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Patient Case Presentation
Neurosurgery Red ServiceGabriel Zada, MD
Sean McNatt, MD
LAC-USC Medical Center
May , !""#
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Patient $%A%
& History of Present Illness:
'!! (ont) old *e(ale +
'+rritability, nauseavo(iting, decreased %o%
inta.e *or # days rior to ad(ission
'Lo/ grade *ever er arents
'Multile visits to e(ergency roo( 0 clinics
over last /ee., got intravenous *luids andarents told )er illness /as viral
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& History of Present Illness (continued):' Presented again to Pediatrics 1R /it) let)argy, altered (ental
status
' 2radycardic to ulse o* 3"s, )yertensive
' +ntubated and sedated in 1R *or air/ay rotection
'No recent sei4ures, no sic. contacts
& Past Medical History:
' Past (edical and surgical )istory unre(ar.able' 5er( birt), unco(licated
'Nor(al develo(ental (ilestones
Patient $%A%
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& Physical Exam:
'Patient intubated, sedated
'So(nolent but arousable
'Regards e6a(iner, not *ollo/ing co((ands'Puils bris.ly reactive and e7ual
'16traocular (ove(ents intact
'5one nor(al
'Moving all e6tre(ities /it) *ull o/er
'Nor(oce)alic, no e6ternal signs o* trau(a
Patient $%A%
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C5 +(aging
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+nitial Manage(ent
& Patient ad(itted to Neurosurgical +CU
& Rig)t ventriculosto(y laced
& +nitial +CPs in t)e !"s, nor(ali4ed /it) drainage& CS8 yello/, roteinaceous
& 9ig) ventriculosto(y outut :;
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MR+ 2rain
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MR Sectroscoy
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MR Sectroscoy
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>erative Manage(ent
& Rig)t arieto-occiital cranioto(y
& +ntraoerative ventriculosto(y used to
cannulate ventricle& Gross 5otal Resection
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C)oroid Ple6us 5u(ors?Epidemiology
& Co(rise "%
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& Most resent /it) )ydroce)alus secondary to CS8 overroduction:3-B
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& 2elieved to arise sontaneously& Many tu(ors de(onstrated to )arbor c)ro(oso(al
aberrations :usually c)ro(oso(e !!=
& CPP )as been lin.ed e6eri(entally to t)e S"
DNA ri(ate virus& Large 5 antigen is t)e (aEor regulator o* t)e S"
virus rotein roducts, and interacts /it) t)e roducto* t)e
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C)oroid Ple6us Paillo(a?Pathology
& Cauli*lo/er-li.eH aearance& 1vidence o* rior )e(orr)age o*ten observed
& 5u(or sur*ace is *rond-li.e, si(ilar to nor(al c)oroidle6us
& Stro(a )as a *ibrous consistency
& Can di**erentiate CPP *ro( aillary eendy(o(a basedon )istology?' 1endy(o(a )as stro(a co(osed o* neuroglia and eit)elial
cells /it) cilia
& +((uno)istoc)e(istry not e6tre(ely )el*ul *or t)eselesions
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C)oroid Ple6us Carcino(a?Pathology
& !B-B@ o* c)oroid le6us neolas(s are carcino(a& Di**erentiating *eatures? :er F9> criteria=
'Nuclear atyia, NC ratio, (itotic *igures
' Loss o* nor(al aillary arc)itecture
' +nvasion o* brain arenc)y(a t)roug) eendy(a& +((uno)istoc)e(istry /it) )ig)er Ii#3 inde6
labeling
& ariant o* CPP /it) stro(al invasion JJJ
' 2ranc)ing aillae /it) t)in-/alled, ectactic blood vessels' More co(le6 arc)itecture t)an standard CPPs
C)oroid Ple6us 5u(ors?Pathology
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C)oroid Ple6us Paillo(a-Normal papillary architecture-Columnar Cu!oidal cells
-"ingle layer stal#s
C)oroid Ple6us Carcino(a-Piled up epithelium-$oss of papillary architecture
C)oroid Ple6us 5u(ors?
" f f " l I
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& Study by M Levy et al, Neurosurgery, !"";
& Many ot)er series o* CPCs )ave a /ide variability in survival ti(esand outco(es
& ariant o* :benign= CPP /it) invasive c)aracteristics
& Retrosective revie/ o* ;! atients
& atients /it) traditional CPPs, atients /it) variant CPPs yet
invasive :atc)y, local invasion= yet benign )istology& >nly one subtotal resection in atient /it) variant
& 8ive year survival rate? ;""@
& Su((ary? Stro(al invasion (ay not be as use*ul a criterion o*carcino(a as nuclear *eatures and loss o* arc)itecture
& Gross total resection is t)e .ey in all cases
"ignificance of "tromal In%asion
5 i l CPP
ariant :+nvasive= CPP?
& l t f ith li
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5yical CPP -&eplacement of epithelium'
-In%asion into surrounding !rain
&rom M $e%y et al' Neurosurgery' **+
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& C5 o*ten de(onstrates unctate calci*ication
& MR+?
' +sodense to brain on 5; i(aging' 2rig)tly en)ancing lesions
' 1nlarged c)oroidal artery can be noted
' CP carcino(as /it) necrosis, calci*ication,
)e(orr)age, )o(ogeneous en)ance(ent' CP aillo(as /it) (ottledH aearance
C)oroid Ple6us 5u(ors?&adiographic eatures
C)oroid Ple6us 5u(ors? M& "pectroscopy
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& Study by Irieger et al,Neurosurgical ocus, !""
