Papillary craniopharyngioma

Case contributed by Frank Gaillard
Diagnosis certain


Visual symptoms.

Patient Data

Age: Adult
Gender: Female

CT brain


Contrast enhanced CT demonstrates a suprasellar mass which vividly enhances. Although contrast does make it harder to assess, there is no convincing evidence of calcification. The pituitary fossa is unremarkable and the anterior cerebral arteries, although contacted, are not encased. There is no cystic component. 

MRI brain


MRI of the brain demonstrates a predominantly solid enhancing suprasellar mass with a small cystic component posteriorly, towards the left, which demonstrates no T1 hyperintensity. 

Case Discussion

This case illustrates many of the typical features of a papillary craniopharyngioma: mainly solid suprasellar mass without calcifications and without T1 hyperintensity. 

This patient went on to have a craniotomy and resection of the mass. 


Microscopic Description:  Sections show the lesion is comprised of squamous epithelium, which tends to form a prominent basal layer without keratohyaline. Within the other layers there are varying degrees of separation of individual cells with prominent intercellular bridges. The epithelium rests on a fibrovascular stroma within which there are varying degrees of hyalinization of blood vessels and the stroma. In some areas the lesion is adjacent to brain parenchyma which shows reactive astrocytes, fibrillary astrocytes and in some areas Rosenthal fibers. Focal perivascular chronic inflammatory infiltrates are seen in some regions of the fibrovascular stroma. There are also occasional lipid-laden macrophages seen in the stroma. There are no areas of wet keratin seen. No hemosiderin or cholesterol crystals are seen.

Final Diagnosis: papillary craniopharyngioma.

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