Choroid plexus papilloma

Case contributed by RMH Neuropathology

Presentation

Not available.

Patient Data

Age: 36 years
Gender: Female
CT

CT Brain

There is a 2.9 x 1.9 x 2.4 cm solid mass within the right inferior fourth ventricle extending through the right foramina of Luschka with distortion of the right medulla and partial effacement of the ventricle. Small foci of calcifications are present and the lesion enhances vividly.

There is mass effect and partial effacement of the inferior aspect of the fourth ventricle. No upstream ventricular dilation or evidence of transependymal CSF shift. No other abnormal enhancement is demonstrated.

MRI

MRI Brain

There is a 2.9 x 1.9 x 2.4 cm mass within the right inferior fourth ventricle extending through the right foramina of Luschka with distortion of the right medulla and partial effacement of the ventricle.

It is predominantly solid with a few small cystic foci at its periphery.

The solid component is hyperintense to brain parenchyma on T2 weighted sequence, isointense on T1, and enhances vividly.

There are multiple vascular flow voids. No abnormal diffusion restriction within the lesion. Multiple foci of coarse calcification on recent non-contrast CT scan is noted.

Inferiorly, the mass abuts the right PICA at its origin. T2 flow-void in the right vertebral artery is preserved.

There is mass effect and partial effacement of the inferior aspect of the fourth ventricle. No upstream ventricular dilation or evidence of transependymal CSF shift.No other abnormal enhancement is demonstrated.

Conclusion:

Enhancing mass with peripheral cystic foci within fourth ventricle and extending through foramina of Luschka, without obstructive hydrocephalus.

Haemangioblastoma would be the most common adult solid/cystic posterior fossa tumour with flow voids, but classically should not contain calcification.

Medulloblastoma, choroid plexus papilloma and infratentorial ependymoma are possibilities although rare in adults.

Pathology

MICROSCOPIC DESCRIPTION: 1,2. The sections show a moderately cellular tumour, forming well-defined papillary structures. Some psammoma bodies are noted. The tumour cells are cuboidal to columnar in shape. They have ovoid nuclei and small nucleoli. No mitoses are seen. There is no microvascular proliferation or necrosis. No evidence of brain invasion is identified. The tumour cells are focally transthyretin positive. They are TTF-1, thyroglobulin and BER-EP4 negative. The features are those of choroid plexus papilloma.

DIAGNOSIS: 1,2. Posterior fossa lesion: Choroid plexus papilloma.

Case Discussion

Choroid plexus papilloma is an uncommon, benign neuroepithelial intraventricular tumour which can occur in both the paediatric (more common) and adult population. They are classified as a WHO grade I tumor if typical and WHO grade II if atypical. They are, fortunately, far more common than the more aggressive choroid plexus carcinoma (WHO grade III), which they outnumber 5:1. 

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Case information

rID: 38522
Case created: 22nd Jul 2015
Last edited: 13th Mar 2016
Inclusion in quiz mode: Included

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