Literature ReviewBilateral Choroid Plexus Metastasis from Papillary Thyroid Carcinoma: Case Report and Review of the Literature
Introduction
Intraventricular tumors may arise from the ventricular wall, adjacent cerebral structures, or extracranial neoplastic lesions. The most common intraventricular neoplastic lesions include choroid plexus papilloma and meningioma. Metastases to the ventricles are infrequent, accounting for 6% of intraventricular tumors. Renal cell carcinoma (RCC) is the most reported primary carcinoma that causes intraventricular metastasis 8, 9. Most intraventricular metastases result from hematogenous dissemination of primary tumor to the choroid plexus via the anterior or posterior choroidal artery. Metastatic lesions are most commonly (>50%) located in the trigone of lateral ventricles because of the large tufts of choroid plexus in the trigone 6, 9. Choroid plexus can be the first site of metastasis for extracranial malignancies, but involvement of the choroid plexus usually accompanies metastases to other sites. To our knowledge, among 40 cases of choroid plexus metastasis reported thus far, tumor metastasized bilaterally in only 1 case of colon adenocarcinoma (11). We present a case of bilateral choroid plexus metastases arising from papillary thyroid carcinoma (PTC).
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Case Report
A 52-year-old woman presented with a 6-month history of severe headache, nausea and vomiting, and speech disturbance. Neurologic examination revealed right hemiparesis and mild speech disturbance mimicking Wernicke aphasia. She had a history of PTC of classic variant diagnosed about 3 years ago, followed by thyroidectomy and radioiodine ablation therapy. Magnetic resonance imaging (MRI) depicted a well-circumscribed mass in both lateral ventricles that homogenously enhanced after gadolinium
Discussion
Tumor spread to the choroid plexus may occur through a hematogenous route via the anterior or posterior choroidal arteries or through cerebrospinal fluid seeding. Tumors most likely to metastasize to the choroid plexus are RCC and lung adenocarcinoma. Other tumors with documented spread to the choroid plexus include colon, stomach, breast, thyroid, bladder, melanoma, and lymphoma. In pediatric patients, metastases to the choroid plexus have been reported to arise from Wilms tumor,
Conclusions
Metastases to the choroid plexus from extracranial tumors are very rare, with only 40 cases reported thus far. A demographic analysis of these cases suggests there may be a tropism of some extracranial carcinomas, such as RCC, for choroid plexus. We report the eighth case of choroid plexus metastasis arising from thyroid cancer. Although it is rare, choroid plexus metastasis from PTC must be included in the list of differential diagnoses for intraventricular tumors, especially in patients with
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.