Choroid plexus xanthogranuloma

Case contributed by Dr Aruna Pallewatte


Nonspecific headache and tingling sensation of body for 6 months duration. Neurology examination was uneventful.

Patient Data

Age: 40 years
Gender: Female

There are two lesions within the posterior horns of lateral ventricles. The lesion in left posterior horn is much larger measuring 10X15mm and slightly expanding the posterior horn. They are  low signal in T1, Moderately high in FLAIR. The lesions are  high signal in T2 and difficult to differentiate from surrounding CSF.

No post contrast enhancement. These Lesions show distinct high signal on DWI

3rd ventricle is normal and rest of the brain also appears unremarkable.

Case Discussion

Xanthogranulomas of the choroid plexus are common benign lesions which only rarely cause symptoms. These consist of desquamated epithelium into the lumen of choroid cysts within the choroid plexus. Therefore the MRI signal characteristics depend on the mixture of lipid, fluid and blood products .They appear like cystic lesions. A helpful distinctive feature is high signal on DWI. ADC may be intermediate or low signal. The sizes vary  ranging from tiny  lesions to large prominent masses. In this patient the largest lesion is 1.5x1cm which is seen in left posterior horn, They can also present in the trigone of the lateral ventricle. These lesions are bilateral in 2/3 of patients as seen in this patient.

These are almost certainly incidental finding as the patient's clinical presentation cannot be explained by this lesion.

Symptomatic cases are rare and commonly due to lesions located in the third ventricle causing obstruction of the Foramen of Monro.

Main differential diagnosis for Xanthogranuloma is Choroid plexus cyst

Submitted by  Dr. Aruna Pallewatte, Dr. Lakmini Alahakoon and Dr. Priyanka Gunathunga.

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