Cerebellopontine angle craniopharyngioma: case report and literature review

Cerebellopontine angle craniopharyngioma in familial adenomatous polyposis

Background

Craniopharyngiomas are benign tumors arising in the sellar and suprasellar regions. Although ectopic tumors do occur, it is usually due to local spread or recurrent tumors. Purely ectopic cerebellopontine angle (CPA) or 4th ventricle tumors are extremely rare and have been found to be significantly associated with familial adenomatous polyposis (FAP), a genetic disorder.

Case Description

Only four cases of ectopic CPA craniopharyngioma associated with FAP have been reported to date. Here, we present the 5th case of ectopic CPA craniopharyngioma on a background of FAP. The previously described cases have been elaborated as well.

Conclusion

CPA tumor with a background of FAP should raise a differential diagnosis of craniopharyngioma, and similarly, a CPA primary ectopic craniopharyngioma may raise suspicion of underlying APC gene mutation.

The association of ectopic craniopharyngioma in the fourth ventricle with familial adenomatous polyposis: illustrative case

BACKGROUND

Craniopharyngioma (CP) often arises in the sellar and suprasellar areas; ectopic CP in the posterior fossa is rare. Familial adenomatous polyposis (FAP) is a genetic disorder involving the formation of numerous adenomatous polyps in the gastrointestinal tract, and it is associated with other extraintestinal manifestations.

OBSERVATIONS

The authors reported the case of a 63-year-old woman with FAP who presented with headache and harbored a growing mass in the fourth ventricle. Magnetic resonance imaging (MRI) findings revealed a well-circumscribed mass with high intensity on T1-weighted images and low intensity on T2-weighted images and exhibited no contrast enhancement. Gross total resection was performed and histopathology revealed an adamantinomatous CP (aCP). The authors also reviewed the previous reports of ectopic CP in the posterior fossa and found a high percentage of FAP cases among the ectopic CP group, thus suggesting a possible association between the two diseases.

LESSONS

An ectopic CP may be reasonably included in the differential diagnosis in patients with FAP who present with well-circumscribed tumors in the posterior fossa.

Unusual and Rare Locations for Craniopharyngiomas: Clinical Significance and Review of the Literature

OBJECTIVE

This study discusses rare and unusual locations of primary craniopharyngiomas.

METHODS

We describe a case of a craniopharyngioma in the cerebellopontine angle. As a result of this unusual location, we performed a literature review of the ectopic occurrence of craniopharyngiomas using Pubmed, Cochrane Database, Trip, and Google Scholar to search for the terms "unusual," "uncommon," and "ectopic" in combination with "craniopharyngioma." The bibliographies of relevant articles were also searched.

RESULTS

We found 28 reported cases of rare anatomic locations for primary craniopharyngiomas. The average age of the patients was 30.8 years. Several patients had Gardner syndrome.

CONCLUSIONS

Craniopharyngiomas are most often located in the suprasellar region. Presentation in sites outside the parasellar region is rare. Among these ectopic sites, the cerebellopontine angle appears to be the most common location.

Craniopharyngioma

This report is a review of findings on the diagnosis, treatment, clinical course, and prognosis of craniopharyngioma patients. Craniopharyngiomas are rare, partly cystic and calcified embryonic malformations of the sellar/parasellar region with low histological grade (WHO I°). A bimodal age distribution has been shown, with peak incidence rates in childhood-onset at 5-14 years and adult-onset craniopharyngioma at 50-74 years. Clinical manifestations are related to hypothalamic/pituitary deficiencies, visual impairment, and increased intracranial pressure. If the tumor is favorably localized, the therapy of choice is complete resection, with care taken to preserve optical and hypothalamic functions. In patients with unfavorable tumor localization (i.e., hypothalamic involvement), recommended therapy is a limited hypothalamus-sparing surgical strategy followed by local irradiation. Although overall survival rates are high (92%), recurrences and progressions are frequent. Irradiation has proven effective in reducing recurrences and progression, and timing of postsurgical irradiation in childhood-onset cases is currently under investigation in a randomized multinational trial (KRANIOPHARYNGEOM 2007). Anatomical involvement and/or surgical lesions of posterior hypothalamic areas can result in serious quality of life-compromising sequelae such as hypothalamic obesity, psychopathological symptoms, and/or cognitive problems. It is crucial that craniopharyngioma be managed as a frequently chronic disease, providing ongoing care of pediatric and adult patients' clinical and quality of life consequences by experienced multidisciplinary teams.

Primary intracranial ectopic craniopharyngioma in a patient with probable Gardner's syndrome

The authors describe a patient with an adamantinomatous craniopharyngioma (CPG) arising in the cerebellopontine angle (CPA), who also had probable Gardner's syndrome. This 31-year-old man presented with headache and dizziness. Brain CT and MRI showed a 5 × 4-cm lesion with multiple small calcifications in the left CPA. The patient underwent suboccipital craniotomy with tumor removal. Histopathological findings indicated an adamantinomatous CPG. This patient also showed characteristics of Gardner's syndrome. Although this syndrome is associated with intracranial neoplasms, it is unclear whether patients with both Gardner's syndrome and CPG are part of the heterogeneity of Gardner's syndrome.

Isolated primary craniopharyngioma in the cerebellopontine angle

Between January 2000 and January 2011, we diagnosed three patients with isolated craniopharyngioma in the cerebellopontine angle (CPA). Brain MRI revealed cystic lesions with various imaging characteristics, including hypointensity on T1-weighted (T1W) images and hyperintensity on T2-weighted (T2W) images. The first patient's lesion showed rim enhancement after gadolinium administration. The second patient's lesion showed mixed signal intensity on both T1W and T2W images. The third patient's MRI showed a well-defined cystic lesion in the right CPA that compressed the brainstem. This lesion was hyperintense on T1W images and hypointense relative to cerebrospinal fluid on T2W images, and was peripherally enhanced after gadolinium administration. All three patients underwent surgical intervention through a suboccipital retrosigmoid craniotomy/craniectomy and lesions that did not adhere to adjacent tissues were removed completely. Histopathological examination confirmed the tumors to be adamantinomatous craniopharyngioma. The post-operative course was uneventful for all patients uneventful and no tumor recurrences were detected at the last follow-up. Primary CPA craniopharyngioma can be completely removed surgically, provided it does not densely adhere to vital structures.

Primary cerebellopontine angle craniopharyngioma in a patient with Gardner syndrome

Craniopharyngiomas usually involve the sella and suprasellar space. Ectopic craniopharyngiomas have rarely been reported at the cerebellopontine angle (CPA). We report a rare primary craniopharyngioma of the CPA without extension into the sellar region. The lesion was initially detected by MRI during investigation of multiple scalp fibromas. Multiple osteomas of the skull and face were detected 2years later, and colonic adenomatous polyposis was detected 4years later; typical features of Gardner syndrome. This is the third report of a primary CPA craniopharyngioma in a patient with Gardner syndrome.

A Primary Extraosseous Ewing Sarcoma in the Cerebellopontine Angle of a Child: Review of Relevant Literature and Case Report

BACKGROUND AND IMPORTANCE:

We report the occurrence of a primary intracranial extraosseous Ewing sarcoma/peripheral primitive neuroectodermal tumor (EES/pPNET) in the cerebellopontine angle in a child.

CLINICAL PRESENTATION:

A 10-year-old girl presented with symptoms and signs of an infratentorial space-occupying lesion that was confirmed by magnetic resonance imaging and followed up by subtotal surgical resection. Tumor cells displayed membranous expression of CD99, and one of the typical translocations of EES/pPNET (chromosome 22) was demonstrated by cytogenetic analysis.

CONCLUSION:

The literature regarding the histopathological, molecular, radiological, prognostic, and therapeutic features of intracranial EES/pPNET is reviewed, emphasizing the distinction of this entity from the central PNET. Although exceptionally rare, intracranial EES/pPNET should be considered in the differential diagnosis of lesions in the cerebellopontine angle.

Metastatic craniopharyngioma: case report and literature review

BACKGROUND

Distant spread of craniopharyngioma is a rare but important complication. Most cases are a result of spread along the surgical path. We describe a rare case of metastatic leptomeningeal craniopharyngioma as a result of dissemination along CSF pathways in a child. A review of previously described cases is provided.

CASE PRESENTATION

A 14-year-old male was diagnosed with metastatic craniopharyngioma on routine follow-up imaging after multiple surgeries and radiation for locally recurrent craniopharyngioma. The lesion was erosive through the right parietal bone, but had remained clinically silent. The lesion was distant from previous surgical paths. The patient underwent right parietal craniotomy and resection of the lesion. Duraplasty and cranioplasty were necessary for closure. Histopathology confirmed adamantinomatous craniopharyngioma. One-year follow-up demonstrated no recurrence.

DISCUSSION

A review of reported cases suggests that leptomeningeal implantation may be an important step in metastases of craniopharyngioma, although the mechanism is poorly understood. Attention to tumor spillage at the time of surgery may be important in preventing distant recurrences.

Craniopharyngioma: modern concepts in pathogenesis and treatment

PURPOSE OF REVIEW

Craniopharyngioma is a benign tumour. Its tendency to recur after excision and the high surgical risk due to involvement of the most vital structures of the brain mean that alternatives to radical surgery should be considered, namely limited surgical procedures followed by radiotherapy. Since both options present inherent risks, optimal craniopharyngioma treatment remains controversial. This paper aims to critically review the recent literature on craniopharyngioma.

RECENT FINDINGS

The management of children with craniopharyngioma has benefited from concerted efforts by national and international groups to improve outcome and reduce morbidity. From the current literature it is evident that there is a trend to better integrate all treatment modalities available, tailoring therapies to specific risk factors. Modern imaging and new surgical and radiotherapy techniques are increasing the possibility of cure. Biological markers are under investigation and this will increase our knowledge on craniopharyngioma.

SUMMARY

Studies on treatment, biology and pathogenesis of craniopharyngioma, available in the current literature, grew considerably in the last year. Although a consensus has not been reached on all aspects of this complex disease, there is a trend in the field to move quickly towards a better understanding of the disease to improve treatment strategies and to produce clinical cooperative trials.