sellar masses and ovarian masses differential, an approach by Dr. Anil jangir MD radiodiagnosis , jodhpur Rajasthan

1. Presented by Dr. Anil jangir
Guided by Dr. R.N Gehlot

2. Common sellar and parasellar tumors
- Pituitary adenoma
- Craniopharyngioma
-Meningioma
-Rathkes cleft cyst
-Chiasmatic glioma
-Dermoid
-Epidermoid
-Germinoma
-Schwannoma
-Metastasis
- Giant aneurysm

3. Epidermoid cyst
- Well circumscribed
- Non enhancing
- Homogenously hypodense lesion
- CSF signals on T1/T2/FLAIR
- Can cause bone thinning
- Bright on DWI (Most helpful MR sequence for
Making diagnosis )
• (d/d-Arachnoid cyst appears dark like CSF on DWI)
- Central eccentric
Chiasmatic CP angle
Quadrigeminal plate Middle cranial fossa
sylvian fissure

4. Pituitary adenoma
-Micro adenoma usually enhance later or lesser then normal
pituitary
Suprasellar extension, Inferiorly into sphenoid sinus/clivus
-Isointense to brain parenchyma on T1
*Macro adenoma may contain hemorrhagic or cystic component.
Acute hemorrhage may lead to rapid expansion of the gland and
Cause acute compression of optic chiasma ( pituitary apoplexy)
Hemorrhage appears hyperintense on T1

5. Pituitary apoplexy
Pituitary apoplexy due to hemorrhage in macroadenoma

6. Pituitary apoplexy
-Caused by hemorrhagic/ischemic necrosis of pituitary
gland
-pre-existing macroadenoma usually seen
- Sheehan syndrome- acute postpartum ischemic
necrosis
- H/o Medical management (bromocriptine/cabergoline)
of prolactinoma
- Signal intensity on MR depends on clot age
- On T1- heterogeneously iso to hypo
- T2- iso to mildly hyperintense on T2 initially then
hypointense
- Blooming on T2 may seen
- T1 C+ rim enhancement

7. Rathke’s cleft cyst(RCC)
-Mean age of presentation is 45 years, can be sellar or
suprasellar
Most symptomatic RCC are 5-15mm in diameter, can cause
pituitary dysfunction, visual disturbance and headache.
-On NECT- hypo/iso/hyperdense
-T1- hypo/ hyperintense, T2- most of hyperintense , FLAIR-
hyperintense
-An enhancing rim sign of compressed pituitary (claw sign)can
be sign
-Non enhancing intracystic nodule (dot sign)- pathognomic of
RCC
-Can present with cyst apoplexy caused by sudden intracystic
hemorrhage

8. Claw sign Dot sign
Fluid dluid level

9. Fig. A

10. Child present with
Predominantly cystic
suprasellar mass with
peripheral calcification
on NECT
Fig. B

11. Fig.C

12. fig. D
12 year old
boy present
with
suprasellar
mass

13. Solid ovarian mass differential
diagnosis
-Epithelial tumor- Brenners tumor
-Germ cell tumor- Teratoma, dysgerminoma
-Sex cord tumor- Fibroma, thecoma, Granulosa cell tumor
-Metastatic- krukenberg tumor

14. -- Signet ring Metastasis to ovary – usually large, b/l solid adnexal
mass showing heterogenous contrast enhancement
Primary gastric cancer metastasize to Liver(m/c), lungs, adrenal and
ovaries.
Can come from stomach (signet ring cells-m/c), Colorectal (2nd m/c),
breast, lung, contralateral ovary, pancreatic, cholangiocarcinoma
On MRI- b/l complex ovarian mass with hypointense solid component
and T1/T2 hyperintense mucin component

15. Biopsy proven case of signet cell
adenocarcinoma of stomach with b/l ovarian
metastasis(krukenberg tumor)

16. Brenners tumor
-Usually small solid mass, discovered
incidentally, may present multiloculated
solid-cystic mass
- Amorphous calcification is seen in
solid portion
- On CT solid component is enhance
- On T2WI dense fibrous stromal
component is low signal intensity
Immature teratoma
Have predominant solid component
- May show internal
necrosis/hemorrhage
- More malignant
- Rest of the features are similar to
mature teratoma

17. Dysgerminoma
- Rare ovarian tumor,
predominantly in young women
-Multilobulated solid mass with
prominent fibrovascular septa
Grsnulosa cell tumor
-can be solid/multiloculated
cystic/completely cystic
-heterogeneously solid due to
intratumoral bleed/necrosis/fibrous
degeneration
No intracystic papillary projection,
no tendency to peritoneal seeding

18. Fibroma & thecoma
- Benign, fibroma is m/c sex cord tumor,
present as solid mass, ass. With ascites or
meigh syndrome
- homogenous solid mass delayed
enhancement
- Have abundant collagen component so
appears low signals on T1 & very low
signal on T2(diagnostic for fibroma) d/d
– pedunculated uterine leiomyoma
- Having dense scattered calcifications
- Scattered high signal intensity represent
edema or cystic degeneration