Shunt-related abdominal metastases in a child with choroid plexus carcinoma: case report.
ABSTRACT Metastasis of primary brain neoplasms to the abdomen through a ventriculoperitoneal shunt (VPS) has been described for many types of tumors, including medulloblastoma, germ cell tumors, astrocytoma, oligodendroglioma, lymphoma, ependymoma, and melanoma. Choroid plexus tumors (CPTs) are located within the cerebrospinal fluid-containing spaces of the brain and frequently disseminate throughout the craniospinal subarachnoid space, yet VPS-related metastasis of a CPT to the abdomen has not been reported previously.
We present the case of a 3-year-old boy with choroid plexus carcinoma of the lateral ventricle and preoperative intraventricular dissemination of the tumor. The patient later developed VPS-related abdominal metastases causing abdominal ascites.
Surgical resection of the tumor was followed by chemotherapy and craniospinal radiation, but the tumor further disseminated throughout the craniospinal subarachnoid space. When the child presented with abdominal ascites, the distal VPS catheter was externalized and drained cerebrospinal fluid at a rate of more than 750 ml/d. Paracentesis was performed for persistent ascites, and cytological analysis of the fluid revealed metastatic tumor cells.
The child died from widely metastatic tumor and aspiration pneumonia. CPT metastasis to the abdomen through a VPS should be considered in patients with the appropriate clinical findings. This condition may exacerbate overproduction of cerebrospinal fluid, which can occur with CPTs, and treatment must be individualized. Unusual options may be considered, such as long-term shunt externalization or paracentesis.
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ABSTRACT: We describe the case of a 7-year-old white boy who presented with a mixed malignant germ cell tumor with predominant embryonal carcinoma component. The patient underwent right ventriculoperitoneal (VP) shunt placement for hydrocephalus at the time of diagnosis. He received multiagent chemotherapy followed by second-look surgery. Despite an initial response to chemotherapy, the patient had metastatic progression of disease within the craniospinal axis. He received craniospinal radiation and high-dose chemotherapy. Although, he had resolution of central nervous system (CNS) disease, follow-up off treatment revealed extra-abdominal metastases. This is a rare case to discuss abdominal metastasis of a CNS germ cell tumor in a patient with a VP shunt. The influence of VP shunt placement on treatment and management decisions of patients with CNS tumors will be discussed.Journal of Pediatric Hematology/Oncology 01/2012; 34(1):e12-6. · 0.96 Impact Factor
Article: Imaging Evaluation of CSF Shunts.[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE. The objective of this article is to describe an approach to imaging CSF shunts. Topics reviewed include the components and imaging appearances of the most common types of shunts and the utility of different imaging modalities for the evaluation of shunt failure. Complications discussed include mechanical failure, infection, ventricular loculation, overdrainage, and unique complications related to each shunt type. CONCLUSION. This article reviews the imaging features of common CSF shunts and related complications with which radiologists should be familiar.American Journal of Roentgenology 01/2014; 202(1):38-53. · 2.74 Impact Factor
Chapter: Choroid Plexus Tumors[Show abstract] [Hide abstract]
ABSTRACT: Choroid plexus tumors (CPTs) are rare, primary brain tumors arising from the neuroepithelium of the choroid plexus. Although they may be found in patients of any age, the vast majority occur in the pediatric population. Up to 70% of these neoplasms occur in children, with over half arising in children under 2 years of age . The annual incidence for CPTs is low, with 0.3 cases/ million reported . Despite this, the annual incidence in the pediatric age group is as high as 3–5%, and up to 12% in those children under 2 years of age [22, 25]. CPTs account for 0.4–0.8% of all brain tumors, between 0.9% and 3% of all primary pediatric brain tumors, and up to 10–20% of pediatric brain tumors during the first year of life [1, 10, 11, 46]. Case reports exist describing in utero findings of CPTs by ultrasound, or of the diagnosis of CPTs in the neonate, suggesting that some of these lesions may occur congenitally [3, 36, 55].12/2009: pages 587-596;