Craniopharyngioma in children and adults. Correlations between radiological and clinical manifestations

The plain Radiograph in Ophthalmology: A Wasteful and Potentially Dangerous Anachronism

The indications for 822 consecutive referrals for skull radiography were prospectively studied in a large eye hospital over a one year period. In 85.9% of patients the results were normal, and in 89% of the remainder they had no positive effects on management; all patients in whom a ‘beneficial’ effect could be identified would have been more appropriately investigated by other means. Fourteen of 25 patients whose skull radiographs were normal were shown by computed tomography or magnetic resonance imaging to have orbital or intracranial lesions. Views of the optic canals, orbits or paranasal sinuses were also requested in 336 patients. With appropriate use of alternative imaging methods, no patient's treatment would have been adversely affected if none of the skull radiographs had been obtained.

Contrast-enhanced MR imaging in neuroimaging

MR imaging without and with gadolinium-based contrast agents (GBCAs) is an important imaging tool for defining normal anatomy and characteristics of lesions. GBCAs have been used in contrast-enhanced MR imaging in defining and characterizing lesions of the central nervous system for more than 20 years. The combination of unenhanced and GBCA-enhanced MR imaging is the clinical gold standard for the noninvasive detection and delineation of most intracranial and spinal lesions. MR imaging has a high predictive value that rules out neoplasm and most inflammatory and demyelinating processes of the central nervous system.

Benign lymphoepithelial tumor of the pituitary

Here, we report a case of lymphoepithelial tumor that developed in the sellar and suprasellar regions in a 56-year-old woman. The lesion was composed of abundant but benign squamous cell nests (Erdheim's nests) and heavy lymphoid tissue with well-developed lymphoid follicles. Therefore, it mimicked tonsil or adenoid tissue, but was disorganized. We report this case to define the pathogenesis and proper diagnostic terminology of this unusual sellar and suprasellar lesion, and we assume that its origin is the infundibulum.

Nasal craniopharyngioma: case report and literature review

OBJECTIVE

We report the first case in the English language literature of an adamantinomatous infrasellar craniopharyngioma, and we describe our management strategy.

CASE REPORT

A 46-year-old woman presented with a six-month history of left-sided nasal obstruction and epistaxis. Rhinological examination revealed a left-sided, polypoidal lesion lying medial to the middle turbinate. An urgent examination under anaesthesia was organised; biopsies were considered characteristic of craniopharyngioma. Magnetic resonance imaging and computed tomography demonstrated a well defined, heterogeneous, infrasellar mass centred in the midline, extending anteriorly into the left nasal cavity and posteriorly encasing both internal carotid arteries. Craniofacial resection was performed via a midfacial degloving approach, with adjuvant radiotherapy. The patient was disease-free one year post-operatively.

CONCLUSION

Craniopharyngiomas should be considered in the differential diagnosis of a unilateral nasal polyp. Although technically benign, they are locally aggressive. Therefore, we recommend complete excision with adjuvant radiotherapy if margins are involved or close.

Metastatic papillary craniopharyngioma: case study and study of tumor angiogenesis

We report a case of suprasellar papillary craniopharyngioma metastatic to the temporoparietal region 2 years after its initial resection. The literature documents examples of craniopharyngioma recurrences along the surgical tract, as well as remote ipsi- and contralateral metastases via cerebrospinal fluid seeding. Ours is the second report of a craniopharyngioma of papillary type to exhibit metastatic behavior. The tumor spread opposite the side of craniotomy. Although a rare occurrence, it confirms the limited capacity of histologically benign craniopharyngiomas to undergo meningeal seeding, likely the result of surgical manipulation. Immunohistochemical demonstration of increased microvascular density and vascular endothelial growth factor expression, as well as a high vascular endothelial growth receptor (VEGFR2) signal by in situ hybridization, suggests that tumor vascularity facilitated angiogenesis and may have been involved in the establishment and growth of the metastatic deposit.

Children with craniopharyngioma. Early growth failure and rapid postoperative weight gain

Pre- and postoperative growth was analyzed in 22 children with craniopharyngioma. In 19 children a growth failure preceded the diagnosis by a mean of 4 years. Six children were obese preoperatively. During the first 3 postoperative months relative weight increased greater than 10% in 14/21 children (there was one surgical death). One year after surgery 13/21 were obese. Neither the size of the tumor nor the mode of surgery was decisive in the development of the obesity. Serum insulin and insulin-like growth factor I (IGF-I) were assessed in four children with growth hormone deficiency (GHD) who, after surgery for craniopharyngioma, were growing normally without GH substitution. One of them was normal in weight and had normal insulin and IGF-I levels; the others were obese and had supranormal insulin and subnormal IGF-I levels. One of the four and two other children with unsubstituted GHD reached final height SDS -0.8, -2.0 and -2.4. One child with normal postoperative GH response reached final height SDS -0.7. Final height SDS greater than or equal to -2.5 was gained with GH substitution by 6/11 children. It was greater than 2.0 SD below the height SDS expected from the heights of the parents in 7/11. An adequate monitoring of children's growth would lead to earlier diagnosis and probably better outcome.