Presentation
Sudden severe headache on the background of increasing intermittent headaches.
Patient Data
Large heterogeneously enhancing third ventricular mass with innumerable T2 hyperintense/T1 hypointense small cysts. Subtle foci of T2 / GRE hypointensity suggest small foci of calcification. The mass is adjacent to but not in communication with the posterior clinoid process.
There is no sellar or suprasellar extension and no transependymal edema.
The solid enhancing mass ( * ) is centered in the third ventricle, expanding the supraoptic recess (yellow arrow) and outwardly bowing the floor of the third ventricle (blue arrow). Superiorly the mass extends to the foramina of Monro (red arrows).
It is clearly separate from the pituitary gland (white arrow).
The patient went on to have a craniotomy and excision of the mass.
Histology
Post excision pathology report notes scattered foci of keratin and focal calcification.
Final diagnosis: Third ventricular tumor - craniopharyngioma (WHO I)
Case Discussion
Intraventricular craniopharyngiomas are rare but certainly reported. Like this case, they are usually located in the third ventricle.
Editors note: Unfortunately additional diagnostic information is not available and it is uncertain whether this represents an adamantinomatous craniopharyngioma or papillary craniopharyngioma.
For the purposes of this case, it has been given the diagnosis of craniopharyngioma not otherwise specified (NOS).
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