The ventricular system and choroid plexus as a primary site for renal cell carcinoma metastasis.

BACKGROUND: Brain metastases (BM) are the most common intracranial tumours amongst adults. Ten to 40 % of patients with cancer will develop BM. In this study, we observed a high affinity of renal cell carcinoma (RCC) to the ventricular system, with close association to the choroid plexus. METHODS: This is a retrospective study evaluating data of our prospectively maintained brain tumour database, focusing on consecutive BM patients, who were treated at our center between March 2003 and December 2011. Data collected included primary pathologies, anatomical distribution of the brain metastasis according to neuroimaging, and treatment modalities. RESULTS: We identified 614 patients with BM, of whom 24 (3.9 %) were diagnosed with RCC, harboring 33 lesions. Nine of the 24 patients (37.5 %) presented with an intraventricular location (10 of 33 RCC BM lesions). Of the remaining 590 patients with non-RCC pathologies, five patients (0.8 %) were diagnosed with intraventricular lesions (p < 0.0001). CONCLUSION: In this unselected, consecutive treated BM patient cohort we observed a high affinity of RCC BM to the ventricular system with close association to the choroid plexus. The reason for this affinity is unknown. Surgical approaches for resection of these lesions should be planned to include early control on the vascular supply from the choroidal vessels.

A choroid plexus metastasis of a prostatic adenocarcinoma mimicking a choroid plexus carcinoma: A case report.

A multicystic intraventricular tumour of the right ventricular atrium was incidentally diagnosed on follow-up imaging of a 61-year-old man with a history of prostatic adenocarcinoma. Surgical resection of the lesion was performed after a one-year radio-clinical follow-up due to progressive expansion of the lesion size and a rising prostate specific antigen blood-level. Morphological features with papillary pattern on pathological examination were compatible with malignant adenocarcinoma or choroid plexus carcinoma. The immunoprofile was conclusive for an exceptional choroid plexus metastasis (CPM) of a prostatic adenocarcinoma. To our knowledge, this is the first report of a proven prostatic origin of a CPM.

[A case of metastatic choroid plexus tumor from cholangiocellular carcinoma].

Metastatic intraventricular tumor located in the choroid plexus is very rare. Only a few cases have been reported in the past. According to past reports, these tumors originated from lung, colon, and so on, but not from the bile duct. This is the first case report of choroid plexus metastasis from cholangiocellular carcinoma. A 57-year-old woman who had a history of cholagiocellular carcinoma, demonstrated intraventricular tumor. Although sufficient examination was performed, the tumor was difficult to diagnose as being a metastatic tumor or a choroid plexus carcinoma. Because of this, we performed endoscopic biopsy of the intraventricular tumor. However intraoperative findings were not helpful in distinguishing metastatic tumor and choroid plexus carcinoma. Postoperatively, histological examination was performed. However it was still difficult to differentiate this rare tumor from choroid plexus carcinoma by only hematoxylin and eosin stain. For further examination, Ber EP-4 stain was performed. Ber EP-4 showed strongly positive which indicates metastatic tumor. This method led us to make an appropriate diagnosis of this extremely rare tumor. We considered that in order to diagnose this rare tumor, appropriate histopathological examination, including immunohistopathological examination should be performed.

Progeny in an Inhospitable Milieu-Solitary Intraventricular Metastasis From a Triple-Negative Breast Cancer Mimicking Central Neurocytoma: Case Report and Review of Diagnostic Pitfalls and Management Strategies.

BACKGROUND: Triple-negative breast cancer (TNBC) is one of the most invasive subtypes of breast cancer, with high rates of visceral metastases and recurrence. Choroid plexus metastasis from breast cancer is infrequent despite a high incidence of brain parenchymal metastasis. METHODS: We report a case of solitary metastasis to the choroid plexus from a TNBC that masqueraded as central neurocytoma, and we review the PubMed database for similar cases focusing on their diagnostic challenges and management strategies. RESULTS: A 28-year-old woman with a history of TNBC presented with recurrent seizures, headache, and vomiting. Imaging studies depicted a well-defined lesion in the right anterior lateral ventricle that was attached to the septum pellucidum. After an initial radiological diagnosis of central neurocytoma, she deteriorated rapidly with intraventricular hemorrhage requiring emergency transcallosal microsurgical tumor decompression. Histopathological examination and immunohistochemistry confirmed breast carcinoma as the origin of the intraventricular mass. A review of the PubMed database identified only 2 case reports of choroid plexus metastases from breast cancer reported thus far. CONCLUSIONS: Choroid plexus metastases are exceedingly infrequent and can be mistaken for the more common central neurocytoma. The intraventricular milieu is inhospitable suggesting some extracranial carcinomas develop traits that help them to thrive in the acellular cerebrospinal fluid. Intraventricular mass lesions with a history of primary neoplasm should raise suspicion for choroid plexus metastases. A high index of suspicion despite excellent control of the primary tumor and the absence of systemic metastases is indispensable.

Clinical Outcomes in Patients with Renal Cell Carcinoma Metastases to the Choroid Plexus.

OBJECTIVE: Intraventricular metastatic brain tumors account for a small, but challenging, fraction of metastatic brain tumors (0.9%-4.5%). Metastases from renal cell carcinoma (RCC) account for a large portion of these intraventricular tumors. Although patient outcomes have been assumed to be poor, these have not been reported in a modern series with a multimodality treatment paradigm of radiotherapy (RT), resection, and cerebrospinal fluid (CSF) diversion. We have presented the first case series of patients with intraventricular metastatic tumors from RCC. METHODS: We performed a single-institution retrospective review of patients with intraventricular RCC metastases treated from January 2003 to January 2019. Volumetric analysis was used to delineate the tumor size and the Kaplan-Meier method to evaluate the survival data. RESULTS: A total of 22 intraventricular RCC metastases were identified in 19 patients with 61.3 patient-years of follow-up. The median patient age was 64 years, and the median tumor volume was 2.2 cm3. Overall, 19 metastases had been treated initially with RT. Of these, 16 had received stereotactic body RT and 3 had received whole brain RT. Three tumors were surgically excised and had received adjuvant stereotactic body RT in the upfront setting. Although 5 patients had presented with obstructive hydrocephalus, none had required CSF diversion. After treatment, 5 metastases had progressed, resulting in 1- and 3-year progression-free survival rates of 81.6% and 68%, respectively. The median overall survival was 2.8 years, with 1- and 5-year overall survival rates of 76.7% and 28.3%, respectively. Leptomeningeal carcinomatosis was not observed. CONCLUSIONS: Despite the relatively limited overall survival for this population with metastatic cancer, comparable to contemporary parenchymal brain metastasis cohorts, reasonable local central nervous system control was achieved in most patients using a paradigm of focal RT and resection, where indicated. Finally, CSF diversion was not required even in patients presenting with hydrocephalus.

Thyroid carcinoma metastasis to the choroid plexus of the lateral ventricle.

We present a rare case of a lateral ventricle choroid plexus metastasis arising from thyroid carcinoma in a 62-year-old man. The patient underwent subtotal excision of the intracranial tumour followed by total thyroidectomy with good outcome. We review previous reports of intracranial thyroid metastases and discuss the role of surgical resection, radiosurgery, whole brain radiotherapy and radioactive iodine therapy. There is no consensus regarding treatment in the literature due to small numbers of patients reported. We recommend surgical resection for single accessible lesions.

Solitary Metastasis of Adenocarcinoma of Submandibular Gland to Choroid Plexus in Cerebellopontine Angle: First Case Reported in Literature.

BACKGROUND: Adenocarcinoma of the salivary gland (AdCASG) is a rare and malignant tumor of the salivary glands. Albeit, metastatic lesions occur anecdotally in the choroid plexus and most rarely in the cerebellopontine angle (CPA). We report the first case of metastatic AdCASG to the choroid plexus of the lateral recess of the fourth ventricle located in CPA, emphasizing the clinical presentation and neuroradiologic findings. CASE DESCRIPTION: A 40-year-old man was referred with signs of increased intracranial pressure and a unilateral hearing problem. Magnetic resonance imaging showed a pear-shaped, vividly enhancing tumor in the left CPA. The tumor was a metastatic AdCASG. Gross total resection of the lesion was followed by a conventional radiotherapy lead in a 5-year tumor-free control interval. CONCLUSIONS: Metastatic lesions to the choroid plexus may show a pedunculated shape in magnetic resonance imaging. It is hypothesized that tumor seeding may occur through the veins, lymphatics, and nerve sheaths in the skull base region. Tissue specimen is necessary to confirm such rare pathology.

Solitary choroid plexus metastasis from carcinoma of the oesophagus.

Metastatic tumors to the brain presenting exclusively in the choroid plexus are rare and are most frequently associated with renal cell carcinoma. In this paper, the authors report an unusual case of intraventricular metastasis, and to the authors' knowledge, this is the first case of solitary metastasis from oesophageal carcinoma to the choroid plexus to be described in the literature. Metastatic disease is an important differential diagnosis which must be considered even for a patient without a documented primary malignancy who presents with a single lesion in the ventricle.

Solitary metastasis of renal cell carcinoma to the third ventricular choroid plexus with rapid clinical manifestation by intratumoral hemorrhage.

A 72-year-old man who had undergone nephrectomy for left renal cell carcinoma (RCC) presented with worsening of cognitive function and frequent loss of consciousness. Computed tomography (CT) revealed tumor mass in the third ventricle and hydrocephalus. A ventriculoperitoneal (VP) shunt was placed to treat the hydrocephalus. The postoperative course was uneventful, and he was followed closely without aggressive therapy. Four months after surgery, the tumor expanded rapidly due to intratumoral hemorrhage and he died due to sepsis. The autopsy findings revealed a solitary metastatic RCC in the third ventricle, with massive intratumoral hemorrhage. Solitary metastasis of RCC to the third ventricle is quite rare and difficult to treat. The case report highlights that early diagnosis and treatment are critical, even in slowly progressive RCC patients, because of the possibility of intratumoral hemorrhage.

Bilateral Choroid Plexus Metastasis from Papillary Thyroid Carcinoma: Case Report and Review of the Literature.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. It has an indolent clinical course and favorable prognosis. Brain metastasis is uncommon and complicates about 0.1%-5% of PTCs. Metastasis to the choroid plexus of the lateral ventricles has been reported in 7 cases of thyroid malignancies, all of which were unilateral. METHODS: We report a case of a 52-year-old woman with a history of PTC who presented with severe headache, nausea and vomiting, right hemiparesis, and speech disturbance. Imaging studies depicted lesions in both lateral ventricles. RESULTS: The patient underwent microsurgical tumor resection. Histopathologic examination revealed choroid plexus metastasis from PTC. CONCLUSIONS: Metastases to the choroid plexus from extracranial tumors are very rare, with only a few cases reported thus far. A demographic analysis of these cases suggests there may be a tropism of some extracranial carcinomas, such as renal cell carcinoma, for choroid plexus, especially in the lateral ventricles. We report the eighth case of choroid plexus metastasis, but it is the first bilateral one arising from thyroid cancer.

Choroid Plexus Metastasis of Follicular Thyroid Carcinoma Diagnosed due to Intraventricular Hemorrhage.

Choroid plexus metastasis (CPM) is extremely rare and originates most frequently from renal cell carcinoma (RCC). We herein report the case of a 58-year-old man who developed a solitary CPM lesion derived from follicular thyroid carcinoma in addition to intraventricular hemorrhage. Computed tomography revealed acute hydrocephalus as a result of the hemorrhage, and we planned endoscopic hematoma evacuation. Since it was too difficult to reach the hematoma, we considered the possibility of a neoplasm and performed a biopsy of the lesion, the results of which led to an accurate diagnosis of CPM in this case. We also review previous reports of CPM originating from thyroid carcinoma compared with RCC.

Choroid plexus epithelium (normal and neoplastic) expresses synaptophysin. A potentially useful aid in differentiating carcinoma of the choroid plexus from metastatic papillary carcinomas.

As an incidental finding in paraffin sections of brain tissue used as positive controls for synaptophysin immunostain, the cytoplasm of choroid plexus epithelium present was found to stain strongly positively for this substance. This was subsequently found to be the case in normal choroid plexuses in autopsy material from infancy to old age, as well as in epithelial cells of papillomas and carcinomas of the choroid plexus. The latter findings may prove useful in differentiating choroid plexus carcinomas from metastatic papillary carcinomas of extracerebral origin with the exception of neuroendocrine carcinomas of various sites that are usually positive for synaptophysin.

Solitary metastasis to the choroid plexus of the third ventricle mimicking a colloid cyst: a report of two cases.

Cerebral metastasis to the choroid plexus is rare and almost always occurs in the presence of multiple cerebral metastases. We present two cases of a solitary cerebral metastasis to the choroid plexus of the anterior third ventricle mimicking a colloid cyst. There appears to be an increased tendency for renal cell carcinomas to metastasis to the choroid plexus. Metastatic disease is an important differential diagnosis even for solitary lesions of the anterior third ventricle.

Single solitary metastasis of the slowly progressive type of renal cell carcinoma to the choroid plexus--case report.

A 68-year-old male developed a solitary metastasis in the choroid plexus of the right lateral ventricle 7 years after left nephrectomy for renal cell carcinoma. The lesion was totally removed and the patient has been free from recurrence for 30 months postoperatively. Pure solitary metastasis to the choroid plexus is very rare, but five of the 15 cases originated from renal cell carcinoma. There may be a link between this type of metastasis and the slowly progressive type of renal cell carcinoma.

Choroid plexus metastasis from gastric cancer--case report.

A 64-year-old male presented with a unique choroid plexus metastasis from gastric cancer. Computed tomography and magnetic resonance imaging demonstrated a moderately enhanced mass in the lateral ventricle. The tumor was totally removed and histological examination revealed adenocarcinoma. Systemic investigation revealed gastric cancer. The differential diagnosis for intraventricular masses should include the possibility of metastasis from unidentified primary lesions.

Choroid plexus metastasis of colon cancer.

This article presents an extremely rare case of solitary metastasis in the choroid plexus of the inferior horn of the right lateral ventricle three years after a colectomy for colon cancer. We discuss the current literature on this tumor together with the magnetic resonance (MR) imaging and computed tomography (CT) findings.

[Renal cell carcinoma metastasizing to choroid plexus of lateral ventricle; a case report].

A rare case of renal cell carcinoma metastasizing to the choroid plexus of the lateral ventricle is reported. A 59-year-old woman was admitted to our institution on November 26, 1987 complaining of left-half headache for one month. She had a past history of right nephrectomy due to renal cell carcinoma 4 years before admission, and of right radical mastectomy due to breast cancer 10 years before admission. She had no abnormal neurological findings and laboratory results were normal. CT scan revealed a well-circumscribed, apparently homogeneously enhancing mass in the left lateral ventricle with mild ventricular dilatation. Left vertebral angiogram showed a tumor stain fed by the left posterior choroidal artery. The most likely diagnosis was thought to be metastasis of renal cell carcinoma. The patient underwent the operation for tumor removal via the posterior interhemispheric transcallosal approach 14 days after admission. A histological examination of the tumor determined the diagnosis of clear-cell type renal cell carcinoma. The operation was uneventful and the patient was discharged 20 days after operation without neurological deficit. But she had recent-memory disturbance, low activity, and gait disturbance in May 1989. CT scan revealed ventricular dilatation and tumor recurrence at the same site. She also suffered from diabetes due to the regrowth and invasion of primary tumor to the pancreas. She was discharged free of neurological defects after ventriculo-peritoneal shunt. In December 1989, she gradually deteriorated due to the regrowth of the intraventricular metastatic lesion, and now she is bedridden. Choroid plexus metastasis is quite rare, and, to our knowledge, only three cases have been described.

Hurthle cell carcinoma presenting as a single choroid plexus metastasis.

Choroid plexus masses represent approximately 0.3-0.8% of intracranial tumors. Herein we present, to our knowledge, the first reported patient with an isolated Hurthle cell papillary thyroid carcinoma metastasis to the choroid plexus of the lateral ventricle. Unresponsive to iodine ablation and refusing surgery, the patient underwent Gamma Knife radiosurgery (Elekta AB, Stockholm, Sweden), receiving 15Gy to the 50% isodose line. The lesion regressed until 5years later at which time it was unresponsive to 18Gy and required surgical resection. Although extraneural metastatic cancers are recognized as potential sources for the single choroid plexus mass, we must consider even the unusual culprit in patients with a history of cancer.

Evaluation of rare choroid plexus metastasis from papillary thyroid carcinoma with multimodality imaging.

Papillary thyroid carcinoma (PTC) is the most common malignancy of thyroid gland. Though it metastasizes primarily through lymphatics, hematogenous spread is not infrequent. We report the case of a 62-year-old male patient with intraventricular choroid plexus metastasis from PTC, incidentally detected on post-high-dose radioiodine therapy whole-body I scan, which is an extremely rare presentation. Only 3 cases of choroid plexus metastasis from thyroid carcinoma have been reported. Further multimodality radiological investigations confirmed diagnosis and helped in assessing treatment response. The patient received gamma-knife stereotactic radiosurgery, and follow-up radiological imaging suggested improvement of intracranial metastasis.