Choroid plexus papilloma of the III ventricle in an infant

A case of choroid plexus papilloma of the III ventricle associated with hydrocephalus in an 1-month-old boy is reported. The tumor was removed after placement of a ventriculoperitoneal shunt; however, the histologically mainly benign tumor grew very rapidly. The cause of this rapid growth may have been a drop in the intraventricular pressure after the shunting procedure.     

Choroid plexus papillomas of the III ventricle in childhood

Ten infants and children with choroid plexus papilloma of the III ventricle are presented. Hydrocephalus of various degrees was present in all patients, and seven patients had bilateral ventriculoperitoneal shunts prior to craniotomy. All patients were investigated with computed tomography and angiography. Tumor was resected through the transfrontal-transventricular approach in nine and through a transcallosal approach in one. One patient died intraoperatively due to an uncontrollable hemorrhage from a subependymal vein at its point of entry into the homolateral internal cerebral vein, and another died shortly after surgery due to hypothalamic trauma. The remaining eight patients are alive without recurrence over a minimum follow-up period of 3 years; three have mental retardation and seizure disorder. Despite this tumor's deep location and vascularity and occurrence in infancy, choroid plexus papillomas of the III ventricle can be successfully resected. Appropriate care for hydrocephalus and intra- and postoperative management are important.     

Choroid plexus papilloma and Aicardi syndrome: case report

A case of Aicardi syndrome associated with a choroid plexus papilloma of the third and both lateral ventricles in a 15 months old baby girl is repported. The tumor was completely removed via three craniotomies. Reports of the literature with the association of choroid plexus papilloma and Aicardi syndrome are rare. We suggest that children diagnosed with Aicardi syndrome should routinely undergo imaging studies of the brain, such as computed tomography or magnetic resonance.     

Choroid plexus cyst of the third ventricle presenting as acute triventriculomegaly

INTRODUCTION: Cystic lesions in and around the third ventricle have been known to cause intermittent and acute obstruction of the foramen of Monroe with rapid onset symptoms. Most of these lesions are seen on routine investigations, whereas some are not so obvious resulting in mistaken diagnosis. Symptomatic choroids plexus cysts have only been infrequently reported, predominantly in the lateral ventricle. CASE REPORT: A 3-year-old female child presented with rapid loss of consciousness for the first time. Computed tomography and magnetic resonance imaging scans only showed triventriculomegaly. Endoscopy revealed a cyst of the third ventricle, which was excised, leading to good recovery. Biopsy of the wall revealed a choroid plexus cyst. CONCLUSION: Choroid plexus cysts are rare causes for symptomatic obstruction of the third ventricle and may be difficult to detect on routine investigations and may lead to the wrong choice of treatment. Endoscopic fenestration or excision is a good option to manage such lesions.     

Choroid plexus papilloma: Light and electron microscopic study of three cases

Summary Three cases of choroid plexus papilloma were studied by light and electron microscopy. All had the typical papillary pattern, and, in addition, two exhibited solid areas of tumor growth which predominated in one case.PAS positive (diastase resistant) and argyrophilic cytoplasmic inclusions were present in all three tumors but were particularly abundant in the predominantly solid one. Ultrastructurally, the inclusions appeared as irregularly shaped structures containing lipid droplets, filamentous material and microtubules, and resembled the silver bodies of Biondi found in normal choroid plexus.Along with other ultrastructural features of normal choroid plexus, these cytoplasmic inclusions may be helpful in the differential diagnosis of papillary tumors involving the ventricular system.     

Choroid plexus papilloma in a 4-month-old child: a case report

We report a case of choroid plexus papilloma arising from the right lateral ventricle in a 4-month-old infant. Because of intermittent vomiting, abdominal pain, and diarrhea, the child was initially treated with intravenous rehydration, which aggravated the symptoms, and a bulging fontanel developed. Before a planned lumbar puncture, cranial ultrasound was performed, which disclosed a choroid plexus papilloma. The tumor was removed surgically, and the child made an uneventful recovery. We discuss the diagnostic value of cranial ultrasound compared to computed tomographic (CT) scan and angiography.     

脉络丛乳头状瘤影像学诊断及临床治疗研究

目的探讨脉络丛乳头状瘤的CT、MRI表现及临床治疗方法。方法回顾性分析我院收治的28例经术后病理证实为脉络丛乳头状瘤（包括1例不典型者）患者的临床资料。本组病例术前均行CT、MRI检查。结果肿瘤位于侧脑室者19例,位于第四脑室者7例,位于第三脑室者2例;所有患者均行显微手术治疗,肿瘤完全切除22例,部分切除6例（术后均行放射治疗）。术后5个月至5年,随访平均3．2年,21例治愈,4例复发,2例死亡,1例失访。结论MRI常呈颗粒状混杂信号且浸泡于脑脊液中为脉络丛乳头状瘤典型的影像学表现;手术切除是目前其首选治疗措施;放射治疗是未全切除者术后的主要辅助治疗手段。     

Solitary metastasis to the choroid plexus of the third ventricle mimicking a colloid cyst: a report of two cases.

Cerebral metastasis to the choroid plexus is rare and almost always occurs in the presence of multiple cerebral metastases. We present two cases of a solitary cerebral metastasis to the choroid plexus of the anterior third ventricle mimicking a colloid cyst. There appears to be an increased tendency for renal cell carcinomas to metastasis to the choroid plexus. Metastatic disease is an important differential diagnosis even for solitary lesions of the anterior third ventricle.     

脉络丛乳头状瘤术后椎管内种植二例

脉络丛乳头状瘤(choroid plexus papillomas，CPP)是临床少见的颅内良性肿瘤，约占颅内肿瘤0．4％-0．6％，手术后椎管内播散种植更为罕见。本文报道CPP术后椎管内播散种植2例并进行临床分析。     

Choroid plexus papillomas of the III ventricle in infants Report of three cases

The III ventricle is an uncommon location for choroid plexus papilloma at any age. We describe three new cases of choroid plexus papillomas of the III ventricle (CPPs). All children were boys under 4 months of age and all presented with increased intracranial pressure, hydrocephalus and macrocephaly. The three were examined by preoperative computed tomography (CT) and ultrasonography. Two of them were investigated with magnetic resonance imaging (MRI). The first case was treated with a right corticofrontal transventricular approach and subtotal resection, so that he required a second operation through a transcallosal approach. In the other two cases a transcallosal approach was used. Two children needed permanent ventriculo-peritoneal shunts. The average follow-up of 4.3 years has revealed no neurological deficits in any case. The timing of and the need for shunting are major considerations. Clinical and imaging follow-up (CT and/or ultrasonography) are very helpful in controlling postoperative hydrocephalus and subdural effusion, avoiding unnecessary shunting in many cases. The operative approaches, transcortical and transcallosal, are discussed. Received: 19 July 1996     

Endoscopic removal of a cystic choroid plexus papilloma of the third ventricle: a case report and review of the literature

Cystic choroid plexus papilloma (CPP) of the third ventricle is rare. The authors have reported a case of cystic CPP resected successfully through neuroendoscopic approach. An 18-year-old young man was admitted to our hospital, presented with blurred vision and paroxysmal, intermittent, severe headache for 1 month as well as nausea and vomiting. The findings of neurological examination were normal except for a bilateral papilledema. Magnetic resonance and computerized tomography revealed a cystic lesion in the third ventricle, which did not furnish a definite diagnosis. The tumor was totally resected through neuroendoscopic approach and was found in histopathological examination to be a CPP. The patient retained free of symptoms at 2 year follow-up. To the best of the authors’ knowledge, this is the first reported case of a cystic CPP of the third ventricle involved adult and endoscopic surgery might be a preferred technique to it.     

Alexander's disease in infancy and childhood: a report of two cases

Summary Two cases of Alexander's disease are described. One case of infantile onset died at the age of 6 months and the second case was of the juvenile type with onset at 2 years and death at 10 years. A clinical diagnosis of this disease is difficult since signs can vary according to the age of the patient. The severity of the pathological changes can also depend upon the age of onset of this disease, but they are restricted to the central nervous system. The Rosenthal fibre is the characteristic feature of Alexander's disease and we have examined for the first time its ultrastructure and immunocytochemical characteristics at the electron microscopical level and demonstrated coexpression of anti-glial fibrillary acidic protein and anti-ubiquitin antisera.     

Chordoid glioma of the third ventricle: A report of two cases,one with ultrastructural findings

Chordoid glioma, which generally occurs in adults, is a rare CNS tumor arising in the anterior part of the third ventricle. We report two cases of chordoid glioma of the third ventricle in a 42‐year‐old woman and a 51‐year‐old man, respectively. Both tumors showed essentially the same histological and immunohistochemical features; the tumors were composed of cords and nests of epithelioid, GFAP‐immunoreactive cells in a mucinous stroma with lymphoplasmacytic infiltrates at the tumor periphery. Ultrastructural examination in one case revealed that the tumor cells were characterized by the presence of hemidesmosomes and associated focal basal lamina formation, intermediate junctions, microvilli and cilia, and intercellular microrosettes with microvilli. Of interest was that small blood vessels with fenestrated endothelial cells were present in the stroma. In the brain, the presence of fenestrated endothelial cells is a feature of the circumventricular organs (except the subcommissural organ), among which the organum vasculosum of the lamina terminalis is located in the anterior part of the third ventricular floor that is lined by specialized ependymal cells known as tanycytes. These findings further strengthen the hypothesis that chordoid glioma may represent a peculiar clinicopathological subtype of ependymoma (chordoid ependymoma) originating from the lamina terminalis area.     

Congenital choroid plexus papilloma of the fourth ventricle

A newborn infant with marked hydrocephalus had a large papilloma of the choroid plexus originating in the fourth ventricle and infiltrating the brain stem. The computed tomographic (CT) scan appearance was distinctive, showing vascularity and marked enhancement with contrast medium. Histological confirmation was made from several surgical sites. Total removal of the tumor was not possible. Review of congenital choroid plexus brain tumors reveals the location of this child's tumor in the fourth ventricle to be uncommon.     

Malignant choroid plexus papilloma of the IV ventricle

We report a case of malignant choroid plexus papilloma (MCPP) of the IV ventricle in a child with prominent extraventricular expansive growth, mostly into the cerebellopontine angle. Interestingly enough, the tumor was entirely covered by thin, smooth, membranous, fibrous tissue, probably derived from the pia mater. In addition, hydrocephalus was not observed. The reason for the lack of hydrocephalus remains speculative, but it is possible that the presence of pure, nonexpansive, fibrous covering on the tumor might have suppressed the tumor growth to some extent, resulting in progressively increased intratumoral pressure. This, in turn, caused the suppression of excessive cerebrospinal fluid production by the tumor cells. From the diagnostic standpoint, immunohistochemical studies, using antiepithelial membrane antigen (EMA) and antitissue polypeptide antigen (TPA), were demonstrated to be useful for diagnosing the tumor.     

Endoscopic endonasal transplanum transtuberculum resection of a large solid choroid plexus papilloma of the third ventricle

Choroid plexus papilloma (CPP) is a highly vascular solid or mixed solid-cystic tumor. Previously described resection techniques for the more common solid CPP in the third ventricle have all been through the transcranial route. The authors review the literature and describe a patient who, to their knowledge, is the first successful resection of a large, completely solid CPP of the third ventricle through an entirely endoscopic, extended transphenoidal approach. Using modern neuroendoscopic methods and closure techniques, a gross total resection was accomplished and a successful closure without postoperative cerebrospinal fluid leak was achieved despite the presence of preoperative hydrocephalus. For appropriately selected lesions, an extended endonasal skull base resection can be performed successfully for vascular tumors despite the presence of preoperative hydrocephalus.     

Choroid plexus papilloma of cerebellopontine angle with extension to foramen magnum.

A case of choroid plexus papilloma resembling meningioma of cerebellopontine (CP) angle with its extension to foramen magnum is presented. Occurrence of this tumour in CP angle is very rare. Its extension towards foramen magnum is further rare. It was a real diagnostic enigma preoperatively as the tumour was resembling meningioma upto some extent on radiological study. Retromastoid craniectomy with microsurgical excision of tumour and its extension was achieved in toto. Tumour was attached to few rootlets of lower cranial nerves which were preserved. Attachment of the tumour with lower cranial nerves again caused diagnostic confusion with neurofibroma intraoperatively.