Neuroradiology

Choroid plexus papilloma

intraventricular tumour arising from the choroid plexus (see choroid plexus tumour).The most common locations are the trigone in children and the fourth ventricle in adults.

Macroscopically they are cauliflower-like masses contained within the ventricle, with possible infiltration of the brain tissue. Microscopically they resemble normal choroid plexus, with a thin fibrovascular stromal core surrounded by a layer of columnar epithelium. Symptoms are usually related to hydrocephalus; the prognosis is benign, since the tumour, if correctly diagnosed, may be totally removed surgically.

On CT papillomas are usually isodense to slightly hypodense tumours with marked enhancement (Fig.1). MR shows a well delineated, usually isointense intraventricular mass that enhances markedly. Hydrocephalus is usually asymmetrical, the homolateral ventricle usually being more dilated. The temporal horn may be "sequestered" and markedly dilated. Angiography shows dilated choroidal arteries feeding the tumour and a marked capillary stain.

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Fig.1

a. Axial CT, without contrast. Slightly hyperintense nodular lesion apparently within the right trigone. The lesion is partially calcified. b, c. MR, T1- and T2-weighted images. The tumour is inhomogeneously isointense in T1 and hyperintense in T2, with central hypointensity due to calcifications. The intraventricular location is well appreciated. d, e, f. MR after intravenous gadolinium injection (axial, coronal and sagittal). Marked enhancement of the soft component of the tumour. g. Right carotid angiogram, arterial phase. Hypertrophy of the anterior choroidal artery and precocious blush of the tumour nodule
Choroid plexus papilloma, Fig.1 (a)
Choroid plexus papilloma, Fig.1 (b)
Choroid plexus papilloma, Fig.1 (c)
Choroid plexus papilloma, Fig.1 (d)
Choroid plexus papilloma, Fig.1 (e)
Choroid plexus papilloma, Fig.1 (f)
Choroid plexus papilloma, Fig.1 (g)