Presentation
Persistent headache for several months. No menses for 4 years.
Patient Data
There is an enhancing multilobulated mass in the fourth ventricle which appears heterogeneous on T2-weighted sequences. There is vasogenic edema in the dorsal aspect of the pons extending into the right brachium pontis. This also vasogenic edema in the medulla. Mild ventriculomegaly. There are areas of susceptibility within the lesion. Preserved flow voids in the vessels comprising the circle of Willis and venous sinuses.
Case Discussion
This is a choroid plexus papilloma located in the fourth ventricle. The patient had partial tumor resection via suboccipital craniotomy. Gross pathology of the specimens retrieved showed smooth and irregularly shaped fragments of tan or pink soft tissue. Histopathology showed mainly acinar and pseudoglandular patterns. The sample was remarked to have some overlapping features of low-grade neuroendocrine neoplasm/carcinoid tumor and low-grade choroid plexus papillary neoplasm papilloma. However, the location and histopathology favored acinar type choroid plexus papilloma. The sample stained positive for synaptophysin, S-100, vimentin, and focally for GFAP, RCC, and HER2.
The patient did well-post-operatively. Other than residual lower extremity weakness, patient has not had any recurrence of signs and symptoms.
Co-authors:
Joshua Goldwag
Travis Bevington, MD