Choroid Plexus Papilloma in Adults
Choroid Plexus Papilloma in Adults Choroid plexus papilloma (CPP) is a rare, benign tumor that originates from the choroid plexus tissue within the ventricles of the brain. While more commonly diagnosed in children, especially infants and young children, its occurrence in adults is relatively uncommon, making it a noteworthy subject for neuro-oncologists and neurosurgeons alike. Understanding this tumor’s characteristics, clinical presentation, and management options is essential for timely diagnosis and effective treatment.
The choroid plexus is responsible for producing cerebrospinal fluid (CSF), which cushions the brain and spinal cord and helps maintain intracranial pressure. Tumors arising from this tissue, such as CPP, tend to grow slowly and are generally classified as WHO Grade I tumors, indicating benign behavior. Despite their benign nature, they can cause significant symptoms due to their location and size, especially in adult patients.
In adults, choroid plexus papillomas often present with symptoms related to increased intracranial pressure. Headaches, nausea, vomiting, and visual disturbances are common complaints, often resulting from obstructive hydrocephalus—an accumulation of CSF due to blockage of normal flow pathways. Some patients may also experience focal neurological deficits, such as weakness or sensory changes, depending on the tumor’s location within the ventricular system. Seizures are less common but can occur if the tumor irritates adjacent brain tissue. Choroid Plexus Papilloma in Adults
Diagnosing CPP in adults involves a combination of neuroimaging and clinical assessment. Magnetic resonance imaging (MRI) is the modality of choice, revealing a well-defined, enhancing mass within the ventricular system, most frequently near the lateral ventricles or the third ventricle. These tumors often appear as lobulated, highly vascular lesions with characteristic features that differentiate them from other intraventricular masses, such as ependymomas or metastatic tumors. Contrast-enhanced MRI helps delineate the tumor’s margins and assess the extent of surrounding edema or hydrocephalus. Choroid Plexus Papilloma in Adults
While imaging provides valuable clues, definitive diagnosis requires histopathological examination following surgical removal or biopsy. Under the microscope, CPPs display a papillary architecture with fibrovascular cores lined by a single layer of uniform epithelial cells. The abs
ence of mitotic activity and cellular atypia confirms its benign nature. Immunohistochemical staining further aids in distinguishing CPP from other tumor types.
Surgical resection remains the primary treatment for choroid plexus papilloma in adults. Complete removal of the tumor often results in excellent long-term outcomes and a low likelihood of recurrence. The surgical approach depends on the tumor’s location and size, with techniques such as open craniotomy or minimally invasive pathways employed to access the ventricular system safely. Managing hydrocephalus, if present, may involve preoperative or intraoperative CSF diversion procedures like ventriculostomy or shunt placement. Choroid Plexus Papilloma in Adults
Choroid Plexus Papilloma in Adults Follow-up care includes regular imaging to monitor for recurrence, although this is rare with complete excision. In cases where the tumor is incompletely resected or exhibits atypical features, adjuvant radiotherapy may be considered, though its role remains limited given the tumor’s benign nature.
In conclusion, choroid plexus papilloma in adults, though uncommon, should be considered in the differential diagnosis of intraventricular tumors presenting with signs of increased intracranial pressure. Early diagnosis and surgical intervention typically result in favorable outcomes, emphasizing the importance of awareness among clinicians. Advances in neuroimaging and surgical techniques continue to enhance the prognosis for affected patients. Choroid Plexus Papilloma in Adults
