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| TEACHING IMAGES |
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| Year : 2021 | Volume
: 9
| Issue : 2 | Page : 359-360 |
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Choroid plexus xanthogranuloma: Radiological features
S Sheetal1, S Amith Kumar2
1 Department of Neurology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, India
2 Department of Neurology, Lourdes Hospital, Kochi, Kerala, India
| Date of Submission | 19-May-2021 |
| Date of Decision | 01-Jun-2021 |
| Date of Acceptance | 03-Jun-2021 |
| Date of Web Publication | 29-Dec-2021 |
Correspondence Address:
Dr. S Sheetal
16 FG, The Edge, Skyline Apartments, Thirumoolapuram, Thiruvalla - 689 115, Kerala
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/amhs.amhs_119_21
Choroid plexus xanthogranulomas are rare tumors of the central nervous system. They are usually asymptomatic and are often reported as incidental autopsy findings. Although they are mostly asymptomatic, rarely, these tumors can result in obstructive hydrocephalus. The etiology of these tumors is often uncertain. They are also known as cholesterol granuloma and are typically composed of large foam-filled cells with clusters of lymphocytes and macrophages and multinucleated giant cells. The radiological features vary, owing to the heterogeneity of content. We hereby report the neuroimaging findings of choroid plexus xanthogranuloma, located in bilateral lateral ventricles, which was detected incidentally in a patient.
Keywords: Choroid plexus xanthogranulomas, incidental, lateral ventricles, radiological appearance
How to cite this article:
Sheetal S, Kumar S A. Choroid plexus xanthogranuloma: Radiological features. Arch Med Health Sci 2021;9:359-60 |
| Case Description | |  |
A 64-year-old woman presented with a history of slip and fall, followed by holocranial headache. There was no history of loss of consciousness, vomiting, or seizures. Neurological examination was unremarkable. Magnetic resonance imaging (MRI) of the brain showed bilateral rounded choroid plexus lesions, located in the atria and trigone of bilateral lateral ventricles, showing near cerebrospinal fluid intensity on T2 without complete attenuation on fluid attenuation inversion recovery (FLAIR) images, and high signal on diffusion-weighted images (DWI), with low apparent diffusion coefficient values, suggestive of choroid plexus xanthogranulomas [Figure 1] and [Figure 2]. | Figure 1: Magnetic resonance imaging of the brain; (a) Coronal T2 images showing bilateral rounded choroid plexus lesions, located in the atria and trigone of bilateral lateral ventricles, showing near cerebrospinal fluid intensity (blue arrow); (b) Axial fluid attenuation inversion recovery images showing incomplete attenuation of these lesions (yellow arrow)
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 | Figure 2: (a) Axial diffusion-weighted images showing bilateral rounded choroid plexus lesions, located in the atria and trigone of bilateral lateral ventricles with high signal (green arrow); (b) Axial apparent diffusion coefficient showing low values of these lesions (purple arrow), suggesting diffusion restriction
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These are rare lesions of the central nervous system, the incidence on autopsy being reported as 1.6%–7%.[1] They are usually asymptomatic and found incidentally on neuroimaging. Occasionally, they may cause hydrocephalus or intraventricular hemorrhage, but they rarely warrant surgery.[2] Histologically, they are composed of cholesterol clefts, lymphocytes, giant cells, foamy macrophages (xanthoma cells), and hemosiderin.[2] They have heterogeneous radiologic features because of their lipid and blood components. On MRI, they usually appear isointense or hypointense on T1-weighted images and hypointense on T2-weighted images and show diffuse or rim-like enhancement following gadolinium administration. The hyperintense appearance on DWI is the most important clue to diagnosis.[3] Hemorrhages at the periphery of these lesions or accumulation of lipids may manifest as hyperintensities adjacent to the lesions on T2-weighted sequences.[4] The differential diagnosis includes other lesions of lateral ventricles such as papillomas, meningiomas, and ependymomas.[2] Choroid plexus papillomas are isointense on T1 and iso to hypointense on T2 and do not restrict on DWI.[5] Ependymoma is heterogeneously hypointense on T1 and hyperintense on T2, and FLAIR with homogenous contrast enhancement on MRI and DWI shows no restriction.[5] Hence, bilaterality of the lesion and the presence of diffusion restriction help in the identification of choroid plexus xanthogranuloma. This benign lesion can result in unwarranted panic unless diagnosed and counseled properly.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Patel SM, De S, Das S, Krishnan P. Bilateral xanthogranuloma of the choroid plexus in an infant. J Pediatr Neurosci 2020;15:330-1.  [Full text] |
| 2. | Emon ST, Ozturk E, Meric K, Aker F, Orakdogen M. Symptomatic bilateral xanthogranuloma of the choroid plexus. J Neurosci Rural Pract 2017;8:S123-6. |
| 3. | Yetkinel S, Bek S Choroid plexus xanthogranuloma: Is it an incidental finding? Turk J Neurol 2016;22:194-5. |
| 4. | Miranda P, Lobato RD, Ricoy JR, Lagares A, Ramos A. Xanthogranuloma of the choroid plexus of the third ventricle: Case report and literature review. Neurocirugia (Astur) 2005;16:518-22. |
| 5. | Park SH, Park HR, Chi JG. Papillary ependymoma: Its differential diagnosis from choroid plexus papilloma. J Korean Med Sci 1996;11:415-21. |
[Figure 1], [Figure 2]
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