Background: Choroid plexus papilloma (CPP) is a rare, benign, World Health Organization (WHO) Grade I neuroepithelial neoplasm arising from the choroid plexus. It predominantly affects infants and young children, typically presenting with obstructive hydrocephalus; incidental discovery in an adult, particularly at autopsy, is uncommon. We report a case of an incidental lateral ventricular choroid plexus papilloma discovered at forensic autopsy in a young man whose death was attributed to acute cardiac failure in the setting of substance abuse.

Case Presentation: A 19-year-old male was found dead with no antemortem clinical history available. Forensic autopsy revealed cardiomegaly with biventricular hypertrophy, pulmonary edema and hemorrhage, hepatic fatty change, and congestion of the kidneys and spleen. The brain showed cerebral edema, tonsillar herniation, and uncal grooving, together with a well-circumscribed, greyish-white intraventricular mass within a dilated lateral ventricle. Toxicological analysis of urine detected cocaine and benzodiazepines. Histopathological examination of the intraventricular mass demonstrated a benign papillary neoplasm with fibrovascular cores, foci of calcification, and adjacent normal choroid plexus tissue, confirming a diagnosis of choroid plexus papilloma (WHO Grade I). The certified cause of death was acute biventricular heart failure due to hypertensive heart disease in the setting of substance abuse (cocaine and benzodiazepines).

Conclusion: This case highlights the occasional discovery of clinically silent, benign central nervous system neoplasms at forensic autopsy and underscores the importance of complete, systematic post-mortem examination — including routine sectioning and sampling of the brain — even when a plausible cause of death is otherwise apparent. It also illustrates the well-documented cardiotoxic potential of cocaine, which remains the more direct and immediate contributor to death in this case.

Keywords: Choroid plexus papilloma, incidental finding, forensic autopsy, sudden death, substance abuse, cocaine cardiotoxicity.