Chraniopharyngioma, case 3

CLINICAL HISTORY:
This 29-year old woman complains of visual disturbances with a left visual field defect.

NEUROLOGICAL EXAMINATION reveals a left temporal hemianopia and difficulties in the perception of colors.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): A small mass is identified, protruding into the suprasellar cistern. Focal calcification is noted.

b) CONTRAST-ENHANCED SCAN (IMAGE 2): Intense enhancement of the lesion is noted.

MRI:
a) CORONAL T1-WEIGHTED (370/20/1) SPIN-ECHO SEQUENCE (IMAGE 3): The mass, with a slightly hypointense signal, is seen in the suprasellar region. Marked elevation and flattening of the optic chiasm is appreciated.

b) CORONAL (IMAGE 4) AND SAGITTAL (IMAGES 5 AND 6) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: The majority of the mass is intensely and homogeneously enhancing (arrowheads), with the exception of a focal calcification (arrow) in the right supero-lateral part of the tumor. The mass amputates the anterior recess of the third ventricle. The tumor can be clearly distinguished from the hypophysis.

RADIOLOGICAL DIFFERENTIAL DIAGNOSIS is craniopharyngioma. Some consideration must be given to meningioma of the diaphragma sellae or a hypothalamic glioma.

SURGICAL FINDINGS: At surgery a tumor mass was found with intra- and suprasellar location and retrochiasmatic extension. The chiasm was considerately elevated. Part of the tumor was cystic and filled with a yellow-green semi-fluid, which was aspirated. The more solid part of the tumor was partially resected. Treatment was completed with radiotherapy.

ANATOMOPATHOLOGY was consistent with craniopharyngioma.

FOLLOW-UP: Four years after surgery, follow-up CT remains stable. The patient is doing well with improved visual fields.

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Craniopharyngioma

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