

Xanthogranuloma of choroid plexus is an extremely rare, benign, and mostly asymptomatic intracranial lesion. We report a case of symptomatic lateral ventricular xanthogranuloma resected via a neuronavigator-guided ventriculoscopic approach. Then we review recent English medical literature and notice that craniotomies have been the most popular treatment. But our choice of a ventriculoscopic approach possesses unique advantages such as minimized neural tissue damage, shortened operative time, less blood loss, and safer access to central structures over conventional open surgeries. Informed consent has been obtained from the patient and his immediate family regarding this case report.

Symptomatic intraventricular xanthogranulomas

This article reviews symptomatic intraventricular xanthogranulomas, based on a case presentation. Bilateral xanthogranulomas of the choroid plexus were removed surgically from the lateral ventricles of a 12-year-old boy. At 9 years of age, he had evidence of increased intracranial pressure and was hospitalized. Dense enhancing masses were detected in computerized tomogram (CT) brain scan. The lesions were in the region of trigones with extension into the temporal horns and into the right occipital horn. The masses were brightly yellow and greasy. They measured 8.5 x 5.5 x 3.5 cm and 10 x 6.5 x 4.5 cm, respectively, and proved to be xanthogranulomas. Review of 35 reported symptomatic intraventricular xanthogranulomas revealed 11 lesions in the lateral ventricles in which six of them were bilateral. Twenty-two lesions were in the third ventricle, and two lesions were in the fourth ventricle. The lesion shows no significant sexual predilection. The patients’ average age is 37.6 years for males, 32.4 years for females, and 34.3 years for both sexes. The size of symptomatic lesions ranged from 1 to 3 cm in diameter but a few were large, up to 8 to 10 cm. The origin of foamy (xanthoma) cells in the xanthogranulomas arising in the choroid plexus is thought to be multicentric including the choroidal epithelium and stromal arachnoidal cells that have undergone xanthomatous changes. Increased intracranial pressure is the significant clinical feature of the intraventricular xanthogranulomas as in other mass lesions within the skull. Surgical extirpation is the treatment of choice if the lesion is accessible and the patient’s general condition is suitable.

Preoperative stent placement for intradural vertebral artery stenosis from a rare xanthogranuloma

✓ In this report, the authors discuss a novel use of intradural vertebral artery (VA) stent placement to protect a tumor-encased vessel from injury during lesion resection. The tumor was a rare foramen magnum region xanthogranuloma and a component of Erdheim—Chester disease (ECD). This 64-year-old man presented with large masses encasing and compressing the intracranial segments of each VA. Preoperatively, a left VA stent was placed to protect the arterial wall during resection of the tumor. Histopathological study results on the subtotally resected mass were consistent with xanthogranuloma, a rare benign histiocytic tumor frequently occurring in patients with ECD. Further radiographic evaluation in the patient revealed an osteolytic lesion of the eleventh thoracic vertebra supporting the diagnosis of ECD disease. Based on this case study, the authors recommend the following: 1) tumor-encased vessels can be protected preoperatively by stent placement to assist with tumor debulking; and 2) patients diagnosed with a xanthogranuloma should be evaluated for multisystem involvement consistent with ECD.

[Symptomatic xanthograuloma of the lateral ventricle]

Xanthogranulomas of the choroid plexus in the lateral ventricle are usually asymptomatic lesions found incidentally at autopsy. Symptomatic cases are rare. We present the case of a 30-year-old woman with a xanthogranuloma of the right lateral ventricle who showed intracranial hypertension and visual disturbance. Plain T1-weighted magnetic resonance images disclosed a isointense right temporal lesion in the ventricular horn which showed decreased signal intensity on T2-weighted images and massive enhancement on T1-weighted images after gadolinium injection. She was operated on through a right temporal craniotomy with total excision. We review the literature and discuss radiological findings on MRI.

Xanthogranuloma with massive hematoma in the third ventricle: case report

OBJECTIVE AND IMPORTANCE

Symptomatic xanthogranulomas of the ventricular system are rare entities. No case of a massive hematoma in the xanthogranuloma, which may cause sudden deterioration, has been reported. This is the first report of a massive hematoma arising from a xanthogranuloma in the third ventricle.

CLINICAL PRESENTATION

A 35-year-old woman was referred to our hospital with a 1-month history of progressively deteriorating consciousness. Neuroradiological findings revealed a mass in third ventricle and obstructive hydrocephalus.

INTERVENTION

Bilateral external ventricular drainage was performed as an emergency treatment. Two weeks later, the mass was removed totally via the transcallosal-transforaminal approach. The disturbance of consciousness completely disappeared 2 weeks after the second operation. The pathological diagnosis was xanthogranuloma causing massive hematoma.

CONCLUSION

The pathogenesis, clinical and radiological features, differential diagnosis, and treatment of this rare benign tumor are discussed. The hypothalamic dysfunction caused by a massive hematoma in the lesion of the third ventricle may cause sudden deterioration and death, whether the obstructive hydrocephalus exists. The risk of hemorrhage and hydrocephalus still remains after aspiration alone because of the presence of the cyst wall. Radical extirpation should be the choice of treatment for xanthogranulomas or colloid cysts of the third ventricle.

Paroxysmal bilateral dysosmia treated by resection of the olfactory bulbs

Dysosmia, or the distortion of olfaction, is most commonly preceded by viral illness or head trauma, but has a variety of etiologies. The precise nature of the disease process remains obscure. Medical management is largely empiric, and has been aimed at treating underlying illnesses, restricting triggering medications, as well as various pharmacologic interventions. Successful eradication of a severe case of persistent unilateral paroxysmal dysosmia with resection of the ipsilateral olfactory bulb has been reported. We report here a case of bilateral paroxysmal dysosmia, refractory to medical therapy, successfully treated with bilateral olfactory bulb resection.

Intracranial xanthogranuloma of the dura in Hand-Schüller-Christian disease. Case report

The authors describe a 37-year-old man with the classic clinical features of Hand-Schüller-Christian disease. He presented with symptoms of increased intracranial pressure due to obstructive hydrocephalus secondary to a huge xanthogranuloma involving falx cerebri and tentorium cerebelli. Immunohistochemical and ultrastructural studies failed to demonstrate Langerhans histiocytes, however. The implication of this finding is discussed in light of the recent relevant literature.

Symptomatic xanthogranuloma of choroid plexus with unilateral hydrocephalus. Case report

Xanthogranulomas involving the choroid plexus of the lateral ventricles are generally asymptomatic lesions. The case is reported of a 50-year-old man in whom a xanthogranuloma of the choroid plexus had occluded the left trigone, causing unilateral hydrocephalus of the left temporal horn and neurological symptoms. A review of the literature shows that xanthogranulomas of the glomus of the lateral ventricles differ from the xanthomatous cystic lesions of the third ventricle, which are probably akin to colloid cysts.

Symptomatic intraventricular xanthogranulomata. A report of 2 cases

Intraventricular xanthogranulomata may occasionally be seen as incidental findings at post-mortem. It is however, exceptionally rare for them to become symptomatic, but if they do, it is usually attributable to obstruction of the CSF pathways. Two further symptomatic cases are presented and the literature is reviewed. Treatment is surgical excision, but stereotactic biopsy should be avoided due to the often impenetrable nature of the capsule.

Symptomatic xanthogranuloma of the third ventricle: report of two cases and review of the literature

Two patients with symptomatic xanthogranuloma of the third ventricle are presented. Both presented with a short history of increased intracranial pressure owing to hydrocephalus secondary to obstruction of the foramina of Monro. Computed tomography scanning demonstrated in both cases a round hypoisodense nonenhancing mass localized in the third ventricle, with dilatation of the lateral ventricles. Macroscopically complete surgical removal by a right transventricular approach was achieved in both patients. Eleven cases of xanthogranulomas of the third ventricle, including our own, have been published in the literature. The pathogenesis, clinical and radiological features, differential diagnosis, and treatment of this rare benign lesion are briefly discussed.