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There is a heterogenously enhancing mass filling the sella and extending up the stalk to the level of the optic chiasm which is superiorly displaced and compressed. High T2 signal is present, most marked on the left. There is no intrinsic high T1 signal and the mass is heterogenous but predominantly T2 bright. It shows no diffusion restriction and no fluid fluid levels. There is no normal pituitary evident apart from a tiny amount of intrinsic high T1 signal posteriorly in the sella which may represent the posterior pituitary. There is no extension into the cavernous sinuses.
CONCLUSION: Heterogeneous sella/suprasellar mass is most likely a cystic macroadenoma, although as appearance of the mass is unusual alternative diagnoses (e.g. craniopharyngioma and metastasis) should be considered.
The patient went on to have surgery.
Paraffin sections show a small fragment of anterior pituitary tissue and a separate fragment of craniopharyngioma. The latter is composed of irregularly shaped epithelial islands with a peripheral basaloid cell layer and stellate reticulum. No keratinization is seen. The fragment shows a central small cyst filled with amorphous material. The anterior pituitary fragment is composed largely of corticotroph cells with strong immunostaining for ACTH. There is patchy strong staining for TSH and staining of individual cells for prolactin.
FINAL DIAGNOSIS: adamantinomatous craniopharyngioma
Adamantinomatous craniopharyngiomas are usually encountered in children.