Magnetic Resonance Imaging and Clinical Findings Associated with Choroid Plexus Spinal Cord "Drop" Metastases

Clinical, magnetic resonance imaging, and histological description of a choroid plexus papilloma with disseminated intraventricular and spinal cerebrospinal fluid drop metastases in a young adult dog: a case report

A 2-year-old male entire Cane Corso was presented for investigations into a 1-week history of ambulatory paraparesis and pelvic limb ataxia gradually deteriorating. Magnetic resonance imaging (MRI) revealed intraventricular space-occupying lesions affecting the fourth ventricle and lateral apertures and intradural-extramedullary space-occupying lesions at the level of C7 vertebra, L4-L5, and L7-S1 intervertebral disk spaces. Due to poor quality of life, the patient was euthanized. A post-mortem examination revealed partially encapsulated, multifocally infiltrative, and moderately cellular neoplastic masses. The histological description was similar for all masses. The cells appeared cuboidal with round central nuclei and a moderate amount of eosinophilic cytoplasm and were arranged almost exclusively in single-layered papilliform patterns supported by a fibrovascular stroma. Mitoses were rarely observed (1/2.37 mm2). The primary neoplasm was morphologically most consistent with a choroid plexus papilloma despite drop metastases. This is the first report of a histologically confirmed primary ventricular choroid plexus papilloma causing disseminated MRI-apparent intraventricular and spinal drop metastases.

Solitary intraventricular tumors in dogs and cats treated with radiotherapy alone or combined with ventriculoperitoneal shunts: A retrospective descriptive case series

BACKGROUND

Intraventricular tumors are rare, optimal treatment is not defined. Symptomatic patients often exhibit life-threatening hydrocephalus. With several months time-to-effect after radiotherapy (RT), increased intracranial pressure is concerning. This increase in pressure can be overcome by ventriculoperitoneal shunting (VPS).

OBJECTIVES

Retrospective evaluation of outcome and complications in dogs and cats with intracranial tumors treated with either RT or VPS/RT.

ANIMALS

Twelve client-owned cats and dogs.

METHODS

Dogs and cats with symptomatic intraventricular tumors treated with definitive-intent RT or VPS/RT were included in a retrospective, descriptive case series. Complications, tumor volume evolution, time-to-progression, and survival time were determined.

RESULTS

Twelve animals were included: 1 cat and 5 dogs treated with single-modality RT and 4 cats and 2 dogs treated with VPS/RT. Neurological worsening seen in 4/6 animals during single-modality RT and 2/6 died during RT (suspected brain herniation). All dogs with VPS normalized clinically by the end of RT or earlier. Complications occurred in 4/6 animals, all but 1 were successfully managed surgically. Imaging follow-up in 8 animals surviving RT showed a marked decrease in tumor volume. Median survival time was 162 days (95% confidence interval [CI]: 16; infinity) for animals treated with RT and 1103 days (95%CI: 752; infinity) for animals treated with VPS/RT. Median time-to-progression was 71 days (95%CI: 7; infinity) and 895 days (95%CI: 704; infinity) for each group, respectively. Two dogs died because of intraventricular metastasis 427 and 461 days after single-modality RT.

CONCLUSIONS AND CLINICAL IMPORTANCE

Ventriculoperitoneal shunting led to rapid normalization of neurological signs and RT had a measurable effect on tumor volume. Combination of VPS/RT seems to be beneficial.

Spinal ectopic choroid plexus papilloma in a cat

Case summary

A 10-year-old male neutered Russian Blue cat was presented with a 2-month history of progressive non-ambulatory paraparesis. Spinal MRI revealed a well-demarcated, compressive intradural extramedullary mass at the level of T1 vertebra. The mass had subtle hyperintensity on T2-weighted images, was isointense on T1-weighted images and had diffuse, marked enhancement following gadolinium administration. Neuroaxis MRI, including limited brain sequences, excluded other visible lesions. Thoracic and abdominal radiographs were unremarkable. The mass was resected via a dorsal C7–T2 laminectomy and durotomy. Histopathology revealed a neoplasm composed of columnar-to-polygonal cells forming bilayered palisading patterns with a few apical cilia. Three mitoses were noted in 10 high-power fields. This was consistent with an epithelial neoplasm and initially a metastatic adenocarcinoma was considered most likely. Full-body CT with contrast and including the brain found rhinitis but did not identify any additional neoplastic foci. Biopsies of the nasal cavity and fine-needle aspiration of the spleen and liver were unremarkable. On immunohistochemical evaluation, pan-cytokeratin and E-cadherin immunolabelling was observed; however, synaptophysin, thyroglobulin, chromogranin A and glial fibrillary acidic protein was not detected. This, along with the histological morphology and absence of a primary tumour, was compatible with an ectopic choroid plexus neoplasm. Follow-up performed at 3, 14 and 24 months postoperatively revealed neurological improvement without recurrence.

Relevance and novel information

We describe the presentation, histopathological and immunohistochemical features and outcome of a case of a rare ectopic choroid plexus neoplasm in the spinal cord of a cat.

Long-Term Outcome After Surgical Resection of a Spinal Choroid Plexus Tumor in a Dog

A 6 yr old castrated male Clumber spaniel was referred for evaluation of acute paraplegia. MRI of the thoracolumbar spine demonstrated an intradural-extramedullary mass lesion at the level of T12 and extradural spinal cord compression at L1-L2. A hemilaminectomy was performed to achieve gross total resection of the mass lesion and removal of extruded disc material. A diagnosis of spinal choroid plexus tumor (CPT) and intervertebral disc extrusion was made. At 4 mo postoperatively, MRI demonstrated a mass lesion at the right lateral aperture of the fourth ventricle. Spinal drop metastasis from a primary intracranial CPT was suspected. The dog was ambulating independently and neurologically normal at that time. At 17 mo postoperatively, a third MRI was performed owing to decreased postural reactions in both hind limbs and vision loss in the right eye, and it demonstrated an increase in size of the intracranial mass lesion. These two additional MRI studies of the entire central nervous system showed no other metastatic lesions nor any evidence of local recurrence. At 25 mo postoperatively, the dog died at home. This is the first case report of surgical intervention and antemortem histopathological diagnosis of a spinal CPT in a dog.

Characteristics of Diffuse Leptomeningeal Glioneuronal Tumor With First-Episode Headache and Rapid Blindness Misdiagnosed as Viral Meningoencephalitis

Diffuse leptomeningeal glioneuronal tumor has a high degree of malignancy and high mortality. The purpose of this paper is to describe the characteristics of atypical diffuse leptomeningeal glioneuronal tumor and analyze the causes of misdiagnosis as viral meningoencephalitis. An adolescent female patient presented with headache, nausea, vomiting, sharp vision loss and cognitive dysfunction. After poor therapeutic effect of standard antiviral treatment, further inspection found that malignant cells were detected by cerebrospinal fluid (CSF) cytology; and enhanced magnetic resonance imaging (MRI) showed extensive enhancement of the leptomeningeal. In conclusions, when patient with unexplained high intracranial pressure, it is necessary to be alert to the diagnosis of diffuse leptomeningeal glioneuronal tumor. Multiple examinations of fresh CSF are helpful to increase the positive detection rate of tumor cells. Early diagnosis and active treatment are conducive to improving survival rate.

Clinical Features and Prognostic Risk Factors of Choroid Plexus Tumors in Children

Background:

Decision-making concerning the treatment of choroid plexus tumor (CPT) in pediatric patients remains a topic of considerable debate. The aim of this work was to describe clinical features and prognostic risk factors of CPT in the pediatric population and to provide theoretical opinions regarding clinical decisions for CPT.

Methods:

The data of 96 patients with CPT and younger than 14 years were retrospectively analyzed. Clinical characteristics such as pathological type of CPTs, rate and severity of hydrocephalus, treatment and outcome, and recurrence were investigated. For categorical variables, the Pearson's Chi-square test was performed. The Mann–Whitney U-test was used for comparisons between nonnormally distributed parameters. Log-rank test was used for progression-free survival (PFS).

Results:

The study included 70 choroid plexus papilloma (CPP) cases, 17 atypical choroid plexus papilloma (aCPP) cases, and 9 choroid plexus carcinoma (CPC) cases. Compared with patients with CPP or aCPP, patients with CPC had a shorter disease course (median: CPP, 4 months; aCPP, 2 months; CPC, 1 month; H: 23.5, P < 0.001), higher rate of acute hydrocephalus (CPP, 27.1%; aCPP, 52.9%; CPC, 77.8%; χ² = 10.9, P < 0.05), and lower incidence of cure rate (CPP, 85.7%; aCPP, 70.5%; CPC, 33.3%; χ² = 13.5, P < 0.05). The severity of hydrocephalus with tumor in the lateral or third ventricle was significantly higher than that with tumors in the fourth ventricle (severe hydrocephalus: lateral ventricle, 51.7%; third ventricle, 47.0%; fourth ventricle, 11.1%; χ² = 26.0, P < 0.001). Patients with gross total surgical resection had no better PFS than those with partial resection because of the use of adjuvant therapy in the latter (χ² = 4.0, P > 0.05). Patients with CPC experienced shorter time for recurrence than those with CPP or aCPP (χ² = 40.1, P < 0.0001).

Conclusions:

Our results indicated that CPP in the fourth ventricle could trigger serious clinical symptoms at an early stage, requiring early intervention. Adjuvant treatment might be necessary for patients with partially resected CPP, aCPP, and CPC to achieve a favorable outcome.