Headache and diminution of vision of the left eye.
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A fairly defined globular supra-sellar mass lesion is seen showing to be hypointense on T1 and hyperintense on T2, with some small peripheral cysts, and intense rather homogenous post-contrast enhancement. The lesion measures 3.5 X 3.1 X 2.9 cm in its main axial and cranio-caudal diameters respectively. The lesion is seen widening and splaying the arteries of circle of willis with indentation and widening of the cerebral peduncles. The lesion is seen abutting the inferior frontal and temporal lobes. That lesion is seen abutting the optic chiasma. It is seen compressing the hypothalamus and anterior inferior aspect of the 3rd ventricle. The lesion is seen compressing and significantly attenuating the A1 segment of the left ACA. The pituitary gland is identified intact within the sella turcica below the lesion.
This case illustrates a well-defined, solid-cystic, and vivid enhancing suprasellar tumour that spares the pituitary gland. In this age group the differential diagnosis to be considered is made between:
- epicentre is usually outside the pituitary fossa
- dural tail common
- enhancement is homogeneous and vivid
- papillary subtype is more frequently solid, although cystic components are still more common than entirely solid lesions
- epicentre is in ~90% of cases in the suprasellar region