Adamantinomatous craniopharyngioma

Case contributed by Dr Henry Knipe

Presentation

Worsening vision over a few months.

Patient Data

Age: 35 years
Gender: Male

Suprasellar predominantly low density mass with peripheral calcification. The pituitary is seen separate to the mass and appears normal. No bony changes. 

In the suprasellar region is a lobulated mass with cystic signal and high peripheral T1, the latter seen as calcium on the previous CT. Irregular enhancement is seen peripherally.The pituitary is seen separately. The optic chiasm is displaced. 

Case Discussion

The patient went on to have a resection. 

Histology

Paraffin sections show several fragments of an adamantinomatous craniopharyngioma. These consist of irregularly shaped islands of epithelium with prominent peripheral basaloid cell layers, a central squamous epithelium with focal keratinization and intermediate stellate reticulum. No mitotic figures or areas of necrosis are identified. Adjacent brain parenchyma shows well-developed piloid gliosis with numerous Rosenthal fibers identified.

DIAGNOSIS: adamantinomatous craniopharyngioma.

Characteristic imaging features of adamantinomatous craniopharyngioma, although the age of presentation is unusual (peak presentation age for this subtype is 10-14 years). 

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