Choroid plexus papilloma MRI

A 3 yo female child presents with vomiting.

MRI Brain

Findings:
Axial T1w image shows a lobulated, intra ventricular mass in the left lateral ventricle, isointense
to grey matter, left lateral ventricle slightly expanded compared to right. Intense homogenouse enhancement on post contrast T1, frond like surface projections. A single linear vascular flow void noted on Non contrast T1.

Radiological and histopathological diagnosis: Choroid plexus papilloma.

Choroid plexus papilloma

Syn: Choroid plexus papilloma (CPP)
An intraventricular, papillary neoplasm derived from choroid plexus epithelium.

Imaging wise a lobuated well circumscribed intra ventricular Cauliflower-like mass with frond like surface projections intensely and homogenously enhancing on post contrast is a diagnostic clue.
Most common locations, in ~ 50% cases atrium of lateral ventricle, left > right. , followed by fourth ventricle and third ventricle. Multiple masses are also known.
On CT density of mass is iso- or hyperattenuating in ~75% cases with an associated calcification in ~25%.
On MRI Iso intense to cortical grey matter on T1 and iso to hyper intense on T2 with an  associated linear vascular flow voids within the lesion.
Usually larger in size by the time of diagnosis, often associated with overproduction" hydrocephalus".

DD 
Choroid plexus carcinoma (CPCA) : Difficult to distinguish CPP from CPCA by imaging findings alone. Often associated with adjacent brain parenchymal invasion.

Clinical Presentation
Most common signs/symptoms: Macrocrania, bulging fontanelle, vomiting, headache, ataxia
Child in first two years of life with signs and symptoms of elevated ICP
Focal neurologic signs and symptoms suggests CPCA.

Prognosis
Benign, slowly growing. May seed CSF pathways (CPP & CPCA)

Treatment
Total surgical resection.

Reference : Diagnostic imaging Osborn.