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Neuroradiology Case of the Week

Case 356

October 2008

Daniel Ginat, MD, MS and P-L Westesson, MD, PhD, DDS

Clinical Presentation: Patient 1 is a 63-year-old with male with concern for intracranial hemorrhage. Patient 2 is a 65-year-old male with mental status changes.

Imaging Findings: In both patients, the lateral ventricle trigone glomus contains rounded, mass-like lesions containing a fat-density component and a rim of calcification.

Diagnosis: Xanthogranuloma

Discussion: Xanthogranulomas are benign lesions that occur in the glomus of the lateral ventricle of the choroid plexus and are frequently bilateral [1-2]. On CT, these lesions are well-circumscribed and found to contain fat-density material, calcifications, and sometimes a cystic component. On diffusion-weighted MR imaging, xanthogranulomas often demonstrate high-signal intensity [1].
     Although they may become rather large and mass-like, xanthogranulomas should not be mistaken for neoplasm. Rather, they are considered incidental findings that result from inflammatory or degenerative processes, as they contain lymphocytes and macrophages. Other inflammatory lesions that can involve the choroid plexus include rheumatoid nodule and sarcoid granuloma. The differential diagnosis for choroid plexus neoplasm comprises choroid plexus papilloma (most common), choroid plexus carcinoma, ependymoma, meningioma, and metastatic disease.
     Clinically, xanthogranulomas are generally of no significance. As a form of degenerative process, xanthogranulomas increase in prevalence with age. Very rarely, these may produce symptoms, manifesting as visual disturbances [3].

References:

1. Grossman RI, Yousem DM. Neuroradiology: The Requisites, vol. 2, Philadelphia: Mosby/Elsevier, 2003.
2. Loevner, L. Brain Imaging Case Review. Philadelphia: Mosby/Elsevier, 1999.
3. Hicks MJ, Albrecht S, Trask T, Byrne ME, Narayan RK, Goodman JC. Symptomatic choroid plexus xanthogranuloma of the lateral ventricle. Case report and brief critical review of xanthogranulomatous lesions of the brain. Clin Neuropathol. 1993 Mar-Apr;12(2):92-6. [PubMed]