Choroid plexus papilloma

Findings

There is a frond-like mass in the trigone of the right lateral ventricle with mostly isointense signal on T1 and T2, demonstrating intense contrast enhancement. There is no local parenchyma invasion. There is severe hydrocephalus.

Differential diagnosis:
- Choroid plexus papilloma
- Choroid plexus carcinoma
- Choroid plexus meningioma
- Villous hypertrophy
- Intraventricular metastasis
- Ependymoma


Diagnosis: Choroid plexus papilloma


Key points

General
- Tumor that arise from the choroid plexus epithelium
- WHO Grade I tumor – benign slow growing tumor
- Four to eight times more common than choroid plexus carcinoma

Epidemiology
- Most common brain tumor in those under 1 year of age
- 75% of cases are in those under 10 years old
- Approximately to 2 to 4% of pediatric brain tumors
- Approximately 0.5% of adult brain tumors

Clinical Presentation
- Signs and symptoms of increased intracranial pressure from CSF overproduction and impaired CSF resorption
- May present with focal neurologic deficit

Treatment
- Surgical resection
- Almost 100% 5 year survival rate for choroid plexus papilloma
- Often require post resection shunting


Radiology

Lobulated, frond, or "cauliflower-like" intraventricular mass
Often arises in the lateral ventricle trigone in children
Often arises in the 4th ventricle and cerebellopontine angle in adults
May have drop metastasis to the spinal canal
Associated with hydrocephalus because of CSF overproduction or obstruction
Only limited local parenchymal invasion (compared to choroid plexus carcinoma)
Often difficult to differentiate from choroid plexus carcinoma

CT
- Iso or hyper dense ventricular mass
- 25% contain punctuate calcification
- Intense enhancement
- May have cysts or hemorrhage

MRI
- T1 Iso or hypo intense
- T2 variable hyper intense, with flow voids
- Intense enhancement