Solid and enhancing pituitary region mass

Last revised by Laura Meeker on 24 Nov 2021

Solid pituitary lesions with enhancement are by far the most commonly encountered appearance of pituitary region masses.

Differential diagnosis

  • macroadenoma
    • by far the most common entity
    • typically enhances less vividly than other entities
    • elevates the dura of the diaphragma sella (as the origin is within the pituitary)
    • the sella is expanded and remodeled
    • non-normal pituitary tissue is usually visible
  • pilocytic astrocytoma
    • children 
    • enlarged optic chiasm or nerve
    • variable enhancement
  • craniopharyngioma
    • papillary subtype is more frequently solid, although cystic components are still more common than entirely solid lesions
    • epicenter is in ~85-95% of cases in the suprasellar region 1
    • in ~20% of cases, there is extension into the pituitary fossa 1
  • meningioma
    • epicenter is usually outside the pituitary fossa
    • dural tail common
    • enhancement is homogeneous and vivid
    • if the carotid is encased, then it is usually narrowed
  • metastasis
    • uncommon
    • irregular margins
    • may have erosion/destruction of bony margins without expansion (rapid rather than slow growth)
  • inflammation / infiltration
  • germinoma
    • usually pediatric population
    • often involves inferior recesses of the third ventricle
    • often also involves pineal region
  • pituicytoma
  • granular cell tumor of the pituitary (pituitary choristoma)

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