Extraventricular choroid plexus papilloma in the brainstem

Case report

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Choroid plexus papilloma (CPP) is extremely rare in the brainstem. The authors report the case of a 10-year-old boy with a lesion in the pons that was misdiagnosed as a glioma preoperatively. The boy underwent partial resection of the lesion, which was diagnosed as a CPP based on histopathological findings. The authors review the MRI findings in this case and conclude that the presence of a well-defined boundary and no obvious cerebral edema are valuable features for distinguishing brainstem CPP from glioma. Although previous reports of parenchymal CPPs have described enhancement on contrast-enhanced T1-weighted MR images, the lesion in this case did not demonstrate significant enhancement. The authors note that the diagnosis of extraventricular CPP cannot be ruled out in a case of brainstem tumor without marked enhancement.

Abbreviations used in this paper:CPA = cerebellopontine angle; CPP = choroid plexus papilloma.

Article Information

Address correspondence to: Chao You, M.D., Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang St., Chengdu, Sichuan 610041, People's Republic of China. email: shion17928@yahoo.cn.

Please include this information when citing this paper: published online July 26, 2013; DOI: 10.3171/2013.6.PEDS137.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative MRI. Axial T2-weighted imaging (A) and T1-weighted imaging (B) showed a regular mass with a clear boundary surrounded by pontine tissue. The ventral cortex of the pons was compressed and thinned (arrows). The right CPA cistern (asterisk in A) was not completely blocked by the lesion. No marked enhancement was seen within the mass on axial T1 contrast-enhanced imaging (C), and no peritumoral cerebral edema was revealed on axial FLAIR imaging (D). Coronal T1-weighted contrast-enhanced imaging (E) demonstrated a homogeneous nonenhancing mass located at the right side of pons, without apparent associated lateral shift of the brainstem.

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    Photomicrograph of the CPP specimen. The tumor tissue consisted of fibrovascular cores lined by a single layer of uniform cuboidal to columnar epithelium with oval nuclei. H & E, original magnification × 200.

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    Axial CT scan obtained on the 3rd day after surgery. The mass was smaller with reduced mass effect. The right side of the prepontine cistern was wider than on preoperative images, and the normal morphology of the fourth ventricle was restored.

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