Choroid Plexus Papilloma

Choroid Plexus Papilloma

Harsha Dod 12 Jun 2010 12:54

38 year male, presented with history of slurring of speech since 2 months, difficulty in swallowing, imbalance and dimness of vision.

Surgery 1st 2004 Midline sub occipital cranectomy of IV ventricular tumor. Choroid plexus papilloma.

Recurrence in 2008 -operated again

Third recurrence now. MRI shows 2.8x2.5x2.4 cm cystic and mural nodule in inferior part of IV ventricle , compressing and scalloping medulla oblongata. Shows enhancement on post contrast. Perilesional vasogenic edema present. Another lesion present in quadrigeminal plate cistern on left side. (This was present in 2008 also)

This time the local nerurosurgeon has referred directly for Radiation.

Valuable opinion please.

Re: Choroid Plexus Papilloma

Santam Chakraborty 12 Jun 2010 15:49

Were the two excisions total or subtotal? If subtotal recurrent leisons have a very poor prognosis. Another pertinent question - is this papilloma or carcinoma? I mean has the HPE been reviewed again?

---

Re: Choroid Plexus Papilloma

Rohit Malde 12 Jun 2010 18:06

This presentation fits in well with a choroid plexus papilloma. But i agree HP review is not going to be harmful, as there are case reports of malignant transformation.

Third recurrence — Neurosurgeon cannot assure safe resection —- This is a indication for radiotherapy.
No high level evidence, small case series of a few dozen patients.
RT Dose: used in literature 45 Gy-50.4 Gy @ 1.8 Gy / #

Santam, sorry to pull on you on this one, but what does very poor prognosis mean in your dictionary.
This is a benign tumour, and WHO classify these as WHO grade I neoplasms, as opposed to a Glioblastoma.
Neurosugeons are careful, so as not to cause any longterm neurological disability.

I can appreciate your concern, but this patient still has a quite a few Diwali & New years to see.

Re: Choroid Plexus Papilloma

VIMOJ J NAIR 27 Jun 2010 19:38

I second Dr Malade's opinion. Would also suggest a review of HPR for any atypicality!

Even though the indications for RT is not strong. As surgery is the main stay of treatment. Some authors follows the wait and watch policy after incomplete surgery. While others have given RT in the recurrent and in the primary setting in incomplete surgery.

Would suggest CEMR spine in the follow up and work up to r/o possibility of seeding in CP papilloma.

---

It is our choices that show what we really are, far more than our abilities.