Presentation
Rapid mental decline, headache and history of renal cell carcinoma.
Patient Data
Intraventricular mass centered in the left lateral ventricle arising from the choroid plexus with heterogeneous signal intensity, T1/T2 isointense with cortex, FLAIR hyperintense, areas of moderate diffusion restriction, and multiple internal flow-voids with intense enhancement.
Note the remarkable dilatation of the 3rd and lateral ventricles (hydrocephalus) and the fluid-fluid levels in the dependent portions of the occipital horns consistent with intraventricular hemorrhage.
There is T2/FLAIR periventricular white matter hyperintensity consistent with transependymal flow of the CSF and small gliotic lesions in the frontal white matter (Fazekas grade I).
Five days later
Multiple small ring-enhancing lesions with rapid washout in the pancreatic parenchyma mostly involving the head, neck and uncinate process, best seen in the arterial phase, consistent with pancreatic metastases from renal cell carcinoma.
Note the right nephrectomy and left ovarian varicocele.
Additional findings: Pneumobilia filling the common and left intrahepatic bile duct with dilatation and air-fluid level in the former (post-cholecystectomy).
Case Discussion
A case of choroid plexus metastasis and pancreatic metastases in a patient with a history of pathologically proven renal cell carcinoma who presented with headache and rapid mental decline over the past two weeks.
MRI revealed an intraventricular mass which was biopsied and responded well to gamma-knife radiosurgery. So did the pancreatic metastases under chemotherapy.
Renal cell carcinoma is the most common tumor to metastasize to the choroid plexus and pancreas 1.
Choroid plexus metastases are rare and mainly found in the lateral ventricles because most of this highly vascular structure is located there. Tumors can spread through a hematogenous route or CSF seeding 2.
Pancreatic metastases are uncommon, usually asymptomatic and mostly found incidentally on imaging or at autopsy. Any part of the gland can be affected and they show no typical appearance 1,3.
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