MedPix Medical Image Database COW - Case of the Week Case Contributor: Wendy Smoker Affiliation: University of Iowa Health Care

MedPix No: History Pt Demographics: Age = 1 y.o. Gender = girl 15 month old girl fell off a chair. The following day, she was acting more somnolent. Head CT was abnormal. Downloaded by (-1)

MedPix No: EXAM & LABS Physical exam was normal for age. No neurological deficits

Choroid Plexus Carcinoma Hydrocephalus Downloaded by (-1)

Choroid Plexus Carcinoma Hydrocephalus Downloaded by (-1)

Choroid Plexus Carcinoma Hydrocephalus Downloaded by (-1)

Choroid Plexus Carcinoma Hydrocephalus Downloaded by (-1)

Choroid Plexus Carcinoma Hydrocephalus Downloaded by (-1)

Choroid Plexus Carcinoma Hydrocephalus Downloaded by (-1)

Choroid Plexus Carcinoma Hydrocephalus Downloaded by (-1)

Choroid Plexus Carcinoma Hydrocephalus Downloaded by (-1)

Choroid Plexus Carcinoma Hydrocephalus Downloaded by (-1)

Choroid Plexus Carcinoma Hydrocephalus Downloaded by (-1)

Choroid Plexus Carcinoma Hydrocephalus Downloaded by (-1)

Choroid Plexus Carcinoma Hydrocephalus Downloaded by (-1)

FINDINGS CT: 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 DIAGNOSIS What is your Differential Diagnosis? Choroid plexus carcinoma - Choroid plexus papilloma - PNET - Medulloepithelioma (infants) - Teratoma - Metastatic Adenocarcinoma (adults) -

Diagnosis: Choroid Plexus Carcinoma Dx Confirmed by: Biopsy

DISCUSSION Wesley 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 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. * Site accessed on 02/07/08. Site was lasted revised 07/23/ Uncommon Brain Tumors Chenda, Kesari, Chen. Copyright