jiafm, 2010-32(2) april-june. - forensic medicine

ISSN 0971-0973 J Indian Acad Forensic Med, 32(2)Case ReportAdult Choroid Plexus Papilloma: Cause of Sudden Death*Dr. S. Ranjan Bajpai, MD, **Dr. D. S. Badkur, MD, DFM, FIAFM, ***Dr. Reeni Malik, MD,****Dr. Arneet Arora, MD, DNB, *****Dr. Jayanthi Yadav, MD,Abstract:Choroid plexus papilloma (CPP) is a rare, benign neoplasm, relatively more common in childhood. It isassociated with signs and symptoms of increased intracranial pressure, frequently in association with obstructivehydrocephalus. CT and MRI are the investigations of choice and are diagnostic. Sudden deaths have been reported,but are very unusual. A 41 year old male was brought for medico-legal autopsy examination on ground of suddendeath. He was reported to have headaches over a long period of time. On autopsy examination, massive subarachnoidhemorrhage was seen on both the cerebral hemispheres and cerebellum. A cyst measuring about 1cmdiameter was found in choroid plexus of right lateral ventricle.On histopathological examination, it was found to be a choroid plexus papilloma. Calcification was alsoevident in the papilloma. From medico-legal aspect, the present case reveals an unusual cause for sudden death in anadult male. The pathology could have been diagnosed easily by CT scan or MRI. When diagnosed, it has goodsurvival rate, the morbidity depending on the extent of pathological effects. The present case was likely to havesurvived having minimal effects with appropriate treatment had he been diagnosed. The pathology is rare and asuspicion for this pathology in the adult male was not expected, but a CT scan to investigate chronic headache waswarranted. Absence of such a suggestion leading to death, which could have been preventable, is sufficient groundfor charge of professional negligence.Key Words: Sub-Arachnoid Haemorrhage, Intracranial Tumours, Choroid Plexus PapillomaIntroduction:Choroid plexus papillomas are rare,accounting for less than 1% of all intracranial tumorsin adults. They are relatively more common inchildhood and constitute 1.5 to 4% of intracranialtumors. [1] They are neuroectodermal in origin andsimilar in structure to a normal choroid plexus in theform of multiple papillary fronds mounted on a wellvascularized connective tissue stroma.CPPs are often associated with a vascularstalk connected to the choroids plexus, allowingmobility within the ventricular system.Corresponding author:*Dr, S.Ranjan BajpaiAssociate Professor, Deptt. of Forensic Medicine,Gandhi Medical College,Bhopal. 462001E mail: arneetrajan@yahoo.co.in*Assistant Professor, Forensic Medicine,A.J. College of Medical Sciences, Mangalore,Karnataka**Director, Medico-legal Institute, Bhopal***Associate Professor, Pathology****Associate Professor,*****Associate ProfessorGrossly, they may appear as reddishcauliflower like growths, which often become heavilycalcified. [2] CPPs are not malignant; however,malignant evolution may occur, with an incidence of10-30%. In a recent series by McEvoy et al, the fiveyearsurvival rate was 100 %. [3]The tumor‟s presence is often heralded bynon-specific signs and symptoms of increasedintracranial pressure. In adults, headache is the mostcommon presenting symptom, which may be relatedto an alteration in head position. CPPs are amenableto complete surgical excision and surgery should beperformed before complications set in. The tumor isliable to spontaneous hemorrhage, resulting in bloodstainedor xanthochromic CSF. Hydrocephalus is acommon complication which may result from directtumor obstruction of the outlet of CSF or due toexcessive production of CSF. [2] CT and MRI arethe investigative procedures of choice in theevaluation of CPPs. Because of the relatively noninvasivenature, high reproducibility and greatcontrast resolution of CT and MRI, they havesupplanted all other methods of neuroimaging.Clinical summary:A 41 years old average built male wasbrought for medico-legal autopsy examination onground of sudden death. He was reported to havecome back from work the previous evening at about 8160