Imaging findings of extraventricular choroid plexus papillomas: A study of 10 cases

Diagnosis of choroid plexus papilloma: Current perspectives and future directions

Choroid plexus papilloma (CPP) is a rare, slow-growing, and typically benign brain tumor that predominantly affects children. CPP is characterized by well-defined circular or lobulated masses in the ventricles, leading to symptoms related to increased intracranial pressure and hydrocephalus. CPP diagnosis relies on a combination of clinical presentation, imaging findings, and histological examination. The World Health Organization (WHO) classification categorizes choroid plexus tumors into CPP (Grade І), atypical CPP (aCPP, Grade II), and choroid plexus carcinoma (CPC, Grade III). This article reviewed current diagnostics modalities and explored the emergence of new diagnostic methods for CPP. Research on molecular markers and genetic alterations associated with CPP is ongoing, and some potential markers have been identified. These results offered insights into potential therapeutic targets and personalized treatment approaches for CPP. Advancements in radiomics and liquid biopsy hold promise for improving diagnostic accuracy and monitoring treatment outcomes for choroid plexus tumors. Radiomics can provide quantitative data from imaging studies, whereas liquid biopsy can analyze tumor-derived genetic material and molecular markers from body fluids, such as cerebrospinal fluid (CSF) and blood. The rapidly evolving fields of molecular and genetic research and novel diagnostic methods require continuous updates and advancements before their application in clinical practice. We hope that these advancements will lead to earlier and more precise diagnoses, better treatment options, and improved outcomes in patients with CPP and other brain tumors.

Association of choroid plexus volume with motor symptoms and dopaminergic degeneration in Parkinson's disease

BACKGROUND

The choroid plexus (CP) is involved in the clearance of harmful metabolites from the brain, as a part of the glymphatic system. This study aimed to investigate the association between CP volume (CPV), nigrostriatal dopaminergic degeneration and motor outcomes in Parkinson's disease (PD).

METHODS

We retrospectively searched drug-naïve patients with early-stage PD who underwent dopamine transporter (DAT) scanning and MRI. Automatic CP segmentation was performed, and the CPV was calculated. The relationship between CPV, DAT availability and Unified PD Rating Scale Part III (UPDRS-III) scores was assessed using multivariate linear regression. We performed longitudinal analyses to assess motor outcomes according to CPV.

RESULTS

CPV was negatively associated with DAT availability in each striatal subregion (anterior caudate, β=-0.134, p=0.012; posterior caudate, β=-0.162, p=0.002; anterior putamen, β=-0.133, p=0.024; posterior putamen, β=-0.125, p=0.039; ventral putamen, β=-0.125, p=0.035), except for the ventral striatum. CPV was positively associated with the UPDRS-III score even after adjusting for DAT availability in the posterior putamen (β=0.121; p=0.035). A larger CPV was associated with the future development of freezing of gait in the Cox regression model (HR 1.539, p=0.027) and a more rapid increase in dopaminergic medication in the linear mixed model (CPV×time, p=0.037), but was not associated with the risk of developing levodopa-induced dyskinesia or wearing off.

CONCLUSION

These findings suggest that CPV has the potential to serve as a biomarker for baseline and longitudinal motor disabilities in PD.

Choroid plexuses at the interface of peripheral immunity and tissue repair in multiple sclerosis

PURPOSE OF REVIEW

Choroid plexuses (ChPs) are key actors of the blood-to-cerebrospinal-fluid barrier and serve as brain immune checkpoint. The past years have seen a regain of interest about their potential involvement in the physiopathology of neuroinflammatory disorders like multiple sclerosis (MS). This article offers an overview of the recent findings on ChP alterations in MS, with a focus on the imaging tools able to detect these abnormalities and on their involvement in inflammation, tissue damage and repair.

RECENT FINDINGS

On MRI, ChPs are enlarged in people with MS (PwMS) versus healthy individuals. This size increase is an early event, already detected in presymptomatic and pediatric MS. Enlargement of ChPs is linked to local inflammatory infiltrates, and their dysfunction selectively impacts periventricular damage, larger ChPs predicting the expansion of chronic active lesions, smoldering inflammation and remyelination failure in tissues surrounding the ventricles. ChP volumetry may add value for the prediction of disease activity and disability worsening.

SUMMARY

ChP imaging metrics are emerging as possible biomarkers of neuroinflammation and repair failure in MS. Future works combining multimodal imaging techniques should provide a more refined characterization of ChP functional changes, their link with tissue damage, blood to cerebrospinal-fluid barrier dysfunction and fluid trafficking in MS.

A case report of atypical choroid plexus papilloma in the cervicothoracic spinal cord

Choroid plexus papillomas (CPPs) are uncommon, benign intracranial tumors that can occur in both children and adults. In adults, CPPs are typically identified in the fourth ventricle, whereas in children, they most commonly occur in the lateral ventricle. CPPs that arise from the extraventricular system are extremely rare and difficult to diagnose. We report a case of extraventricular, atypical CPP located in the cervicothoracic spinal cord of a 2-year-old girl.

Improving Choroid Plexus Segmentation in the Healthy and Diseased Brain: Relevance for Tau-PET Imaging in Dementia

Recent studies have revealed the possible role of choroid plexus (ChP) in Alzheimer's disease (AD). T1-weighted MRI is the modality of choice for the segmentation of ChP in humans. Manual segmentation is considered the gold-standard technique, but given its time-consuming nature, large-scale neuroimaging studies of ChP would be impossible. In this study, we introduce a lightweight segmentation algorithm based on the Gaussian Mixture Model (GMM). We compared its performance against manual segmentation as well as automated segmentation by Freesurfer in three separate datasets: 1) patients with structural MRIs enhanced with contrast (n = 19), 2) young healthy subjects (n = 20), and 3) patients with AD (n = 20). GMM outperformed Freesurfer and showed high similarity with manual segmentation. To further assess the algorithm's performance in large scale studies, we performed GMM segmentations in young healthy subjects from the Human Connectome Project (n = 1,067), as well as healthy controls, mild cognitive impairment (MCI), and AD patients from the Alzheimer's Disease Neuroimaging Initiative (n = 509). In both datasets, GMM segmented ChP more accurately than Freesurfer. To show the clinical importance of accurate ChP segmentation, total AV1451 (tau) PET binding to ChP was measured in 108 MCI and 32 AD patients. GMM was able to reveal the higher AV1451 binding to ChP in AD compared with MCI. Our results provide evidence for the utility of the GMM in accurately segmenting ChP and show its clinical relevance in AD. Future structural and functional studies of ChP will benefit from GMM's accurate segmentation.

Lateral ventricular medulloepithelioma in children: a case report

Medulloepithelioma is an extremely rare highly malignant and rapidly growing tumor that occurs in the central nervous system. There are few reports of medulloepithelioma located in the ventricle. Medulloepithelioma is common in young children and adolescence. Herein, we described an unusual case of vomiting in a 4-year-old male patient with medulloepithelioma, presenting with enlarging head circumference. Because of computed tomography (CT) scan of the head showed signs of brain tumors and hydrocephalus, and enhanced magnetic resonance imaging (MRI) sequence showed increased heterogeneity and honeycomb-like changes on the mass after the administration of a contrast agent, the patient was first diagnosed as choroid plexus papilloma. After undergoing a surgical craniotomy, the patient was diagnosed as medulloepithelioma through pathological examination. We hope that this work will provide more understanding and knowledge of intracranial medulloepithelioma. For medulloepithelioma that occurs in the central nervous system, radiological examination is not sufficient to make a definite diagnosis of the tumor. Pathological examination can confirm the diagnosis of medulloepithelioma and distinguish it from other central system tumors. Surgical resection is a safe and effective method that can prolong the life of patients. However, the prognosis of medulloepithelioma is still poor, and further research is needed to improve the diagnosis and treatment of this rare disease.

Extracerebral choroid plexus papilloma in the pharynx with airway obstruction in a newborn: a case report

Background

Choroid plexus papillomas (CPPs) are rare, usually benign, neoplasms originating in the central nervous system. In this study, we present the first case of a giant airway-obstructing CPP in the pharynx of a newborn.

Case presentation

A cystic mass located in the pharynx was noted in a fetus at the 29th week of gestation. Elective cesarean section was performed at the 38th week of gestation with successful intubation and ex utero intrapartum treatment. On computed tomography, there was a huge airway-obstructing cystic mass in the choana and pharynx. Elective surgery with total excision was performed, and histological examination confirmed the diagnosis of CPP.

Conclusion

We report the first case of an extracerebral airway-obstructing CPP in the pharynx of a newborn. Radiologic examinations are not enough for the diagnosis of CPPs, and complete excision of the tumor with histological confirmation is indispensable for accurate diagnosis and treatment.

Choroid plexus volume is associated with levels of CSF proteins: relevance for Alzheimer's and Parkinson's disease

The choroid plexus (ChP) is a major source of cerebrospinal fluid (CSF) production, with a direct and indirect role in protein clearance, and pathogenesis of Alzheimer's disease (AD). Here, we tested the link between the ChP volume and levels of CSF proteins in 2 data sets of (i) healthy controls, mild cognitive impairment (MCI), and AD patients from the Alzheimer's Disease Neuroimaging Initiative (ADNI) (N = 509), and (ii) healthy controls and Parkinson's disease (PD) patients from the Parkinson's Progression Markers Initiative (N = 302). All patients had baseline CSF proteins (amyloid-β, total and phosphorylated-tau and α-synuclein (only in Parkinson's Progression Markers Initiative)). ChP was automatically segmented on 3T structural T1-weighted MRIs. We found negative associations between ChP volume and CSF proteins, which were stronger in healthy controls, early-MCI patients, and PD patients compared with late-MCI and AD patients. Further grouping of patients of ADNI dataset into amyloid-positive and amyloid-negative based on their florbetapir (AV45) PET imaging showed that the association between ChP volume and CSF proteins (t/p-tau) was lower in amyloid-positive group. Our findings support the possible role of ChP in the clearance of CSF proteins, provide evidence for ChP dysfunction in AD, and suggest the need to account for the ChP volume in future studies of CSF-based biomarkers.

The cerebellar peduncle as localization of a recurrent atypical plexus papilloma: A case report

Background:

Choroid plexus papillomas (CPPs) are infrequently encountered brain tumors with the majority originating in the ventricular system. Rarely, CPP occurs outside of the ventricles.

Case Description:

We report the case of a recurrent CPP that initially originated within the fourth ventricle, though years later it recurred in the left middle cerebellar peduncle.

Conclusion:

Patients with cerebellar plexus papilloma need long-term follow-up comprising regular magnetic resonance imagings since, in patients with a history of CPP, any new mild symptomatology, even years after the initial presentation, may be an early sign of tumor recurrence.

Infantile medulloepithelioma in the lateral ventricle and cerebellopontine angle: Two case reports

RATIONALE

Intracranial medulloepitheliomas are extremely rare and highly malignant. Intraventricular medulloepitheliomas are even rarely reported, and little is known about the clinical features.

PATIENT CONCERNS

In this article, we report two cases of intracranial medulloepitheliomas. In the first patient, a one-month old boy, the tumor was located in in right lateral ventricle, which was the first report of such location of this disease; in the second patient, an eleven-month old girl, the tumor was in right cerebellopontine angle.

DIAGNOSES

Both patients were diagnosed as medulloepithelioma by pathologists.

INTERVENTIONS

Both patients underwent craniotomy to resect the lesion totally.

OUTCOMES

The boy underwent chemotherapy after operation and was alive 3 months after operation. The girl died 6 months after operation, despite aggressive adjuvant chemotherapy.

LESSONS

Surgical resection is safe and effective to prolong patient survival. However, despite aggressive adjuvant therapy, prognosis of medulloepithelioma remains poor, and further study is needed to improve treatment of this rare disease.