Extended calcified and ossified choroid plexus papilloma in the medial temporal surface as a cause of epilepsy: case report

Abstract

Choroid plexus papillomas (CPP) are benign and slow growing tumors (WHO Grade I). The majority of these lesions occur during the first 2 years of life and are mostly located in the ventricular system. Moreover, dense calcification is uncommon. We present a rare case of a 38 years-old man with a two years history of seizures, in which contrast enhanced magnetic resonance imaging (MRI) showed a heterogeneous image with a hypointense center surrounded by a hyperintense halo, for which our first suspicion was a high-grade glioma.   Histologic evaluation showed multiple free-floating papillae with a central fibrovascular core with dense dystrophic calcifications and osseous metaplasia. The cells showed focal immunoreactivity for vimentin, glial fibrillary acidic protein, S-100 protein, TTF-1 and cytokeratin 7. In this case we noted that plexal epithelial cells show varying stages of intracytoplasmic vacuolation with secretion of an amourphous material which apparently causes the extracellular matrix destruction and the formation of irregular calcifications. Ectopic presentation of CPP is extremely rare. The pathogenesis is controversial, and it might be associated to secretion of several pro-tumorigenic factors, cellular senescence and its secretory phenotype can be involved in the extensively unknown occurrence of Senescence-Associated Secretory Phenotype.