Solitary metastasis from renal cell carcinoma to the choroid plexus: A case illustration and review of the literature
- Department of Neurosurgery, Riuniti Hospital, Foggia, Italy,
- Division of Neurosurgery, Giovanni XXIII Hospital, Bari, Italy,
- Department of Neurosurgery, University of Foggia, Foggia, Italy,
- Department of Neurosurgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany,
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy.
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Roma, Italy.
Augusto Leone, Department of Neurosurgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany.
DOI:10.25259/SNI_297_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Antonio Colamaria1, Maria Blagia2, Matteo Sacco1, Savino Iodice1, Francesco Carbone3, Nicola Pio Fochi1, Augusto Leone4, Matteo Landriscina5, Giulia Coppola6, Elena De Santis7, Guido Giordano5. Solitary metastasis from renal cell carcinoma to the choroid plexus: A case illustration and review of the literature. 27-May-2022;13:227
How to cite this URL: Antonio Colamaria1, Maria Blagia2, Matteo Sacco1, Savino Iodice1, Francesco Carbone3, Nicola Pio Fochi1, Augusto Leone4, Matteo Landriscina5, Giulia Coppola6, Elena De Santis7, Guido Giordano5. Solitary metastasis from renal cell carcinoma to the choroid plexus: A case illustration and review of the literature. 27-May-2022;13:227. Available from: https://surgicalneurologyint.com/surgicalint-articles/11615/
Background: Metastatic renal cell carcinoma (RCC) of the choroid plexus is an exceedingly rare condition, with only 35 reported cases to date. Surgical resection of these tumors poses a unique challenge to neurosurgeons since evidence-based treatment guidelines are yet to be designed.
Case Description: The authors describe the case of a 58-year-old woman presenting with progressive neurological deterioration 5 years after a right nephrectomy for a WHO 2016 Stage I RCC. A head, contrast-enhanced, and magnetic resonance revealed signs of obstructive hydrocephalus and a homogeneously contrast-enhancing 5 cm mass located in the trigone of the right lateral ventricle. Furthermore, a search of the literature was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After screening for duplicates, 35 publications met the eligibility criteria. Finally, 17 manuscripts were included for analysis. Moreover, a detailed description of an illustrative case is provided. The median age at diagnosis for intraventricular metastasis from RCC was 62.9 years, showing a slight female prevalence. The lateral ventricles were reported as the most frequent location with only one patient presenting with obstructive hydrocephalus caused by the obliteration of Monro foramen. Management options included either open craniotomy or radiosurgery.
Conclusion: The management of choroid plexus metastasis from RCC is still controversial with various authors proposing different treatment strategies. In this article, in addition to an in-depth case description, a qualitative review of the literature on metastatic RCCs of the choroid plexus using the PRISMA is provided.
Keywords: Brain metastasis, Cerebrospinal fluid, Choroid plexus, Hydrocephalus, Renal cell carcinoma, Stereotactic radiosurgery
Solitary metastases to the choroid plexus are very rare. Three large postmortem series have reported the frequency as being 0.9%, 2.6%, and 4.6% in patients with systemic cancer.[
In the present report, the authors describe the case of a metastatic RCC to the choroid plexus of the right lateral ventricle in a 58-year-old patient treated with total nephrectomy 5 years before presentation. In addition, the first systematic review of the available literature on RCC causing metastasis to the choroid plexus is provided.
Patient’s medical history including comorbidities, concomitant medications, diagnosis, and treatment was taken from clinical records. Written informed consent for the case publication was obtained from the patient. A review of the literature was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Screening was performed by reviewing article titles or full text up to October 2021 using the electronic databases PubMed and the Cochrane Library. The primary search included “RCC” and “Choroid plexus” in the article titles. Only publications in the English language were included and the extracted citations were then screened for duplicates. Later operator “and” was applied on the extracted records by the use of the above-mentioned terms to narrow the scope of the review. Thirty-five articles met eligibility criteria for our qualitative systematic review and 18 were excluded because not relevant. Finally, 17 papers were included in the qualitative analysis [
A 58-year-old right-handed woman presented to our attention with worsening headaches limiting her ability to perform daily tasks, gradual memory deficits, and progressive gait instability. The medical history was significant for a diagnosis of Stage I American Joint Committee on Cancer tumor-node-metastasis RCC that was treated with a right nephrectomy alone 5 years before presentation. At admission, her neurological examination was intact with no focal deficits and normal anal and urinary sphincter continence. A head, contrast-enhanced, and magnetic resonance imaging (MRI) investigation demonstrated a homogeneously contrast enhancing, 5 cm oval mass presumably originated from the choroid plexus in the trigone of the right lateral ventricle with signs of obstruction and dilation of the temporal horn and atrium of the contralateral ventricle [
The postoperative period was unremarkable except for a transient left arm paresis that quickly subsided. The patient’s amnesia gradually improved, and the headaches disappeared, and she was discharged after a control computed tomography (CT) [
The final pathological examination revealed the peculiar pattern of gland tissue with nests of clear cells set within a sinusoidal vascular network [
Analysis of previously reported cases
To date, 35 cases of solitary metastasis from RCC to the choroid plexus have been reported as summarized in [
The mean follow-up time of this population was 25.8 months (range: 2 weeks–30 months), with one postoperative death and one vegetative state. Survival times were not reported in 7 cases (23%), whereas in the cohort described by Crisman et al.,[
Epidemiology of RCC metastases to the ventricular system
Approximately 10–40% of patients diagnosed with cancer will eventually develop brain metastases over the course of their disease with 0.9–4.5% of malignancies found in the ventricular system.[
Metastasis to the choroid plexus
In line with the present review, Toms et al.[
Radiological and pathological diagnosis
For intraventricular metastases, the CT and MRI findings are nondefining, despite being crucial when planning for excision surgery or stereotactic radiosurgery (SRS), allowing the identification of the location, and the number of lesions. In general, solitary metastases from RCC to the choroid plexus appear hyperdense on CT scans and homogeneously contrast enhanced, surrounded by excessive vasogenic edema and intraventricular hemorrhage.[
Microscopic examination of choroid plexus metastases from RCC demonstrates nests of clear cells with the usual acinar pattern, along with hyperchromatic and pleomorphic nuclei contained in a clear cytoplasm and a stroma rich in small blood vessels.[
Current treatment and future perspectives
At present, there is no consensus over the treatment of intraventricular metastases and the preferred surgical approach is decided on several empirical factors including the location of the lesion, the size and number of tumors, and the patient’s performance status.[
Metastatic RCC of the choroid plexus represents an extremely rare entity. For instance, due to the lack of evidence-based guidelines, treatment options remain solely grounded on empirical data. This systematic review of the literature shows that, although not always feasible, SRS is generally more effective in terms of overall survival, tumor control rate, and postoperative recovery when compared with open surgical techniques.
AC, MS, ML, SI, and MB collected the case. NPF, FC, AL, and GG performed the literature research, wrote the paper, and assessed figures and tables. EDS reviewed and confirmed the histological diagnosis. GG, EDS, FC, AL, and NPF made the revision and supervised the project.
The data that support the findings of this study are available from the corresponding author on reasonable request.
Patient’s consent not required as patient’s identity is not disclosed or compromised.
There are no conflicts of interest.
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