Craniopharyngioma (adamantinomatous)

Case contributed by Dr Erik Ranschaert


Headaches for 4 weeks mainly in the evenings and during the night, no visual disturbances.

Patient Data

Age: 11 years
Gender: Female

MRI pituitary region

A suprasellar nodular mass with cystic components. The solid component is located above the pituitary gland. The post-contrast acquisition demonstrates enhancement of the solid nodule and walls of the cystic component.

Evidence of obstructive hydrocephalus of the lateral ventricle with transependymal edema.

Case Discussion

A craniopharyngioma typically involves the sella and suprasellar space (see images). Some craniopharyingiomas can be both intrasellar and suprasellar, having a "snowman" appearance.

The adamantinomatous subtype appears as a predominately cystic suprasellar mass with a solid component (as in this case).  

Description of MRI findings:

  • cystic area which is hyperintense on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images with heterogeneous isointense to hypointense solid components in the caudal part. 
  • signal intensity varies on T1-weighted images. The cystic contents can appear hyperintense if they have a high protein, blood product, and/or cholesterol content. In this case the cystic component is T1-isointense.
  • contrast enhancement is seen, which is characteristic. 
  • compression of the third ventricle may occur and hydrocephalus may be present. Such compression helps in distinguishing craniopharyingioma from Rathke's cleft cyst or pituitary adenoma.
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Case information

rID: 12530
Published: 12th Dec 2010
Last edited: 13th Aug 2019
Inclusion in quiz mode: Included

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