Presentation
Altered vision. Referred to ophthalmology. Field defect on objective testing.
Patient Data
8.4 cm solid-cystic mass centered on the trigone of the right lateral ventricle. This has a lobulated avidly enhancing 4 cm solid component which is closely related to the choroid plexus. The mass extends into the right temporal and parietal lobes.
Resultant midline shift.
MRI BRAIN with contrast
8.4 cm solid-cystic mass centered on the trigone of the right lateral ventricle. This has a lobulated avidly enhancing 4 cm mural nodule which is closely related to the choroid plexus. The mass extends into the right temporal and parietal lobes.
This is causing significant mass effect on the pons/brainstem with mild-moderate midline shift. No hydrocephalus.
No synchronous lesion.
HISTOLOGY - SURGICAL SPECIMEN
A malignant tumor composed of round-elongated cells containing hyperchromatic nuclei situated in a fibrillary stroma. Several cells contain bizarre nuclei. There are Rosenthal fibers and eosinophilic protein droplets (granular bodies). Tumor cells stain positively for GFAP.
The appearances are those of a pilocytic astrocytoma.
Case Discussion
This case was of interest from the initial imaging as there was some debate between the radiologists and clinicians as to the potential tumor type.
Some were of the belief it was centered on and arising from the choroid plexus, although the demographics of the patient (adult vs. young child) were not typical.
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