Fourth ventricular choroid plexus papilloma

Abstract

Dear Editors, A 19-year-old girl presented with headache and dizziness over a 6–month-period. The headaches were frontal and postoccipital with dull throbbing quality and she was taking over the counter pain medications. Her headaches did not occur with coughing or straining. She initially thought that this was related to her recent 90 lb weight loss since being on a diet and exercise. She also noted intermittent dizziness accompanied by gait difficulty and a generalized weakness. The week prior to the admission, she had a severe headache, nausea, dizziness, shortness of breath and diffuse weakness. Her physical examination was remarkable for slight bilateral dysmetria, occasional bilateral hypometric saccades, and nystagmus on end gaze. The T1-weighted MRI with gadolinium revealed a heterogeneously enhancing mass fungating into the fourth ventricle and an obstructive hydrocephalus (Fig. 1). The patient underwent surgical resection, and the pathology confirmed a diagnosis of choroid plexus papilloma. Choroid plexus papillomas, which account for about 0.3–0.7 of all intracranial tumors, are more commonly seen in the pediatric population. The most common reported locations are the lateral ventricles (50%), followed by the fourth (40%) and third ventricles (10%) [1–3]. Given their hypervascularity, they usually demonstrate an intense enhancement on postcontrast images [1, 2]. From histopathologic perspective, choroid plexus papillomas are the most common tumor type arising from choroid plexus. Other pathologies include choroid plexus carcinomas and diffuse choroid plexus hyperplasia. Surgical resection is the treatment of choice for choroid plexus papillomas and progression-free survival approaches 100% even despite an incomplete resection [4]. However, choroid plexus carcinomas, which account for about 8–25% of all choroid plexus tumors, have a strong tendency to spread along the cerebrospinal fluid pathway with a variable response to surgery and adjuvant therapy. Hence, it is important to differentiate benign choroid plexus papillomas from this type of tumors [5].