Papiloma coroideo atípico en paciente de la tercera edad: Revisión bibliográfica a propósito de un caso / Atypical choroidal papilloma in an elderly patient: A literature review on a case

Introducción: Los tumores del plexo coroideo son raros. Contabilizan del 0,3 a 0,6% de la totalidad de los tumores cerebrales en adultos y del 10 a 20% en infantes; en quienes se ha registrado el 70% de estos y de los cuales al menos un 50% suceden en menores de dos años de edad. Objetivos: Esta publicación consiste en describir un caso de la tercera edad con papiloma atípico del cuarto ventrículo, la forma de resolución seleccionada y revisar la bibliografía del tema. Presentación del caso: Masculino de 71 años de edad que consulta por inestabilidad en la marcha y cefalea holocraneana intermitente. Al examen se muestra desorientado, con trastornos mnésicos, marcha magnética e incontinencia urinaria. Se realiza TC contrastada y posterior RM de cerebro con gadolinio objetivándose lesión espacio ocupante hipo-isointensa de 10 cc. Aprox. ocupando el 4to ventrículo, con realce intenso a la administración de contraste y ventriculomegalia asociada con edema transependimario. Intervención: Se realiza exéresis, logrando resección completa y mejoría clínica. Discusión: El papiloma atípico de plexo coroideo (Grado II) es una entidad intermedia que se distingue fundamentalmente del papiloma de grado I por su actividad mitótica; 2 o más mitosis en 10 campos. Conclusión: Este reporte, aborda una patología quirúrgicamente desafiante, potencialmente curable y clásicamente infantil, pero que también puede presentarse en la población geriátrica.

Introduction: Choroid plexus tumors are rare. They account for 0.3 to 0.6% of all brain tumors in adults and 10 to 20% in infants; in whom 70% of these have been registered and of which at least 50% occur in children under two years of age. Objectives: This publication consists of describing a case of the third age with atypical papilloma of the fourth ventricle, the selected form of resolution and reviewing the bibliography on the subject. Case presentation: 71-year-old male who consulted for gait instability and intermittent holocranial headache. On examination, he was disoriented, with memory disorders, magnetic gait, and urinary incontinence. Contrast-enhanced CT and subsequent MRI of the brain with gadolinium were performed, showing a 10 cc hypo-isointense occupying space lesion. Approx. occupying the 4th ventricle, with intense enhancement to contrast administration and ventriculomegaly associated with transependymal edema. Intervention: Exeresis is performed, achieving complete resection and clinical improvement. Discussion: Atypical choroid plexus papilloma (Grade II) is an intermediate entity that is fundamentally distinguished from grade I papilloma by its mitotic activity; 2 or more mitoses in 10 fields. Conclusion: This report addresses a surgically challenging pathology, potentially curable and classically infantile, but which can also occur in the geriatric population.

Transient Mutism following Resection of 4th Ventricle Choroid Plexus Papilloma in a 6-Year-Old Girl

Transient mutism has ben known as a rare complication following a posterior fossa approach to cerebellar tumors, although its pathophysiology remains unclear. Cerebellar mutism may be defined as a transient mutism occurring after a posterior fossa tumor approach in children with unimpaired consciousness, unimpaired symbolic functions, no detectable deficit of cranial nerves or peripheral organs of speech, and no lesions of long pathways in the course of the cranial nerves at the level of the brain stem. Forty two cases in children, and only two cases in adults have been found in the literature. We report a case of transient mutism with oropharyngeal apraxia after total excision of 4th ventricle choroids plexus papilloma in a 6-year-old girl. Postoperatively, the patient became mute and refused food intake without disturbance of consciousness, or lower cranial nerve function. Computed tomography(CT) and magnetic resonance image(MRI) demonstrated no abnormal findings except the surgical lesion in the posterior fossa. The mutism lasted for 3 weeks, but she gradually became fluent. The mechanism of "cerebellar mutism" is briefly discussed with literature review.

Two Cases of Choroid Plexus Papilloma of the 4th Ventricle and Cerebellopontine Angle in Adult

The choroids plexus papillomas are rare neoplasms of central nervous system, constituting about 0.5% of intracranial tumors. They are most common in children, especially in the first two year of life. In adult, they usually occur within posterior fossa, but cerebellopontine(CP) angle choroids plexus tumor is extremely rare. The authors report two cases of 4th ventricle and CP angle choroids plexus papilloma in adult.

A Case of Oligodendroglioma of the Cerebellar Vermis

In the posterior fossa rarely develops oligodendroglioma and a review of the literature yields reports of two cases in the 4th ventricle in Korea. The authors present a case of 65-year-old woman patient with only the symptoms of increased intracranial pressure such as headache, dizziness and vomiting in spite of a large, irregular calcified mass occupying the cerebellar vermis on the brain CT scan. The caudal portion of the tumor attached firmly to the floor of the 4th ventricle and the complete removal of the mass, associated with a good long-term prognosis, was not feasible.

A Case of Oligodendroglioma in the 4th Ventricle

At least 90% of oligodendroglioma have developed above the tentorium, especially in the frontal lobe, but the case of oligodendroglioma arising in the 4th ventricle of the posterior fossa is extremely rare, 0.08% of the total of intracranial tumors. It was first reported by Van Bogaert in 1928. We experienced a case of 11-year-old male patient admitted by headache, nausea and visual disturbance. The operation was performed after brain CT scan, vertebral angiography and ventriculography. But the patient died on the 66th hospital day due to generalized infection unfortunately. It was histopathologically diagnosed the primary oligodendroglioma of the 4th ventricle after autopsy.

Oligodendroglioma in the Fourth Ventricle: Case Report

The authors present a case of oligodendroglioma in the 4th ventricle which is extremely rare in occurrence. The patient is 11 year-old male whose complaints were severe headache and vomiting. In the brain computes tomogram, hyperdense mass seated in the 4th ventricle with marked hydrocephalus. The patient had operation for removal of the tumor. In the operating field, there are no relation of the choroid plexus and specific vesselas but the tumor attached firmly on the floor of the 4th ventricle. The tumor was removed totally. The pathologic specimens were verified oligodendroglioma.