Figure 1
Slowly progressive visual disturbances. Ophthalmologic examination confirmed a definite bilateral loss of vision. Physical examination was unremarkable except for a slight hypertension (135/105 mm Hg) and a slightly elevated blood cortisol level. Prolactin and TSH values were normal.
Craniopharyngioma
The patient presented with slowly progressive visual disturbances. Ophthalmologic examination confirmed a definite bilateral loss of vision. Physical examination was unremarkable except for a slight hypertension (135/105 mm Hg) and a slightly elevated blood cortisol level. Prolactin and TSH values were normal. The following radiographic examinations were performed: skull X-rays, CT scan of the brain, cerebral angiography (not shown, since no abnormalities were detected), and MRI.
Craniopharyngiomas are epithelial tumors arising from squamous cell rests within the pars tuberalis of Rathke’s pouch. For this reason they occur exclusively in the region of the sella turcica and suprasellar cistern.
Craniopharyngiomas account for 3% of all intracranial tumors. Both sexes are equally affected. These tumors are benign in nature and grow slowly. Surrounding structures are compressed rather than invaded. Cystic components are present in 85% of cases. The cysts contain cholesterol crystals in varying concentrations as well as keratin debris. This explain the variable signal intensities observed on MRI examinations. Calcifications, which occur in 75% of cases, are better documented with CT than with MRI. Although craniopharyngiomas exhibit no hormonal activity, endocrine symptoms can occur due to compression of the hypothalamus, pituitary stalk and pituitary gland.
Differential diagnosis include: Pituitary macroadenoma, suprasellar dermoid, teratoma, suprasellar hypothalamic and chiasmatic glioma.
In this case the characteristic calcifications seen on the lateral skull X-ray provided the clue to the diagnosis. In addition two lessons can be learned from this case history. First, even though craniopharyngiomas are slow growing lesions, they tend to recur after surgery. Therefore, follow-up post-operative MRI, before and after contrast administration, is mandatory.
Second, a low field MR system is capable of performing high quality thin section images of the sellar and suprasellar region in a consistent and reproductible way.
References
[1] Atlas SW (editor). Magnetic resonance of the brain and spine (2nd ed). Philadelphia: Lippincott-Raven Publishers, 1996: 894-898.
[2] Lee SH, Rao KCVG, Zimmerman RA. Cranial MRI and CT (3rd ed). New York: McGraw-Hill, 1992: 395-397.
Case information
| URL: | https://eurorad.org/case/935 |
| DOI: | 10.1594/EURORAD/CASE.935 |
| ISSN: | 1563-4086 |
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