Xanthogranuloma with massive hematoma in the third ventricle: case report

Symptomatic xanthogranulomas of the ventricular system are rare entities. No case of a massive hematoma in the xanthogranuloma, which may cause sudden deterioration, has been reported. This is the first report of a massive hematoma arising from a xanthogranuloma in the third ventricle.

A 35-year-old woman was referred to our hospital with a 1-month history of progressively deteriorating consciousness. Neuroradiological findings revealed a mass in third ventricle and obstructive hydrocephalus.

Bilateral external ventricular drainage was performed as an emergency treatment. Two weeks later, the mass was removed totally via the transcallosal-transforaminal approach. The disturbance of consciousness completely disappeared 2 weeks after the second operation. The pathological diagnosis was xanthogranuloma causing massive hematoma.

The pathogenesis, clinical and radiological features, differential diagnosis, and treatment of this rare benign tumor are discussed. The hypothalamic dysfunction caused by a massive hematoma in the lesion of the third ventricle may cause sudden deterioration and death, whether the obstructive hydrocephalus exists. The risk of hemorrhage and hydrocephalus still remains after aspiration alone because of the presence of the cyst wall. Radical extirpation should be the choice of treatment for xanthogranulomas or colloid cysts of the third ventricle.