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NEUROIMAGING
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 330-331
 

Bilateral xanthogranuloma of the choroid plexus in an infant


1 Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
2 Department of Paediatrics, Peerless Hospital and B K Roy Research Centre, Kolkata, West Bengal, India
3 Department of Radiology, Peerless Hospital and B K Roy Research Centre, Kolkata, West Bengal, India

Date of Submission09-Nov-2018
Date of Decision04-Apr-2020
Date of Acceptance25-May-2020
Date of Web Publication06-Nov-2020

Correspondence Address:
Dr. Prasad Krishnan
Department of Neurosurgery, National Neurosciences Centre, Peerless Hospital Campus, 2nd Floor 360 Panchasayar, Kolkata, West Bengal.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpn.JPN_160_18

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   Abstract 

Xanthogranuloma of the choroid plexus is a rare, usually incidentally detected and commonly bilateral intraventricular lesion found in the pediatric population. Its characteristic imaging features are described.


Keywords: Cholesterol granuloma, choroid plexus, diffusion-weighted imaging, xanthogranuloma


How to cite this article:
Patel SM, De S, Das S, Krishnan P. Bilateral xanthogranuloma of the choroid plexus in an infant. J Pediatr Neurosci 2020;15:330-1

How to cite this URL:
Patel SM, De S, Das S, Krishnan P. Bilateral xanthogranuloma of the choroid plexus in an infant. J Pediatr Neurosci [serial online] 2020 [cited 2020 Nov 24];15:330-1. Available from: https://www.pediatricneurosciences.com/text.asp?2020/15/3/330/300047




A 1-month-old child underwent a magnetic resonance imaging (MRI) study following recovery from neonatal meningitis and septicemia (as ultrasound examination of the brain to see for hydrocephalus had suggested some pathology in the lateral ventricles). T1-weighted imaging showed bilaterally symmetric hyperintense mass in abutting walls of both lateral ventricles. The lesion was isointense on T2 sequences and showed restriction on diffusion-weighted imaging (DWI). It appeared to be attached to the choroid plexus and had areas of hemorrhage seen on gradient recalled echo (GRE) sequences [Figure 1] and [Figure 2]. A provisional diagnosis of xanthogranuloma of the choroid plexus was made.
Figure 1: (A) T1 axial MR images showing bilateral hyperintense lesions in the lateral walls of the ventricles, (B) T2-weighted axial images showing the lesions attached to the choroid plexus, of mixed intensity and with edema in adjacent brain, and (C) T1-weighted parasagittal images showing the lesion is in the trigone of the lateral ventricle

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Figure 2: (A) Gradient recalled echo (GRE) imaging sequence showing a hypointense rim––probably representing hemorrhage, (B) diffusion-weighted image (DWI) sequence showing hyperintensity (diffusion restriction) of the lesions––a sign of paramount importance in differentiating it from other neoplastic pathologies with (C) hypointensity of the lesions in apparent diffusion coefficient (ADC) sequence

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Xanthogranulomas of the choroid plexus are benign and rare lesions occurring in the choroid plexus of the lateral and third ventricles.[1],[2] Though on occasion, they may cause hydrocephalus or intraventricular hemorrhage, they are usually asymptomatic and found incidentally while imaging for other conditions.[1],[2] They are usually bilateral[3] and have an autopsy incidence of 1.6%–7.0%[1],[2] with many of these being extremely small and insignificant. They are different from choroid plexus cysts which are commonly seen on antenatal ultrasound (1% of all cases) and are formed by infolding of the neuroepithelium into the stroma and usually disappear by the 28th week of gestation.[4]

Yetkinel and Bek[2] have described their micro-architecture as consisting of “cholesterol clefts, lymphocyctic infiltration, giant cells with multiple nucleoli, foamy macrophages (xanthoma cells), fibrous proliferation, and hemosiderin deposits.” Several causes of pathogenesis ranging from cellular degeneration (desquamation of cuboidal epithelial cells and their sequestration), tissue reaction to hemorrhage, and even systemic disturbances of lipid metabolism have been put forth.[1],[2] Hemorrhages at the periphery of these lesions or pathological accumulation of lipids leading to inflammation may manifest as hyperintensities adjacent to the lesions on T2-weighted sequences. In our patient, hyperintensities in the white matter might also have been consequent to the hemorrhage in the cysts or a sequelae of meningitis. However, diffusion restriction in DWI sequences and the fact that the lesions were bilateral (a pathognomonic radiological finding[2]) led us to this diagnosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
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.  Back to cited text no. 1
    
2.
Yetkinel S, Bek S Choroid plexus xanthogranuloma: Is it an incidental finding? Turk J Neurol 2016;22: 194-5.  Back to cited text no. 2
    
3.
Pear BL Xanthogranuloma of the choroid plexus. AJR Am J Roentgenol 1984;143:401-2.  Back to cited text no. 3
    
4.
Naeini RM, Yoo JH, Hunter JV Spectrum of choroid plexus lesions in children. AJR Am J Roentgenol 2009;192: 32-40.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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