Solitary metastasis of renal cell carcinoma to the third ventricle mimicking a colloid cyst: case report

Abstract

Colloid cysts are the most common third ventricle lesions and metastasis to this area is rare. We presented a case of solitary metastasis from a renal cell carcinoma to the third ventricle choroid plexus mimicking a colloid cyst. A 53-year-old man, who had a history of renal cell carcinoma 12 years ago, was operated for single third ventricle lesion and hydrocephalus via a transcallosal approach. Total removal could not be performed due to intraoperative massive bleeding. Histological examination revealed a metastatic renal cell carcinoma. The patient died on the postoperative 13 th day because of bleeding from the residual tumor. Stereotactic radiosurgery and ventriculoperitoneal shunting might be favorable in such cases in order to avoid serious complications. KeywOrds: Renal cell carcinoma, Choroid plexus, Third ventricle, Metastasis, Colloid cyst ÖZÜçüncü ventrikülün en sık görülen lezyonları kolloid kistlerdir ve bu bölgeye metastazlar çok nadir gözlenir. Biz, görünümü kolloid kiste benzeyen, renal hücreli karsinomun 3. ventrikül koroid pleksusuna metastazı olan bir olguyu bildirdik. Elli üç yaşında, 12 yıl önce renal hücreli karsinom tanısı alan, erkek hasta; tek 3. ventrikül metastazı ve hidrosefali nedeni ile opere edildi. Aşırı intraoperatif kanama nedeni ile tümör tamamen çıkartılamadı. Histolojik sonuç, renal hücreli karsinom metastazı idi. Hasta rezidüel tümör içerisine ve oluşan kanama nedeniyle ameliyat sonrası 13. günde öldü. Bu tür hastalarda cerrahi girişimin yaratacağı ciddi komplikasyonları engellemek için stereotaktik radyocerrahi ve ventriküloperitoneal şant tedavisi daha uygun olabilir.

Solitary metastasis from renal cell carcinoma to the choroid plexus: A case illustration and review of the literature

“…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. [ 8 , 18 ] Further analysis reveals positivity for keratin and epithelial membrane antigen, confirming the epithelial origin of the tumor, and negativity for chromogranin and transthyretin, ruling out benign tumors such as paraganglioma and choroid plexus adenoma. [ 17 ]…”

“…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. [ 8 ] Although microsurgical resection has been successfully adopted for most solitary metastasis in patients with a good clinical course, growing evidence suggests that SRS is associated with a median overall survival of 2 years (4–12 months with open surgical resection), an approximate 96% tumor control rate (compared with 79% for surgical resection), and a faster postoperative recovery. [ 3 , 8 , 22 , 24 ] Although open craniotomy with gross-total resection presents higher morbidity and mortality rates compared with SRS,[ 3 ] the latter should only be considered in case of intraventricular metastasis not exceeding 4 cm in diameter.…”

“…[ 8 ] Although microsurgical resection has been successfully adopted for most solitary metastasis in patients with a good clinical course, growing evidence suggests that SRS is associated with a median overall survival of 2 years (4–12 months with open surgical resection), an approximate 96% tumor control rate (compared with 79% for surgical resection), and a faster postoperative recovery. [ 3 , 8 , 22 , 24 ] Although open craniotomy with gross-total resection presents higher morbidity and mortality rates compared with SRS,[ 3 ] the latter should only be considered in case of intraventricular metastasis not exceeding 4 cm in diameter. [ 8 ] As for the present case, SRS did not represent the treatment of choice since the diameter of the lesion and the overall general status of the patient allowed for a gross-total microsurgical resection.…”

“…[ 3 , 8 , 22 , 24 ] Although open craniotomy with gross-total resection presents higher morbidity and mortality rates compared with SRS,[ 3 ] the latter should only be considered in case of intraventricular metastasis not exceeding 4 cm in diameter. [ 8 ] As for the present case, SRS did not represent the treatment of choice since the diameter of the lesion and the overall general status of the patient allowed for a gross-total microsurgical resection. For instance, recent evidence shows how fractionated SRS could be used for large intraventricular metastases if the patient has a poor Karnofsky score.…”

“…[ 10 , 18 ] To date, 35 cases of choroid plexus metastasis from renal cell carcinoma (RCC) have been reported with only a few papers describing the neurosurgical approach operated for its resection. [ 5 , 8 , 10 , 15 ] Radiological features of intraventricular solitary metastasis are not specific; therefore, pathological analysis is crucial for the differential diagnosis with the more frequent intraventricular meningioma. [ 17 ]…”