Sellar-Suprasellar Extraventricular Choroid Plexus Papilloma : A Case Report and Review of the Literature

Metastatic choroid plexus papilloma presenting as a sellar mass: A case report and literature review

Background

Choroid plexus papillomas (CPPs) are rare neoplasms arising from choroid plexus epithelium representing <1% of all intracranial tumors. Symptoms vary based on location and regional mass effect; however, hydrocephalus is common due to cerebrospinal fluid flow obstruction and/or overproduction. Distant site metastasis or de novo formation in extraventricular sites is rare.

Case Description

A 57-year-old female with a history of a 4th ventricular CPP status post resection in 2004 and 2018 with subsequent gamma knife therapy in 2019 presented with increased thirst and urination. Since her initial surgery, she has experienced significant gait imbalance, diplopia, dysphagia, and right-sided hemiparesis and hemisensory loss. Magnetic resonance imaging revealed a new 1.5 × 1.8 cm suprasellar lesion. She underwent a left supraorbital craniotomy for tumor resection, with pathology revealing metastatic World Health Organization grade II CPP.

Conclusion

Extraventricular manifestation of CPP is rare. De novo or metastatic involvement of the sella has seldom been reported. Treatment should target gross total surgical resection. Adjuvant chemotherapy and radiation may be useful in higher-grade lesions.

Pigmented primary epithelial tumor of the sella: A report of an intriguing case

This is a report of an uncommon primary pigmented papillary epithelial tumor of the sella in a 38-year-old man, who presented with clinicoradiological features of pituitary adenoma. Histologically, the tumor showed features reminiscent of choroid plexus papilloma, that is, conspicuous papillary epithelial morphology with presence of intacytoplasmic melanin and no mitotic activity. Immunohistochemically, the tumor was positive for pancytokeratin (AE1/AE3), S-100 protein and CD56, while it was negative for glial fibrillary acid protein, thyroid transcription factor-1, epithelial membrane antigen, other cytokeratins and pituitary hormones. These findings were not typical of any WHO-defined entity and is thus best regarded as a pigmented papillary epithelial tumor of sella of uncertain histogenesis. The present case is a valuable addition to the spectrum of primary pigmented papillary epithelial tumors originating at an unusual location.

Primary Choroid Plexus Papilloma over Sellar Region Mimicking with Craniopharyngioma: A Case Report and Literature Review

Choroid plexus papillomas (CPPs) are slow-growing and benign tumors, representing less than 1% of all intracranial neoplasms. They are predominantly located in the lateral ventricles in children, and in the fourth ventricle in adults. Primary CPP over sellar regions is extremely rare. There was previously only one case reported in men.

We report the case of a 43-year-old male who initially presented with bilateral temporal hemiapnosia. A brain magnetic resonance imaging (MRI) revealed heterogenous enhanced mass lesion with cyst component compressing upward onto the optic chiasm. A craniopharyngioma was initially suspected. Further endoscopic trans-sphenoidal surgery (ETS) was performed for total tumor resection. After surgery, the patient had visual field improved without tumor recurrence on post-operative MRI in clinical follow-up. Histopathological examination of the lesion confirmed the diagnosis of CPP, with fibrovascular cores covered by a single layer of cuboidal to columnar epithelial cells.

CPP is a rare tumor without specific clinical patterns or imaging findings. Therefore, pre-operative differential diagnosis is difficult for this kind of tumor with complete separation from ventricular system. An ETS for total tumor resection provided effective treatment.