Spinal drop metastasis from a posterior fossa choroid plexus papilloma

Abstract

Choroid plexus papillomas (CPPs) are typically considered as benign tumors, with a favorable long-term prognosis. Drop metastasis of CPP into the spinal subarachnoid space is rare. We report a 42-year-old woman who presented with headache and back pain 6 years after removal of a posterior fossa CPP. Magnetic resonance imaging revealed mass lesions in the lumbosacral subarachnoid space and recurrent intracranial tumor. The lesions were resected and histologically diagnosed was CPP. We consider that CPP can spread via cerebrospinal fluid pathways and cause spinal drop metastasis. Therefore, it is necessary to evaluate the whole spinal axis and to perform periodic follow-up examinations in patients with CPP.

Keywords: Cerebrospinal fluid; Choroid plexus papilloma; Metastasis; Posterior fossa; Spinal.

Fig. 1

Preoperative T1-weighted contrast-enhanced magnetic resonance imaging (MRI) of the posterior fossa showing a fourth ventricle mass (A) and postoperative MRI showing total removal of tumor (B). MRI taken 6 years after operation showing a recurrent tumor (C) and spinal drop metastasis at the level of the L3-S1 vertebra (D).

Fig. 2

Photomicrographs of a section of a biopsy specimen obtained from initial posterior fossa tumor (A) showing papillary growing fibrovascular structures with columnar epithelium. Photomicrographs of a section of a biopsy specimen obtained from recurrent posterior fossa tumor (B) and lumbar spinal tumor (C) showing similar histological findings as shown in A. There was no evidence of cellular atypism, necrosis or mitotic activity (H&E×100).