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

Symptomatic bilateral choroid plexus xanthogranuloma in a pediatric patient

INTRODUCTION

Central nervous system xanthogranulomas are uncommon clinical entities, and symptomatic bilateral choroid plexus xanthogranulomas are rare.

CASE PRESENTATION

We present the case of a 15-year-old male patient with bilateral choroid plexus xanthogranulomas with symptoms of increased intracranial pressure. Gross total resection of the tumor in the left lateral ventricle was performed. The patient improved, and asymptomatic right-sided tumor was monitored at follow-up.

CONCLUSION

The main treatment objective in these tumors is gross total resection. Asymptomatic tumors can be followed without intervention. However, surgery should be performed for symptomatic tumors that cause hydrocephalus or symptoms of increased intracranial pressure.

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.

Levodopa-responsive parkinsonism in a patient with corticobasal degeneration and bilateral choroid plexus xanthogranulomas

Corticobasal degeneration (CBD) has substantial overlap of clinical features with other neurodegenerative diseases including Parkinson's disease (PD). Its clinical diagnostic accuracy is the lowest among the common neurodegenerative diseases, and its antemortem diagnosis is more challenging when CBD is comorbid with another brain disease. We report an elderly male patient with multiple medical conditions and a family history of essential tremor. He presented with progressive tremor that was initially thought to be essential tremor and later diagnosed as PD despite head computerized tomography showing bilateral intraventricular masses and other minor changes. The clinical diagnosis of PD was supported by his responsiveness to low-dose levodopa. However, postmortem neuropathological examination revealed CBD and bilateral choroid plexus xanthogranulomas with mild ventricular enlargement and multifocal ependymal lining injury presumably due to mild hydrocephalus. CBD is typically levodopa-unresponsive, but hydrocephalus-associated parkinsonism is commonly levodopa-responsive. We raise awareness of the present comorbidity and atypical parkinsonism due to the choroid plexus xanthogranuloma-induced hydrocephalus for the clinical diagnosis and management of parkinsonism.

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.

Xanthogranulomatous colloid cyst of the third ventricle

Colloid cyst in the third ventricle is a common entity, whereas a variant of it, namely xanthogranulomatous, is quite rare. The closest imaging differential diagnosis is a purely third ventricular craniopharyngioma. We herein describe a case of xanthogranulomatous colloid cyst presenting with hydrocephalus.

Symptomatic bilateral cerebellar mass lesions: an unusual presentation of intracranial xanthogranuloma

Xanthogranulomas are a group of benign lesions with an incidence of 1.6-7.0% in various autopsy series. Although the lateral ventricle is the most frequent intracranial site involved, most symptomatic cases occur in the choroid plexus, involving the third ventricle. Multicentric bilateral symptomatic cerebellar xanthogranuloma has not been reported previously. We describe a 35-year-old man who presented with a complaint of vertigo, with nystagmus and left-side cerebellar signs found on clinical examination. Radiological evaluation revealed bilateral cerebellar lesions abutting the cerebellopontine angle cistern. The left-side lesion was excised and diagnosed as xanthogranuloma up on histopathological examination. The right-side lesion was subsequently excised 4 years later when it became symptomatic. The role of histopathology cannot be overemphasized in the diagnosis of this rare lesion and long-term follow-up is advised in cases managed conservatively owing to the propensity of this tumor to grow over time.

[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.

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.

Spontaneous isolated lipoma of the choroid plexus in the baboon

A case of symptomless, solitary lipoma of the choroid plexus is described. The tumour was found in the left lateral ventricle of an adult female baboon (Papio papio) in the course of post-mortem examination. Routine histological investigation showed that the tumour was composed exclusively of characteristic adipose cells with scarce collagen septa and without other hamartoma-like constituents, such as glial cells, neurons, cartilage or muscle fibres. The tumour mass was lined by a typical single layer of cuboidal cells; no calcifications were observed either inside the tumour or in the adjacent periventricular regions. This case is reported in view of the rarity of such tumours of the choroid plexus in man and animals, and to throw light on their possible origin.

Spinal xanthogranuloma in a child: case report

A case of a patient with a xanthogranuloma in the thoracic spine is presented. Magnetic resonance imaging revealed an intradural extramedullary tumor between T6 and T9 as a low-intensity mass on both T1- and T2-weighted images. Total removal of this tumor was achieved through a laminoplastic laminectomy. Differentiation of this disease from other xanthogranulomas in the central nervous system is discussed.

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.

Computed tomography of choroid plexus lesions

Computed tomographic (CT) and clinical findings in 14 patients with 17 lesions of the choroid plexus are presented. Primary neoplasms are the most common lesions in this series and include papillomas, meningiomas, carcinoma, astrocytoma, and teratocarcinoma. There are five vascular lesions, consisting of cavernous angiomas, hemangiomas, and an arteriovenous malformation. One patient had bilateral xanthogranulomas. There was association between cavernous angiomas and Sturge-Weber, and between meningiomas and neurofibromatosis. Useful distinguishing clinical and CT features between the different types of lesions are discussed.