Congenital Choroid Plexus Papilloma of Right Ventricle Following Treatment with Phlebotonic during Pregnancy

Case Report

Austin J Reprod Med Infertil. 2015; 2(5): 1024.

Congenital Choroid Plexus Papilloma of Right Ventricle Following Treatment with Phlebotonic during Pregnancy

Haller-Kikkatalo K1,2,3* and Õiglane-Šlik E4

¹Competence Centre on Reproductive Medicine and Biology, Estonia

²Department of Obstetrics and Gynecology, University of Tartu, Estonia

³Women´s Clinic, Tartu University Hospital, Estonia

4Department of Neurology, Children´s Clinic, Tartu University Hospital, Estonia

*Corresponding author: Haller-Kikkatalo K, Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia

Received: June 02, 2015; Accepted: August 08, 2015; Published: August 10, 2015


An extremely rare congenital choroid plexus papilloma of right ventricle of the brain was diagnosed in a newborn at three weeks of age. Due to the increasing production of the liquor the tumor was removed surgically 2 days later. The baby was exposed to flavonoids, Diosmin and Hesperidin (DH) during fetal development due to maternal treatment regimens of posttrombotic venal insufficiency. Flavonoids, as “plant origin” have often been considered to be safe and due to the venotonic and tissue protective properties are mainly used to cure chronic venous insufficiency in human. However, DH has not been used during pregnancy and even though being useful to mother, the benefits of DH may be reversed to unfavorable effect for developing fetus. Especially since flavonoids play a dual role in mutagenesis and carcinogenesis depending of certain member of flavonoid or animal tissue used in experiment. Evidence of putative tumorigenic side-effect of DH mediated by cellular DNA damage directly, via oxidative stress, by interacting with cellular aryl hydrocarbon receptor or affecting vascularization processes via expression of growth factors, has been available since 1998 and is in constant growth. Here we draw attention to the safety of DH, which has not been proved yet, at least during pregnancy. Therefore, special precaution should be taken when DH is desired to use from the beginning of pregnancy and for a long period during pregnancy. The data available today, either directly or indirectly indicate the risk for congenital vascular tumors in human fetus if exposed to DH.

Keywords: Aryl hydrocarbon receptor; Diosmin; Fetal development; Hesperidin; Neovascularization; Oxidative stress

Case Presentation

Congenital choroid plexus papilloma of the brain belongs to the group of congenital choroid plexus tumors [1]. Among these, congenital vascular choroid plexus papilloma of newborns, in particular, accounts for about 1/3 of all congenital brain tumors [2] which constitutes the calculated annual incidence rate of 0.05-0.09 cases per 100 000 children ≤36 months [1,2]. A 10-year retrospective study in Canada identified only 2 cases with congenital/fetal/neonatal brain choroid plexus papilloma and only one of them is still alive [2]. There are few other clinical reports of rare cases of papilloma of the given structure occurring at early childhood [3-6] and are therefore not classified as congenital.

Micronized Diosmin 450mg and Hesperidin 50mg (DH) in addition to warfarin treatment was prescribed twice a day to the 30 year old female after an incident of venous thrombosis of deep femoral vein while using oral contraceptives. The treatment with warfarin was replaced with subcutaneous injections of sodium enoxaparin 20mg/d and oral acetylsalicylic acid 100mg/d 1.5 years later because of pregnancy planning [7,8]. The treatment regime of DH, sodium enoxaparin and acetylsalicylic acid continued during pregnancy up to 6 weeks after delivery. Anormosomic baby boy was born at 39th gestational week via Caesarian section due to fetopelvis disproportion (Head Circumference (HC) was 37.5cm) and fetal tachycardia. The course of pregnancy and procedure for delivery was uncomplicated but the newborn suffered from a mild asphyxia.

At three weeks old he was diagnosed with congenital choroid plexus papilloma of right ventricle of the brain (Figure 1). The HC=41.8cm, large fontanel 4x7cm, sagittal suture was opened 3mm, bilateral Graefe sign turned positive, child was extremely restless, Babinski symptom bilaterally positive. Due to the increasing production of the liquor tumor hold evident and tremendous risk for brain damage, hydrocephaly or death, the tumor was removed by urgent surgery through opened large fontanel at the age of 25 days. Cranial trepanation was performed nearby largely opened large fontanel and tumor was extirpated from right ventricle and the remaining part of it through foramen Monroe. The course of surgery was uncomplicated and since the circulation of liquor was not interrupted no catheter was replaced. The tumor was histologically benign papilloma of choroid plexus. Postoperative HC=40cm, large fontanel was hollowed, Babinski symptom minimally expressed. Electron-Encephalography (EEG) performed on 5th postoperative day revealed underlying damage at the projection of right hemisphere. The general development of child was satisfactory during the following 3 postoperative years. At the age of 3, the right occipitaltemporal partial epilepsy with secondary generalized seizures and loss of consciousness was manifesting.

Citation: Haller-Kikkatalo K and Õiglane-Šlik E. Congenital Choroid Plexus Papilloma of Right Ventricle Following Treatment with Phlebotonic during Pregnancy. Austin J Reprod Med Infertil. 2015; 2(5): 1024. ISSN:2471-0393