PMC6044141_01
First preoperative MRI shows a cystic plexus papilloma in the left parietal region. An enhanced ring can be visualized after gadolinium. Histological diagnosis revealed a CPP grade I WHO
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F1
A contrast-enhanced magnetic resonance imaging (MRI) showed a minimally enhancing cyst wall, full of fluid, without a solid nodular component [Figure 1].
Post operative CT scan showed the partial removal of the extra ventricular cystic lesion
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F2
We performed a CT scan in the immediate postoperative period so as to rule out surgical complications (hemorrhage, ischemia) [Figure 2].
A new MRI, after 7 months, showed a new cystic lesion in the cerebellar vermis with an eccentric nodule, in the temporal lobe and a recurrent multiloculated lesion in the left parietal region. Histological diagnosis was CPC grade III WHO
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F3
On the basis of a partial removal of the lesion and the known histological diagnosis of grade I, after a multidisciplinary assessment, an adjuvant therapy was ruled out and we programmed an enhanced examination (CT to MRI) in follow-up after 6 months [Figure 3]. Imaging showed significant regrowth of the known residual parietal tumor and a new cystic lesion in the cerebellar vermis and left fronto-basal supratentorial region [Figure 3].
(a) Photomicrograph showing benign features of the CPP [hematoxylin and eosin (H and E) original magnification x200] in the sample of the first surgical procedure. (b) Photomicrograph showing frank signs of malignancy of CPC (H and E original magnification x100) in the sample of the second surgical procedure. (c) Demonstrates a representative area of the neoplasia with a high mitotic index (Ki-67 Ab, original magnification x100)
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F4
Because the recurrence was characterized by frank signs of malignancy, according to the current WHO criteria, a diagnosis of CPC (WHO grade III) was made [Figure 4].