Craniopharyngioma (papillary)

Case contributed by Dr Bruno Di Muzio

Presentation

Growing intracranial suprasellar mass in the last 10 years.

Patient Data

Age: 60-year-old
Gender: Male
Modality: MRI

Sagittal T1 FLAIR through the midline with axial diffusion-weighted imaging and coronal postgadolinium T1 images with sagittal postgadolinium images. Correlation with 01/01/2010.

No restriction or diffusion.

The known suprasellar mass now measures 14 x 18 x 9 mm (previously 15 x 11 x 14 mm). As noted previously, the lesion is of mixed signal and shows patchy heterogenous enhancement following gadolinium. It also shows some rim enhancement. It contacts and partly displaces the optic chiasm and bears a close relationship to the pituitary stalk and the pituitary contents.

No new lesion elsewhere.

Modality: CT

Non-contrast volume acquisition has been obtained for intraoperative navigation purposes. Paranasal sinuses are clear. Please refer to diagnostic MRI dated 16/3/2016 for further characterisation of the suprasellar mass, which appears grossly stable in size. Within the left sphenoid body is a very low density region (-110 HU), unchanged from external CT, and corresponds with fat intensity signal on the most recent MRI.

Modality: Pathology

 

MICROSCOPIC DESCRIPTION: 1-3. Sections show a papillary tumour composed of mature squamous epithelium with underlying stroma. The epithelium lacks a granular cell layer but contains scattered goblet cells and neutrophils. No skin adnexal structures are seen. The loose stroma appears odematous. No stelate reticulum is seen. There is no evidence of malignancy.

DIAGNOSIS: 1-3. Brain tumour: Papillary craniopharyngioma.

Case Discussion

The papillary subtype of craniopharyngioma is seen almost exclusively in adults and is formed of masses of metaplastic squamous cells. Cysts do form, but these are less of a feature, and the tumour is more solid. Calcification is uncommon or even rare.

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Case Information

rID: 45227
Case created: 18th May 2016
Last edited: 7th Feb 2017
Inclusion in quiz mode: Included

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