J Korean Neurosurg Soc.  2012 May;51(5):272-275. 10.3340/jkns.2012.51.5.272.

Unusual Radiologic Findings and Pathologic Growth Patterns on Choroid Plexus Papillomas

Affiliations
  • 1Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, Korea. jung-ty@chonnam.ac.kr
  • 2Department of Pathology, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, Korea.

Abstract


OBJECTIVE
Choroid plexus papillomas (CPPs) are generally regarded as benign tumors with typical radiologic and pathologic findings. However, they sometimes have unusual findings. We have analyzed radiologic findings and pathologic growth patterns on CPPs.
METHODS
The study group included 5 male and 5 female patients (age range, 3 months to 58 years : median, 29 years). The study group included 3 pediatric and 7 adult patients. All patients underwent surgery; 9 patients had a gross total resection and 1 patient had a subtotal resection. We analyzed the radiologic findings (location, size, mottle-like appearance, enhancement, calcifications, and hydrocephalus) and pathologic growth patterns (typical papillary, papillary and solid, and papillary and tubular).
RESULTS
The median follow-up duration was 21.3 months (range, 4-47.8 months). There were no recurrences after initial treatment. All patients had benign CPPs. Pediatric CPPs were 3.2 cm masses (range, 2.7-4 cm) with homogeneous enhancement and a mottle-like appearance, which pathologically showed the papillary growth pattern. Hydrocephalus was present in all pediatric patients. Postoperatively, subdural hygroma had occurred in two patients. In adults, CPPs were located in the fourth ventricle in 6 patients and suprasellar area in 1 patient. The size varied from 0.5-4.2 cm. Hydrocephalus and calcifications occurred in 3 and 4 patients, respectively. Three patients showed the heterogeneous enhancement without a mottle-like appearance and pathologically showed combined papillary and solid growth in 2 patients and papillary and tubular growth in one. Postoperatively, two patients with large masses had injuries of the brainstem and underwent shunt procedures for aggravation of hydrocephalus.
CONCLUSION
CPPs may show unusual radiologic findings, which preoperatively give the difficulty to be differentiated from other tumors. CPPs with unusual radiologic findings showed the combined pathologic growth patterns.

Keyword

Choroid plexus papilloma; Complications; Pathology; Radiology

MeSH Terms

Adult
Brain Stem
Choroid
Choroid Plexus
Female
Follow-Up Studies
Fourth Ventricle
Humans
Hydrocephalus
Male
Papilloma, Choroid Plexus
Recurrence
Subdural Effusion

Figure

  • Fig. 1 The pathologic growth pattern. A : Typical papillary growth with papillary structures lined by cuboidal epithelium. There is no evidence of mitosis, necrosis, and anaplasia. B : Ki-67 labeling index is <0.5%. C : The solid growth pattern is shown. D : The tubular growth pattern is shown like glandular structure.

  • Fig. 2 Radiologic findings of CPPs. The tumors are located posteriorly to the medulla (A), which show homogenous enhancement and typical mottled like appearance on the edge. The tumors located posteriorly to the pons (B and C) and the suprasellar tumor (D) show the heterogeneous enhancement and the disappearance of mottled like appearance.


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