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Case series of choroid plexus papilloma in children at uncommon locations and review of the literature.

Prasad GL, Mahapatra AK - Surg Neurol Int (2015)

Bottom Line: Two cases presented with features of obstructive hydrocephalus while the latter presented with compressive effects.Complete removal leads to excellent long-term survival rates.Adjuvant treatment is not required.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

Background: Choroid plexus papillomas (CPPs) comprise around 1% of intracranial neoplasms. The most common location is atrium of the lateral ventricle in children and fourth ventricle in adults. Other rare locations include third ventricle, cerebellopontine (CP) angle and cerebral parenchyma, with only a few cases reported. Authors report three cases of CPP at uncommon locations in pediatric patients. The rarity of these locations, diagnostic dilemma and management aspects are discussed along with an extensive review of the literature.

Methods: Retrospective institutional data analysis of histopathologically confirmed pediatric CPPs from 2010 to 2014.

Results: Authors noted three cases of CPP in children in uncommon locations-one each in the posterior third ventricle, fourth ventricle, and CP angle. All were males in the first decade. Two cases presented with features of obstructive hydrocephalus while the latter presented with compressive effects. Complete excision was achieved in two cases while subtotal removal was performed in one case (fourth ventricular) because of excess blood loss. Mean follow-up duration was 24.6 months (range 20-30 months). One case (of subtotal removal) had fair recovery while other two had excellent outcomes.

Conclusions: Posterior third ventricle, fourth ventricle, and CP angle are uncommon locations for these tumors in children. Complete surgical removal is the treatment of choice and approach needs to be tailored according to the site and size of the lesion. Blood loss is a major concern in young children as they are highly vascular tumors. Complete removal leads to excellent long-term survival rates. Adjuvant treatment is not required.

No MeSH data available.


Related in: MedlinePlus

Case 1. Noncontrast computed tomography showing an isodense lobulated lesion in the posterior third ventricle with obstructive hydrocephalus (a). Plain magnetic resonance imaging axial sections showing the lobulated tumor appearing isointense on T1 and slightly hypointense on T2 sequences (b and c). Axial and sagittal postcontrast magnetic resonance images showing intense, homogeneous enhancement of the lesion, and located caudal to the deep venous system (d and e). Postoperative computed tomography showing no residual tumor with pneumoventricle seen in bilateral frontal horns (f)
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Figure 1: Case 1. Noncontrast computed tomography showing an isodense lobulated lesion in the posterior third ventricle with obstructive hydrocephalus (a). Plain magnetic resonance imaging axial sections showing the lobulated tumor appearing isointense on T1 and slightly hypointense on T2 sequences (b and c). Axial and sagittal postcontrast magnetic resonance images showing intense, homogeneous enhancement of the lesion, and located caudal to the deep venous system (d and e). Postoperative computed tomography showing no residual tumor with pneumoventricle seen in bilateral frontal horns (f)

Mentions: A 5-year-old boy presented with complaints of headache and vomiting of 3 months duration. Neurological examination revealed papilledema and mild upgaze paresis. Noncontrast computed tomography (CT) showed an isodense frond-like lesion in the posterior third ventricle with hydrocephalus [Figure 1a]. Magnetic resonance imaging (MRI) showed a lobulated, intensely enhancing lesion in the region of the posterior third ventricle with obstructive hydrocephalus. The lesion was isointense on T1 and slightly hypointense on T2 sequences having a frond-like appearance and measuring 4.1 cm × 1.9 cm × 2.3 cm [Figure 1b-e]. A ventriculoperitoneal (VP) shunt was performed, followed by definitive surgery. A supracerebellar infratentorial approach was performed in sitting position. The tumor was soft to firm, friable, reddish, vascular, and attached with a single pedicle to the choroidal vessels. The arterial feeder was secured early, and an en bloc complete removal was achieved. Postoperative imaging showed no residual tumor and child had excellent outcome after surgery [Figure 1f].


Case series of choroid plexus papilloma in children at uncommon locations and review of the literature.

Prasad GL, Mahapatra AK - Surg Neurol Int (2015)

Case 1. Noncontrast computed tomography showing an isodense lobulated lesion in the posterior third ventricle with obstructive hydrocephalus (a). Plain magnetic resonance imaging axial sections showing the lobulated tumor appearing isointense on T1 and slightly hypointense on T2 sequences (b and c). Axial and sagittal postcontrast magnetic resonance images showing intense, homogeneous enhancement of the lesion, and located caudal to the deep venous system (d and e). Postoperative computed tomography showing no residual tumor with pneumoventricle seen in bilateral frontal horns (f)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596056&req=5

Figure 1: Case 1. Noncontrast computed tomography showing an isodense lobulated lesion in the posterior third ventricle with obstructive hydrocephalus (a). Plain magnetic resonance imaging axial sections showing the lobulated tumor appearing isointense on T1 and slightly hypointense on T2 sequences (b and c). Axial and sagittal postcontrast magnetic resonance images showing intense, homogeneous enhancement of the lesion, and located caudal to the deep venous system (d and e). Postoperative computed tomography showing no residual tumor with pneumoventricle seen in bilateral frontal horns (f)
Mentions: A 5-year-old boy presented with complaints of headache and vomiting of 3 months duration. Neurological examination revealed papilledema and mild upgaze paresis. Noncontrast computed tomography (CT) showed an isodense frond-like lesion in the posterior third ventricle with hydrocephalus [Figure 1a]. Magnetic resonance imaging (MRI) showed a lobulated, intensely enhancing lesion in the region of the posterior third ventricle with obstructive hydrocephalus. The lesion was isointense on T1 and slightly hypointense on T2 sequences having a frond-like appearance and measuring 4.1 cm × 1.9 cm × 2.3 cm [Figure 1b-e]. A ventriculoperitoneal (VP) shunt was performed, followed by definitive surgery. A supracerebellar infratentorial approach was performed in sitting position. The tumor was soft to firm, friable, reddish, vascular, and attached with a single pedicle to the choroidal vessels. The arterial feeder was secured early, and an en bloc complete removal was achieved. Postoperative imaging showed no residual tumor and child had excellent outcome after surgery [Figure 1f].

Bottom Line: Two cases presented with features of obstructive hydrocephalus while the latter presented with compressive effects.Complete removal leads to excellent long-term survival rates.Adjuvant treatment is not required.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

Background: Choroid plexus papillomas (CPPs) comprise around 1% of intracranial neoplasms. The most common location is atrium of the lateral ventricle in children and fourth ventricle in adults. Other rare locations include third ventricle, cerebellopontine (CP) angle and cerebral parenchyma, with only a few cases reported. Authors report three cases of CPP at uncommon locations in pediatric patients. The rarity of these locations, diagnostic dilemma and management aspects are discussed along with an extensive review of the literature.

Methods: Retrospective institutional data analysis of histopathologically confirmed pediatric CPPs from 2010 to 2014.

Results: Authors noted three cases of CPP in children in uncommon locations-one each in the posterior third ventricle, fourth ventricle, and CP angle. All were males in the first decade. Two cases presented with features of obstructive hydrocephalus while the latter presented with compressive effects. Complete excision was achieved in two cases while subtotal removal was performed in one case (fourth ventricular) because of excess blood loss. Mean follow-up duration was 24.6 months (range 20-30 months). One case (of subtotal removal) had fair recovery while other two had excellent outcomes.

Conclusions: Posterior third ventricle, fourth ventricle, and CP angle are uncommon locations for these tumors in children. Complete surgical removal is the treatment of choice and approach needs to be tailored according to the site and size of the lesion. Blood loss is a major concern in young children as they are highly vascular tumors. Complete removal leads to excellent long-term survival rates. Adjuvant treatment is not required.

No MeSH data available.


Related in: MedlinePlus