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Year : 2004  |  Volume : 14  |  Issue : 4  |  Page : 419-422
Choroid plexus carcinoma : A rare case


Department of Radiology & Imaging, Smt. S.C.L. Hospital Saraspur, Smt. N.H.L Municipal medical college, Ahmedabad - 380 006, India

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Keywords: Choroid plexus, intraventricular mass, choroid plexus papilloma

How to cite this article:
Dani R D, Gandhi V, Thakkar G, Patel P, Kiran P. Choroid plexus carcinoma : A rare case. Indian J Radiol Imaging 2004;14:419-22

How to cite this URL:
Dani R D, Gandhi V, Thakkar G, Patel P, Kiran P. Choroid plexus carcinoma : A rare case. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Sep 18];14:419-22. Available from: http://www.ijri.org/text.asp?2004/14/4/419/28686

   Introduction Top


CNS neoplasms in children under 2 year of age are uncommon(1-2%of all brain tumors).[1] They are very large and highly malignant.Children usually present with macrocrania, seizures& focal neurological deficit.


   Case report Top


A 7-month-old male child presented with of complaints of excessive crying, fever & convulsions since 15 days.

US cranium was done which showed large echogenic mass with areas of necrosis [Figure - 1]. The mass appeared to arise from right lateral ventricle & right parietal region,right choroid plexus was not separatelyseen [Figure - 2]. Midline shift towards left with dilatation of left lateral ventricle noted. We put the diagnosis of choroid plexus carcinoma & advised CT brain.

CECT showed 82.6x83.5mm size heterogeneously enhancing intraventricular mass arising from right lateral ventricle [Figure - 3] & extending into right temporoparietal region with midline shift towards left & dilatation of left lateral ventricle [Figure - 4]. Third ventricle was compressed by mass [Figure - 4]. Another small hyper dense lesion noted in right temporal region, possibility of metastasis.

Finding in favour of highly malignant intraventricular mass possibly

(1) choroid plexus carcinoma (2) intraventricular anaplastic astrocytoma

MR : axial T1WI&T2WI & coronal T1WI &T2WI FLAIR images taken.

Finding in favour of highly malignant intraventricular mass lesion with intratumoral bleed [Figure - 5] & [Figure - 6] & extensive leptomeningeal metastasis [Figure - 7] &[Figure - 9] with CSF spread & ependymal spread within right lateral ventricle [Figure - 8] & [Figure - 9]. Enhancement around upper cervical spinal cord [Figure - 10] with hemorrhagic metastasis in right anterior temporal lobe [Figure - 5] & [Figure - 6].

D/D of choroid plexus carcinoma &Anaplastic astrocytoma should be considered.

Patient was referred to cancer institute where craniotomy in right parietal region was done & tissue taken for histopathological examination (HPE).

HPE was suggestive of choroid plexus carcinoma.

Symptomatic treatment along with radiotherapy was given but the patient died within two months.


   Discussion Top


Choroid plexus papiloma (CPP) is a rare benign intracranial neoplasm comprising 1 % of all all brain tumors, [2] but more common in young children comprising 3% of all brain tumors. [2] They arise from ventricles with the origin being more common from lateral ventricles in children and fourth ventricle in adults [2] with frequency of involvement of ventricles in children- 80 %-lateral, 16% fourth, 4%-third ventricle [3].

Malignant degeneration is not common [10-30%],[1],[3] occurring most commonly in neoplasms located in lateral ventricles and third ventricle.[1],[4]

Almost all choroid plexus carcinomas (CPCs) occur in infant and children of 2-4 years of age. [1],[4] CPPs usually confine to ventricles or its outlet foramina but if malignant degeneration occurs spread into adjacent brain parenchyma is more common.[2] Hydrocephalus may occur as a results of ventricular out flow obstruction [1],[2]. Interventricular extension though uncommon can occur in CPP [3]. Seeding can occur through cerebrospinal axis [1] which results in solitary metastasis from lateral ventricular tumors in children & subarachnoid spread to spine from fourth ventricle in adults [3]. Prognosis in malignant choroids plexus tumors depends on complete resection but over all 5-year survival ranges from 26-40% [2,3]. M:F ratio is 2.8:1[3]


   Radiological findings Top


Plain x-ray: usually not used to investigate choroid plexus(CP) tumor. It may show signs of raised intracranial tension & faint calcification (present in 4.1%cases). [3]

US: useful particularly in infants & can be used as initial screening investigation.

US shows heterogeneous highly echogenic intraventricular mass with irregular borders & hypo echoic areas (necrotic) within mass with hydrocephalus.

DOPPLER may show internal vascular channels.


   Ct Top


Tumor appears iso to hyper dense relative to normal brain parenchyma [1],[2] .It may show area of necrosis & calfication. Haemorrhage is common due to high vascularity & friability [2]. CECT shows intense heterogenous enhancement [1]. Associated findings include hydrocephalus [1],[2]. Though papilloma & carcinoma similar on CT [1],[4] but heterogeneity, irregular borders & parenchymal invasion favour malignancy [2].There may be leptomeningeal involment too.


   Mr Top


T1WI usually shows iso-hypo intensity [2] with areas of increased signal intensity due to haemorrhage.T2WI shows heterogeneously hyperintense mass lesion relative to normal brain parenchyma. On IV contrast tumor shows intense enhancement [2] Associated hydrocephalus may be noted

MR is more sensitive for detection of spread of tumor, particularly to spinal subarachnoid space & meninges.

Angiography may show dilatation of choroidal artery supplying the tumor.

Other signs include small spiral arteries, tumor blush with persistence into venous phase, evidence of ventricular dilatation & displacement of vessels.

D/D of anaplastic astrocytoma should be considered.[5]

 
   References Top

1.Dignostic Neuroradiology ,Anne G Osborn.p-571-577.  Back to cited text no. 1    
2.CT&MR Imaging of whole body,John R. Hagga,volume 1, 4th edition p 150.   Back to cited text no. 2    
3.e Medicine Choroid Plexus Papilloma : Article by Omar Islam M.D www.emedicine.com/radio/topic/171.htm  Back to cited text no. 3    
4.Essentials of CAFFEY'S pediatric x ray diagnosis.p 125-126  Back to cited text no. 4    
5.Grainger & Allison's DIAGNOSTIC RADIOLOGY, A text book of medicine imaging ,4th edition , volume 3 p   Back to cited text no. 5    

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Correspondence Address:
R D Dani
83, Yogeshwarnagar Society, Opp,Anjali Theater, Near Dharnidhar Society, Bhatta, Paldi, Ahmedabad-380007, Gujarat,
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10]

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    Introduction
    Case report
    Discussion
    Radiological fin...
    Ct
    Mr
    References
    Article Figures

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