Rare intraparenchymal choroid plexus carcinoma resembling atypical teratoid/rhabdoid tumor diagnosed by immunostaining for INI1 protein

Extraventricular Choroid Plexus Carcinoma with Spinal Metastasis: A Case Report

We report a case of extraventricular choroid plexus carcinoma (CPC) accompanied by spinal metastasis in a pediatric patient. A 15-year-old female patient presented with chronic progressive headache and blurry vision. Magnetic resonance imaging (MRI) revealed an intra-axial mass in the left frontal lobe. A gross total resection was performed, and the histopathological examination revealed the diagnosis of CPC, confirmed with immunohistochemical (IHC) analysis of GFAP, S100, EM, P53 and Ki67. Eleven months later, MRI result identified another mass in the left frontal lobe. Spinal MRI showed drop metastasis to the spine, accompanied by leptomeningeal seeding. This case demonstrated the importance of IHC and spinal MRI in the management of CPC. This case report may provide more insight into extraventricular CPC cases, which is important for the adequate management of patients with CPC in the future.

Late recurrence of choroid plexus carcinoma

BACKGROUND

Choroid plexus carcinomas (CPC) are rare malignant brain tumours arising from the choroid plexus epithelium. CPC are most common in the paediatric population, particularly those under 2 years of age. Common presentations include headache, diplopia and signs of increased intracranial pressure such as nausea and vomiting. Infants may present with increased head circumference, bulging fontanelles, splayed cranial sutures and/or neurological delay. Diagnosis is made via radiological and histological analysis.

MANAGEMENT AND PROGNOSIS

Gross total resection (GTR) is the preferred treatment and infers the best survival rate, but despite this, prognosis remains poor. The utility of chemotherapy and/or radiation in CPC management remains controversial, and an optimal treatment regimen has not been identified. Even with GTR, recurrence is common and usually occurs within months after resection. Delayed recurrence is exquisitely rare and has been reported very few times to date.

CASE PRESENTATION

Here, we present a rare case of delayed CPC recurrence 10 years after initial presentation. A 2-month-old male was diagnosed with CPC and received GTR, chemotherapy and stem cell transplant. The patient presented with a recurrent CPC 10 years after the initial diagnosis.

CONCLUSIONS

This case demonstrates the importance of long-term surveillance and raises questions regarding the natural history, recurrence patterns and factors contributing to long-term relapse in CPC. Further research should be targeted at identifying patient factors contributing to increased risk of late recurrence and whether adjuvant treatments play any role in decreasing this.

Rapid malignant progression of an intraparenchymal choroid plexus papillomas

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.

Extraventricular Intraparenchymal Choroid Plexus Tumors in Cerebral Hemisphere: A Series of 6 Cases

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.

From the radiologic pathology archives: intraventricular neoplasms: radiologic-pathologic correlation

A variety of neoplasms may arise in the ventricular system. Intraventricular neoplasms may be discovered as an incidental finding at cross-sectional imaging or may manifest with varied symptoms depending on their location, including symptoms of increased intracranial pressure. These lesions may arise from various ventricular structures, including the ependymal lining (eg, ependymoma), subependymal layer (eg, subependymoma), or choroid plexus (eg, choroid plexus neoplasms), or they may have a cell of origin that has yet to be determined (eg, chordoid glioma). Other neoplasms involving the ventricular system include central neurocytoma, subependymal giant cell tumor, meningioma, rosette-forming glioneuronal tumor, and metastases. The differential diagnosis for intraventricular neoplasms can be broad, and many of them have similar patterns of signal intensity and contrast enhancement at imaging. However, the location of the lesion in the ventricular system-along with knowledge of the patient's age, gender, and underlying conditions-will help narrow the differential diagnosis.