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Craniopharyngioma - 3rd ventricle

Case contributed by Dr Alexandra Stanislavsky

Presentation:

50 year old male presents with a sudden severe headache on the background of increasing intermittent headaches.

Patient Data:

Age: 50 years
Gender: Male
Modality: MRI

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 oedema.

Annotated images

Modality: Annotated image

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 tumour - craniopharyngioma (WHO I)

Case Discussion:

Intraventricular craniopharyngiomas are rare but certainly reported. Like this case, they are usually located in the third ventricle. 

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