top of page

Case 10

                                                                                           Contributors

                                                                                  Dr.Vinayak T                                                                                    Dr.Ankit

Diagnosis

Craniopharyngioma

 Radiological Findings, Disease course and Management

 

                                   MRI Brain 

                                                            

                                                                              

​

 

 

 

 

 

 

                                                                 

 

                                                                                

 

 

  

 

 

 

                                                                        

 

 

               

 

 

 

 

 

  

​

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Findings

  • Large well defined lobulated mass lesion with intensely enhancing solid areas and peripherally enhancing cystic areas,seen in the supra-sellar region (the epicenter of the mass appears to be in the supra sellar region)

  • Compression over the pituitary gland seen with enhancing pituitary gland is seen separately

  • Lesion causes compression over the third ventricle with resultant dilatation of third and  bilateral lateral ventricles with peri-ventricular CSF ooze

  • Lesion extends inferiorly in to the interpenducular cistern, with e/o splaying of the cerebral peduncle and mass effect over the mid brain

  • One cystic component extends till the pre pontine cistern and indents on the pons anteriorly

  • Lesion causes mass-effect over the uncus / temporal lobes with obliterration of peri-mesencephalic cistern

  • E/o mild splaying of the internal carotid arteries and middle cerebral arteries bilaterally

Diagnosis

Craniopharyngioma

Disease course and management

Excisional biopsy was done and diagnosis of craniopharyngioma was confirmed

 

                        Post Op CT

 

 

 

 

 

 

 

 

 

​Discussion

  •  Craniopharyngiomas are relatively benign neoplasms

  •  typically arise in the sellar/suprasellar region. 

2 pathological types:​

Adamantinomatous (paediatric)

  • ​Predominantly in children

  • Consists of reticular epithelial cells

  • May be single or multiple cysts filled with thick oily fluid high in protein, blood products, and/or cholesterol

  • Characteristic histological feature: Wet keratin nodules

  • Calcification: usually present 

Papillary (adult)

  • Seen almost exclusively in adults

  • Formed of masses of metaplastic squamous cells

  • Cysts do form,but not the predominant feature,the tumour is more solid

  • Wet keratin is absent. 

  • Calcification is uncommon or even rare 

Imaging Findings

Location

  • Majority: large suprasellar component (95%)

  • Minority: purely suprasellar (20%),

  • Intrasellar location: uncommon (<5%),

  • may be associated with the expansion of the pituitary fossa

  • Larger tumours: may distort the optic chiasm, or

                      compress the midbrain resulting in obstructive                                   hydrocephalus.

Occasionally: appear as intraventricular, homogeneous, soft-tissue masses                    without calcification (papillary subtype).

Third ventricle is a common location. 

Rare or ectopic locations reported include: nasopharynx, posterior fossa,                                                   extension down the cervical spine.

Adamantinomatous

  • Most common form

  • lobulated contour due to multiple cystic lesions

  • Solid components if present, enhance vividly on both CT and MRI

  • Calcification is very common, in the adamantinomatous subtype

  • Tend to be large, extend superiorly into the third ventricle, and encases vessels, may be adherent to adjacent structures

CT

Cysts have near CSF density and are large

Solid component

  • soft tissue density

  • enhancement in 90%

Calcification

  • seen in 90%, typically stippled, peripheral in location

MRI

Cysts: variable mostly or partly T2 hyperintense

T1: iso- to hyperintense to brain

     (due to high protein content machinery oil cysts)

Solid component

T1 C+ (Gd): vivid enhancement

T2: variable or mixed 

Calcification

Difficult to appreciate on conventional imaging

MR angiography: may show displacement of the A1 segment of the anterior cerebral artery (ACA)

MR spectroscopy: cyst contents may show a broad lipid spectrum, with an otherwise flat baseline

​

Papillary 

  • more spherical in outline and lack the prominent cystic component

  • most are either solid or contain a few smaller cysts 

  • Calcification is uncommon

  • tend to displace adjacent structures. 

CT

Cysts

Small and not a significant feature

Near CSF density

Solid component

Soft tissue density

Vivid enhancement

Calcification 

Uncommon, rare

MRI 
Helps in the preoperative definition of the relationship of the tumor to 
  • Optic nerve and chiasm
  • Internal carotid artery and their branches
  • Primary stalk
  • Hypothalamus
  • Third ventricle

Cysts

Variable in signal

85% T1 hypointense 

Solid component

T1: iso- to slightly hypointense to brain

T1 C+: vivid enhancement

T2: variable/mixed 

MR spectroscopy: cysts are filled with water/fluid

​

References

bottom of page