Brain mass in thirsty man!

 

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Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish 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 : Mohsen Zakavati Avval

 

Case Section

Neuroradiology

 

Patient's Information

Gender : Male
Age : 39

 

Clinical Summary

A 39-year-old man with 5m history of Polydipsia, Vision loss (bitemporal hemianopia), Balance disorder and Fatigue

 

Imaging Findings

Brain magnetic resonance imaging (MRI), with and without contrast shows a solid-cystic lesion in suprasellar region with thin ring contrast enhancement.

 

Differential Diagnosis

Pituitary Macroadenoma Germ cell tumors Metastases to the pituitary gland Pituitary tuberculoma Rathke cleft cyst Chordoma

 

Final Diagnosis

Craniopharyngioma

 

Discussion (Related Text)

Craniopharyngiomas are typically very slow growing tumors. They arise from the cells along the pituitary stalk, specifically from nests of odontogenic (tooth-forming) epithelium within the suprasellar/diencephalic region and, therefore, contain deposits of calcium, which are evident on an x-ray. They are classified by histology as benign; however, as with many brain tumors, their treatment can be difficult, and significant morbidities are associated with both the tumor and treatment. Craniopharyngioma is a rare(2/100,000), usually suprasellar neoplasm, which may be cystic, that develops from nests of epithelium derived from Rathke's pouch. Rathke's pouch is an embryonic precursor of the anterior pituitary. Treatment generally consists of subfrontal or transsphenoidal excision. Surgery using the transsphenoidal route is often performed by a joint team of ENT and neurosurgeons. Ten-year recurrence-free survival rates vary from 64% to 96%. The extent of surgical resection is the most important factor in predicting recurrence; because of the intense gliotic reaction provoked by the tumor as it impinges on adjacent brain and the adhesion of large tumors to vascular structures in the supracellar region, incomplete surgical resection remains a significant problem, especially in larger than 5 cm in diameter.

 

References

1. "craniopharyngioma" at Dorland's Medical Dictionary[dead link] 2. Hamid R, Sarkar S, Hossain MA, Mazumder U, Akanda NI, Parvin R (2007). "Clinical picture of craniopharyngioma in childhood". Mymensingh medical journal : MMJ 16 (2): 123–6. PMID 17703145. 3. Baba AI; Câtoi C (2007), "Chapter 16. ENDOCRINE TUMORS", Comparative Oncology, Bucharest: The Publishing House of the Romanian Academy, 16.4.6 Craniopharyngioma, ISBN 978-073-27-1457-7 Check |isbn= value (help), retrieved March 21, 2013 4. Garnett MR, Puget S, Grill J, Sainte-Rose C (2007). "Craniopharyngioma". Orphanet journal of rare diseases 2: 18. doi:10.1186/1750-1172-2-18. PMC 1855047. PMID 17425791. 5. Garrè ML, Cama A (2007). "Craniopharyngioma: modern concepts in pathogenesis and treatment". Curr. Opin. Pediatr. 19 (4): 471–9. doi:10.1097/MOP.0b013e3282495a22. PMID 17630614. 6. Rodriguez FJ, Scheithauer BW, Tsunoda S, Kovacs K, Vidal S, Piepgras DG (2007). "The spectrum of malignancy in craniopharyngioma". Am. J. Surg. Pathol. 31 (7): 1020–8. doi:10.1097/PAS.0b013e31802d8a96. PMID 17592268. 7. Moore, Kraig D.; Couldwell, William T. (January 15, 2000). "41. Craniopharyngioma". In Bernstein, Mark; Berger, Mitchel S. Neuro-oncology: the essentials. Endorsed by the Joint Tumor Section of the American Association of Neurological Surgeons & the Congress of Neurological Surgeons. Thieme. pp. 409–418. ISBN 978-0-86577-880-1. Retrieved August 8, 2011. 8. "Endocrine Pathology". Retrieved 2009-05-08. 9. "CT and MRI

 

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