Answer for BIR CoW 10 Dec 2023
Choroid Plexus Papilloma
Findings
Relatively well defined T1 isointense/ T2heterointense lesion with frond like projection and multiple cystic components, showing subtle diffusion restriction is noted centred in the atrium of right lateral ventricle extending to temporal horn. Multiple foci of gradient blooming noted within the lesion- reflecting calcifications. On contrast administration, the lesion shows avid homogenous enhancement.
Discussion
CPPs are rare tumors of neuroectodermal origin. This lesion is generally a disease of childhood, with a median age at diagnosis of 3.5 years. Typically in infants, their location is supratentorial, within the lateral ventricles (most commonly in the atrium). In adults, the common site is the fourth ventricle. These tumors usually do not invade the brain. Most of the patients with choroid plexus papilloma have hydrocephalus, probably due to overproduction of cerebrospinal fluid by the tumor itself.
IMAGING:
CT - Isodense or slightly hyperdense lesion within the ventricles along with consequent ventriculomegaly. Hydrocephalus is typical. About 25% of the patients have calcification. The lesions are lobulated with slightly irregular margins. They also show intense and somewhat heterogeneous contrast enhancement. Angiographic imaging show enlargement of the choroidal artery.
MRI- well–defined, frond-like intraventricular lobulated masses, which are hypointense on T1WI and hyperintense on T2WI. Flow voids are seen, indicating active blood flow. The lesions are brilliantly enhancing, owing to rich vascularity.
Findings
Relatively well defined T1 isointense/ T2heterointense lesion with frond like projection and multiple cystic components, showing subtle diffusion restriction is noted centred in the atrium of right lateral ventricle extending to temporal horn. Multiple foci of gradient blooming noted within the lesion- reflecting calcifications. On contrast administration, the lesion shows avid homogenous enhancement.
Discussion
CPPs are rare tumors of neuroectodermal origin. This lesion is generally a disease of childhood, with a median age at diagnosis of 3.5 years. Typically in infants, their location is supratentorial, within the lateral ventricles (most commonly in the atrium). In adults, the common site is the fourth ventricle. These tumors usually do not invade the brain. Most of the patients with choroid plexus papilloma have hydrocephalus, probably due to overproduction of cerebrospinal fluid by the tumor itself.
IMAGING:
CT - Isodense or slightly hyperdense lesion within the ventricles along with consequent ventriculomegaly. Hydrocephalus is typical. About 25% of the patients have calcification. The lesions are lobulated with slightly irregular margins. They also show intense and somewhat heterogeneous contrast enhancement. Angiographic imaging show enlargement of the choroidal artery.
MRI- well–defined, frond-like intraventricular lobulated masses, which are hypointense on T1WI and hyperintense on T2WI. Flow voids are seen, indicating active blood flow. The lesions are brilliantly enhancing, owing to rich vascularity.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!