Cryptococcal Choroid Plexitis as a Mass Lesion: MR Imaging and Histopathologic Correlation
Jerry M.E. Kovoora,
Anita Mahadevanb,
Jayakumar P. Narayana,
Srikanth S. Govindappaa,
P. Satishchandrac,
Anisya V. Talyc and
S. K. Shankarb
a Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
b Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
c Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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FIG 1. Brain MR imaging in a 44-year-old man.
A, Axial T1-weighted MR image (672/14 [TR/TE]) depicts a hypointense multicystic mass lesion (arrow) in the left temporal horn; the temporal horn is trapped. Periventricular white matter is also hypointense, and the right medial temporal lobe shows a single rounded lesion (arrowhead) with similar features.
B, Axial T2-weighted (5500/90) image depicts the mass lesion (arrow) in the temporal lobe, periventricular white matter, and the single rounded lesion (arrowhead) in the right medial temporal lobe as hyperintense.
C, Axial T1-weighted (672/14) image reveals an enhancing mass in the region of the foramen of Monro (arrowheads), extending bilaterally into the frontal horns. Choroid plexuses are enlarged and enhanced (arrow).
D, Coronal T1-weighted (672/14) image shows enhancement of the meninges (arrow).
E, Axial fluid-attenuated inversion recovery (9000/119) image reveals dilated hyperintense Virchow-Robin spaces (arrow) in the basal ganglia.
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FIG 2. Examination of the brain 5 hours after death.
A, Coronal section of the brain through mammillary bodies shows a mass filling the superior part of the anterior third ventricle, totally blocking both foramina of Munro, and a similar mass plugging the left temporal horn.
B, Whole-mount section through the third ventricle shows a multicystic, pale mass of cryptococci adhering to the corpus callosum (C) and obliterating the foramina of Munro (arrowheads). Note the ragged ventricular lining. Myelin stain, magnification x3.
C, Whole-mount section through the left temporal horn shows a multicystic cryptococcal mass filling the left temporal horn, sparing only a small area of the ventricle (V). The surrounding white matter is pale because of edema and demyelination. Myelin stain, magnification x2.
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FIG 3. Microphotograph showing cryptococci (arrowheads) floating in a mucoid background in the Virchow Robin space surrounding a vessel (V). Hematoxylin-eosin stain, magnification x300.
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