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What are the main differential diagnoses of the above lesion?
1. Chondrosarcoma of the skull base 2. Meningioma of the skull base 3. Pituitary macroadenoma 4. Plasmacytoma
There is a large, well defined, T1 isointense mass lesion centred over the clivus, with small high signal foci, which my represent intratumoural haemorrhage. The lesion is T2 hyperintense and shows vivid, but heterogeneous, enhancement on post-contrast images. It is invading the sphenoid sinus anteriorly, and the pontine cistern posteriorly, where it also abuts the basilar artery. It invades both cavernous sinuses, more pronounced on the left side with evidence of encasement of the left internal carotid artery (cavernous portion).