mercoledì 7 settembre 2005
Choroid plexus papilloma
Figure 1: CT. Axial cut through level of lateral ventricles. Hyperdense lobulated well-circumscribed mass is noted within the atrium of the right lateral ventricle. There is adjacent compressive edema of the parenchyma of the right parietal lobe, without definitive extension of the mass into the parenchyma. There is moderate hydrocephalus involving both lateral ventricles.
Figure 2: CT. Axial cut through level of frontal horns. Hyperdense mass associated with the right lateral ventricle with adjacent compressive edema on the parenchyma of the right parietal lobe and without definitive extension into the parenchyma is noted. The lateral and third ventricles are moderately dilated. Other images showed the fourth ventricle to be dilated.
Diagnosis: Choroid plexus papilloma
Choroid plexus papillomas are rare tumors arising from the epithelium of the choroid plexus. The choroid plexus produces cerebrospinal fluid. The CSF produced by such a tumor is the key cause of the unusual cases of hydrocephalus due to overproduction of CSF. The overproduction is seen as dilatation of all ventricles in this cause of communicating hydrocephalus. Choroid plexus papillomas represent 60%-70% of tumors of the choroids, 5% of all supratentorial tumors in children, and less than 1% of all primary intracranial tumors. They are usually seen in the first 5 years of life, more typically in infants with signs of significant hydrocephalus. They are much more commonly noted in males.
Classically, they are lobulated isodense to hyperdense masses with occasional punctuate calcifications seen within them. They enhance homogeneously. They usually are seen as an intraventricular mass without extension into or through the ventricular wall. Only aggressive papillomas, accounting for about 5% of cases, will invade adjacent brain.
Although the fourth ventricle is the most common site to find choroid plexus tumors in adults, in children they are usually noted in the lateral ventricle, left more often than right. The ventricular trigone is the most common area of occurrence within the ventricle. The appearance of papillomas in unusual sites has been reported in cases of von Hippel-Lindau syndrome.
Choroid plexus tumors may also be carcinomas, and are usually seen in somewhat older children, aged 3-5 years. Unlike patients with papillomas, those with carcinomas may have focal neurologic signs and signs of hydrocephalus. Involvement is equal for both genders. These tumors most always grow through the ventricular wall.