MedPix Medical Image Database

COW - Case of the WeekCase Contributor: Wendy SmokerAffiliation: University of Iowa Health Care

MedPix No: 13231 - HistoryPt Demographics: Age = 1 y.o. Gender = girl15 month old girl fell off a chair. The following day, she was acting more somnolent. Head CT was abnormal.

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MedPix No: 13231 - EXAM & LABSPhysical exam was normal for age. No neurological deficits

Choroid Plexus Carcinoma

Hydrocephalus

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Choroid Plexus Carcinoma

Hydrocephalus

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Choroid Plexus Carcinoma

Hydrocephalus

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Choroid Plexus Carcinoma

Hydrocephalus

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Choroid Plexus Carcinoma

Hydrocephalus

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Choroid Plexus Carcinoma

Hydrocephalus

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Choroid Plexus Carcinoma

Hydrocephalus

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Choroid Plexus Carcinoma

Hydrocephalus

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Choroid Plexus Carcinoma

Hydrocephalus

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Choroid Plexus Carcinoma

Hydrocephalus

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Choroid Plexus Carcinoma

Hydrocephalus

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Choroid Plexus Carcinoma

Hydrocephalus

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FINDINGSCT: High density mass in the trigone of the right lateral ventricle. Mass effect.MRI: Right lateral ventriclular mass with separate enhancing mass in left temporal horn, suggesting carcinoma. Mass effect with midline shift. Acute hemorrhage, right temporal horn, best seen on GRE images. Trapping of right temporal horn

DIFFERENTIAL DIAGNOSISWhat is your Differential Diagnosis?Choroid plexus carcinoma- Choroid plexus papilloma- PNET- Medulloepithelioma (infants)- Teratoma- Metastatic Adenocarcinoma (adults) -

Diagnosis: Choroid Plexus CarcinomaDx Confirmed by: Biopsy

DISCUSSIONWesley Ferley, MD wrote:- Choroid plexus carcinoma is an aggressive intraventricular tumor derived from choroid plexus epithelium. It corresponds to WHO grade III glioma. It accounts for 30-60 of all choroid plexus tumors in children. 50% occur in the lateral ventricles. The most common presentation is obstructive hydrocephalus (vomiting, vision changes, headache, balance problems, mental status changes). - On CT, these lesions are seen arising from the choroid plexus and are often hyperdense on non-contrast images. They have a grape-like or cauliflower appearance and avidly enhance. They often cause ventricular obstruction. Central necrosis and hemorrhage may occur. The differential diagnosis includes choriod plexus pappiloma, medulloepithelioma (infants), teratoma, and metastasic adenocarcinoma (adults). The 5-year survival is 40%.- References- 1. *http://wiki.cns.org/wiki/index.php/Choroid_Plexus_Carcinoma* Site accessed on 02/07/08. Site was lasted revised 07/23/08.- 2. Uncommon Brain Tumors http:www.uptodate.com. Chenda, Kesari, Chen. Copyright 2008.- -