Adamantinomatous craniopharyngioma

Case contributed by Dr Bruno Di Muzio


Worsening vision.

Patient Data

Age: 35 years
Gender: Male

CT Brain


Technique: Non-contrast stereotaxis images have been obtained through the brain. No previous images are available for comparison.

There is a 22 x 28 x 21 mm suprasellar mass with peripheral calcification. The central component of the mass is of low density (HU 15). The pituitary is of normal size and seen separate to the mass.

No erosion or remodeling of the bone adjacent to the mass and no extension into the sphenoid sinus. Mass abuts the basilar artery and distorts the optic chiasm.

No hydrocephalus. The remainder of the brain is unremarkable. Mucosal polyp within the left maxillary sinus. Nasal meati are patent with no significant septal deviation. Sphenoid sinus is well aerated. Anterior clinoid processes are non-aerated.

Conclusion: Suprasellar mass most likely represents a craniopharyngioma although correlation with MRI images is recommended.​

MRI Pituitary


Technique: Multiplanar, multisequence imaging has been obtained through the brain including post contrast dynamic images through the pituitary fossa.

Findings: Lobulated cystic mass measuring 25 x 31 x 25mm (AP x ML x SI) is centered in the posterior suprasellar region with marginal T1 hyperintensity correlating with calcification seen on CT.

Irregular enhancement of the periphery of the cysts.

The lesion is separate from the normal-appearing pituitary tissue but is inseparable from the infundibulum which seems to pass from anterior toward the right side of the mass.

The mass abuts the posterior margin of the optic chiasm, splaying and laterally displacing the optic tracts.

It indents the floor of the third ventricle and contacts without compressing or encasing supraclinoid ICAs, ACAs and basilar artery. No pulsation artefact seen in relation to this mass. The remainder of the imaged brain (please note this study has been targeted to the pituitary, and as such the whole brain has not been imaged) appears unremarkable.

Conclusion: Findings are most consistent with a suprasellar adamantinomatous craniopharyngioma.


MICROSCOPIC DESCRIPTION: Paraffin sections show several fragments of an adamantinomatous craniopharyngioma. These consist of irregularly shaped islands of epitjelium with prominent peripheral basaloid cell layers, 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.

Case Discussion

This case demonstrates a cystic heterogenous suprasellar tumor confirmed as an adamantinomatous craniopharyngioma

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