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From the Archives of the AFIP

Cerebral Intraventricular Neoplasms: Radiologic-Pathologic Correlation¹

¹ From the Departments of Radiologic Pathology (K.K.K.) and Neuropathology (G.D.S.), Armed Forces Institute of Pathology, 14th St at Alaska Ave, Bldg 54, Room M-121, Washington, DC 20306-6000; and the Departments of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (K.K.K.). Received July 3, 2002; revision requested July 15 and received August 6; accepted August 20. Address correspondence to K.K.K. (e-mail: koeller@afip.osd.mil).

Intraventricular neoplasms are readily seen on cross-sectional images, but the myriad possibilities may make a focused differential diagnosis elusive. Consideration of the tissue within and composing the ventricular lining and the clinical findings provide the means to limit the differential diagnosis when analyzing an intraventricular mass on an imaging study. Ependymomas are typically calcified, are more common in children, are more common in the fourth ventricle, and show intense enhancement on contrast-enhanced images. Subependymomas and central neurocytomas have an affinity for the anterior portion of the lateral ventricle, and both commonly demonstrate a heterogeneous cystic appearance on cross-sectional images. Subependymomas are more common in older adults, whereas central neurocytomas are more common before 40 years of age. Subependymal giant cell astrocytomas always lie near the foramen of Monro and are characterized by frequent calcification, intense enhancement on contrast-enhanced studies, and the presence of other stigmata seen in tuberous sclerosis. When a mass is centered on the choroid plexus, a highly vascular tumor—either choroid plexus papilloma, choroid plexus carcinoma, meningioma, or metastasis—should be suspected. The characteristic heavily lobulated appearance of a choroid plexus tumor favors this diagnosis over other possibilities, although it is not always possible to distinguish between the more common benign form, the choroid plexus papilloma, and the less common malignant counterpart, the choroid plexus carcinoma. By using clinical, demographic, and imaging findings, one can significantly limit the differential diagnosis for many of the most common intraventricular neoplasms.

Index Terms: Astrocytoma, 1612.1832, 1612.3639 • Brain neoplasms, 16.36, 161.38 • Choroid plexus, neoplasms, 1617.3639 • Ependymoma, 161.3636, 164.3636 • Meninges, neoplasms, 161.366 • Neurocytoma, 161.369

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