Neoplastiform xanthomatous granulomas of choroid plexus in a child affected by Hand-Schuller-Christian disease. Case report

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.

Giant cranial extradural primary fibroxanthoma: a case report

Primary fibroxanthoma of the cranium is an extremely rare condition. Xanthomatous tumors of the central nervous system are occasionally associated with diseases such as Hand-Schuler-Christian disease, malignant fibrous histiocytoma, hyperlipidemia, and a complication of metabolic or storage disorders. However, until 2003, only a few cases of primary fibroxanthoma have been reported. We report a giant fibroxanthoma destroying the lateral skull base unaccompanied by a systemic or metabolic disease.

Necrobiotic xanthogranuloma with cutaneous and cerebral manifestations

✓ Necrobiotic xanthogranuloma (NXG) is a rare inflammatory histiocytic disease of the skin. Xanthogranuloma of the central nervous system is rare and few cases have been reported. To the authors' knowledge, there has been no previously reported case of NXG in which an intracranial lesion was found.

This 52-year-old man, in whom NXG with all its cutaneous manifestations had been diagnosed, presented with three episodes of generalized tonic—clonic seizures. A contrast-enhanced computerized tomography scan of his brain revealed a bifrontal, dura-based mass lesion. The lesion was excised and reported to be an NXG that was similar, but not identical to the skin lesions. The patient was placed on a regimen of antiepileptic drug and chlorambucil after surgery.

Xanthosis in the Spinal Epidural Space-An Epiduroscopy Finding

We report the presence of yellow pigment (xanthosis) in the eqidural space of a patient with a chronic painful radiculopathy. A 55-year-old Caucasian male patient with a left L5, S1 radiculopathy underwent epiduroscopy and epidural neurolysis. Epiduroscopy findings in the area of the nerve root associated with the radiculopathy included the presence of diffuse perivascular yellow pigments, increased vascularity and diffuse increased presence of sheets of fibrous tissue. This is a novo epiduroscopy finding. The case demonstrates the potential for epiduroscopy to expand our knowledge about pathological changes associated with some chronic painful conditions.

[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.

Symptomatic solitary xanthogranuloma occupying the cavernous sinus. Case report

The authors report the first case of a solitary xanthogranuloma of the cavernous sinus without systemic manifestation. A 43-year-old woman experienced decreased visual acuity on the right side in association with papilledema and a visual field defect. She was alert and no other neurological sign was observed. She had no family history of hyperlipoproteinemia and no cutaneous and/or systemic xanthomatous lesions. Skull x-ray films showed an enlarged right superior orbital fissure. Computerized tomography revealed a low-density oval mass 2 x 3 cm in diameter in the right cavernous region that was compressing the right optic nerve in the lateral to medial direction. This mass exhibited isointensity on T1-weighted and mixed-pattern hyperintensity on T2-weighted magnetic resonance images with diffuse contrast enhancement. Cerebral angiography demonstrated fine staining in the margin, originating from the right middle meningeal artery. These neuroimaging findings closely mimicked those associated with trigeminal neuroma. The lesion was partially removed via a right-sided zygomatic approach, and her symptoms improved. Clinical characteristics and histopathological features of this rare case are discussed.

Diagnostic imaging of choroid plexus disease

Disorders of the choroid plexus, a central nervous system structure, are rare, but can pose diagnostic difficulties. The purpose of this review is to illustrate the computed tomography and magnetic resonance imaging findings of a wide spectrum of lesions that affect the choroid plexus. The areas covered include (1) neoplasms (papilloma, leukaemia, meningioma, lymphoma and metastases); (2) infections (bacterial, fungal and viral); (3) cysts; (4) haemorrhage; (5) congenital abnormalities (Sturge-Weber syndrome, Klippel-Trenaunay-Weber syndrome and vascular malformations); and (6) non-infectious inflammatory disorders (xanthogranulomas, inflammatory pseudotumour, neurosarcoidosis, rheumatoid nodule and villous hypertrophy). Few of the patterns of choroid plexus involvement are specific for a particular pathological process. Guermazi, A. (2000) Clinical Radiology 55, 503-516.

Central nervous system disease in Langerhans cell histiocytosis

Central nervous system (CNS) disease in Langerhans cell histiocytosis (LCH) is a poorly understood complication of yet unknown frequency. By far the most common manifestation is in the hypothalamic-pituitary system with diabetes insipidus as the leading sign, followed by other endocrinopathies and hypothalamic dysfunction. However, essentially all other parts of the CNS may be involved. On the one hand, space-occupying histiocytic infiltrates may lead to size- and site-depending symptoms, extending from adjacent bone lesions or arising from the meninges or choroid plexus. On the other hand, a progressive neurological deterioration can occur with mainly cerebellar-pontine symptoms. In this article, these clinical patterns are described in correlation with the morphology on MR imaging and histopathology. Further, the therapeutic strategies are reviewed critically, and guidelines for the management of patients with LCH-related CNS disease are presented.

Intradural extramedullary xanthoma of the spine: a rare lesion arising from the dura mater of the spine: case report

OBJECTIVE AND IMPORTANCE

Xanthomatous tumors of the central nervous system are occasionally found in several unrelated diseases such as Hand-Schüller-Christian disease, Weber-Christian disease, histiocytosis X, malignant fibrous histiocytoma, and a complication of metabolic or storage diseases. However, a solitary xanthoma without systemic disease is rare. We present an unusual case of a solitary and benign xanthoma arising in the spinal leptomeninges without systemic diseases or metabolic abnormality, including a lipid profile.

CLINICAL PRESENTATION

A 16-month-old male patient was admitted with a complaint of spastic paraparesis. His magnetic resonance images revealed an intradural extramedullary tumor that showed isosignal intensity on T1-weighted images and high signal intensity on T2-weighted images with homogenous gadolinium enhancement.

INTERVENTION

The tumor arising from the spinal meninges was totally removed. Histological findings and immunochemical studies positive for CD68 and lysozyme stain showed abundant histiocytic cells with foamy cytoplasm. Negative S-100 protein in the immunohistochemical study and the absence of Birbeck granules on an electromicroscopic study excluded the possibility of Langerhan's histiocytosis. These findings corresponded to xanthoma. The patient had no abnormality of lipid metabolism or familial history of xanthoma.

CONCLUSION

The patient improved enough to walk by himself 3 months after the operation.

Huge Langerhans cell histiocytosis granuloma of choroid plexus in a child with Hand-Schüller-Christian disease. Case report

In the literature, only two previous cases of presumed Langerhans cell histiocytosis (LCH) granuloma involving choroid plexus have been reported in patients with Hand-Schüller-Christian (HSC) disease, but those cases were not verified by immunohistochemistry or electron microscopy. The authors report a case of LCH granuloma of the choroid plexuses of bilateral lateral ventricles and the fourth ventricle in a child affected by HSC disease. This disease was confirmed by the presence of Birbeck granules on electron microscopy and positive reactivity to S-100 protein. Clinical, radiographic, and histological features are discussed. This case illustrates that LCH granuloma should be considered in the differential diagnosis of intraventricular masses.

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.

Giant bilateral xanthogranulomas in a child: case report

Symptomatic xanthogranulomas are rare lesions that most commonly occur in adults. A case of giant bilateral xanthogranulomas in a 6-year-old boy, who remains without tumor recurrence 9 years after resection, is presented. The operative management of these unusually large lesions is discussed. The pathogenesis of xanthogranulomas is reviewed as it relates to the presentation of these lesions in the pediatric population.

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.

[Xanthogranuloma of the choroid plexus: a case report]

We report an unusual case of a 30-year-old man who presented blindness and raised intracranial pressure secondary to a huge lateral ventricle xanthogranuloma. Computed tomographic scanning showed a highly calcified hyperdense mass that did not enhance after contrast administration. The mass was subtotally resected via transcallosal approach. The pathogenesis of the choroid plexus xanthogranuloma is discussed.

Xanthogranulomas of choroid plexus

Computed tomographic features of xanthogranulomas of the choroid plexus are presented. The characteristic location of bilateral intense homogeneously enhanced masses with central lucencies is thought to be diagnostic of xanthogranuloma of the choroid plexus.

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

Xanthogranulomas of the choroid plexus are usually asymptomatic. We present a short case report of a 60-year-old male whose symptoms of parosmia and parageusia have been relieved following surgical removal of a xanthogranuloma situated in the right lateral ventricle. Previous case reports and correlation of symptomatology and pathology are discussed.

Posterior fossa xanthogranuloma. Case report

A large subdural xanthogranuloma was removed from the posterior fossa of a 53-year-old woman with symptoms of Hand-Schüller-Christian disease. Two additional masses with similar density on computerized tomography were found in the hypothalamus and in the choroid plexus of the right lateral ventricle.

Xanthogranuloma of the third ventricle. Case report

The case history of a patient with a xanthogranuloma of the third ventricle is presented. This type of lesion formed by desquamation of epithelium is usually noted as an incidental autopsy finding in the choroid plexus of the lateral ventricles. Total removal via a transcortical transventricular route led to complete recovery. These tumors should be suspected in the geriatric population. The computerized tomography findings and a review of the literature are included.

Xanthogranulomas of the choroid plexus in a neuro-epileptic child. Case report

Bilateral xanthogranulomas arising from both choroid plexues were found in a 6-year-old child with epileptic seizures and psychomotor retardation. Both masses were surgically removed without adding any neurological deficits. The xanthogranulomas were fairly large, and the posterior part of both lateral ventricles were slightly dilated, but clinical symptoms and the location of the xanthogranulomas could not be clearly correlated in this case.