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Doctor's Information

Name : Hamidreza
Family : Haghighatkhah
Affiliation :Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree : Associate professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Sayed Mohammad Emrani

Case Section

Head & Neck Imaging

Patient's Information

Gender : Male
Age : 18

Clinical Summary

18 years old boys with visual disturbances

Imaging Findings

A cystic multiloculated mass with lobulated border in supracellar region,with extension into sphenoid and posterior ethmoidal sinuses and prepontin cistern and superior extension to anterior corpus callosom level , left subfrontal region , dorsum cella destruction compression of 3ventricle are seen.region of iso , low ,high signal intralesion suggestive of hemoglobin break down product in early sub acute and chronic phasis or high protein content .Rim enhancement with peripheral edema and gliosis are seen .

Differential Diagnosis

• Rathke cleft cyst (RCe)
• Suprasellar arachnoid cyst
• Hypothalamic/chiasmatic astrocytoma
• Pituitary adenoma

Final Diagnosis

Monstrous craniopharyngioma

Discussion (Related Text)

Monstrous craniopharyngioma .Craniopharyngiomas (CF) are benign tumors, which can be cured by total resection; however, this is not always possible to achieve, thus leading to tumor recurrence. When these tumors achieve disproportionate growth, the treatment is even more difficult, fortunately grotesque CF are not frequent, making experience and data collection more arduous to obtain. .Craniopharyngiomas : occur almost exclusively in the sellar region and are presumed to arise from remnants of Rathke's pouch epithelium.. Approximately two thirds of cases of craniopharyngioma occur in the first two decades of life, mainly between ages 5 and 14 years; Like pituitary macroadenomas, these slow-growing tumors present clinically most commonly with visual disturbances secondary to compression of the optic chiasm, nerves, or tracts. In contrast to pituitary adenomas, slow-growing craniopharyngiomas do not usually enlarge the sella but rather gradually erode the posterior clinoid processes and the upper portion of the dorsum sellae. MR Finding: High signal intensity suprasellar mass on pre-contrast Tl WI ,Short Tl relaxation is the result of high protein content, T2WI: o Cysts = predominately hyperintense o Solid component = heterogeneous (iso/hyperintense, Ca++ portions hypointense) o Hyperintense signal in brain parenchyma adjacent to tumor may indicate • Gliosis, tumor invasion, irritation from leaking cyst fluid

References

John R.Haaga , CT and MRI of the whole body , fifth edition 2009 , page 124

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