CPC-What is outcome of choropid plexus cysts ??

 

What we need to know about Choroid Plexus Cysts(CPC)?.,,

Ans: CPCs are seen in about 1% to 2.5 % of normal pregnancies as an isolated finding, and they are usually of no pathologic significance when isolated. CPCs can be single or multiple, unilateral, or bilateral. The choroid plexus is seen in the axial plane of the head and is located in the lateral ventricle. A CPC appears as a well-circumscribed echolucent area within the choroid plexus. The choroid plexus is homogeneous, with an echogenicity similar to soft tissue. When other anomalies are present, there is a high risk of chromosomal defects, usually trisomy 18.

The presence of CPCs does not increase the risk of trisomy 21 above the background risk.

 

1)                  Axial image of the foetal head shows a choroid plexus cyst. Prevalence in low risk population: - < 2%.

2)                   Association with other malformations:-

3)                  Karyotypic disorders: - with mild pyelectasis; Total 1.7%) had chromosomal abnormalities. Of them many exhibited other malformation i.e. more than one soft marker  and some were elderly-who have increased background risk of excess Chr. Disorders...

4)                  In elderly women Prevalence :is higher

5)                   Amniocentesis indicated or not. - If this is the solo abnormality then no other testing is recommended.

6)                  How many Trisomy foetuses have such malformations? - About 25% of all Trisomy foetuses will exhibit pyelectasis.

7)                   Increased back ground risk of Trisomy: - Mild increased risk: - 1.5 times which is negligible.

8)                   WE have to follow up such case  in third trimester for followings  : - Any FGR? What about Liq vol?

9)                   Neonatal problem:-Follow up / Urinary tract work up. Reflux may persist-so paediatric Nephrologist may be consulted.

 

Take home message :-Detection of CPC warrants a detailed evaluation of foetal hands for possible overlapping digits and clenched fist to rule out Trisomy 18. . Researchers have concluded that the presence of CPCs increases the risk for aneuploidy 1.5 times, mainly trisomy 18.

fetuses between 16 and 25 menstrual weeks; CPCs were identified in  (2.3%), with 1060 cases of isolated CPC. The authors found that no fetus with an isolated CPC had trisomy 18. During the study period, 50 cases of trisomy 18 were identified between 16 and 25 menstrual weeks. CPCs were detected in half of these fetuses.

 

They concluded that prenatal sonographic identification of CPCs warrants an extended anatomic survey that includes the fetal hands. If the fetal examination is otherwise unremarkable, then the risk for trisomy 18 is low.

The probability of a chromosomal abnormality is high when CPCs are associated with any other antenatally detected anomaly, indicating a clear need to offer amniocentesis.

Another group  studied a large unselected population and concluded that the predictive value of CPCs is much lower when no other anomalies are detected. They also concluded that risk did not seem to be related to whether or not cyst size diminishes as gestation progresses, whether the cysts were unilateral or bilateral, or whether they were small or large (60% to 80% < 10 mm). It is probably advisable to regard CPCs as an indication for detailed ultrasound assessment, rather than invasive testing.