A 4-year-old female presented with visual disturbance and headache. An MRI found a 22x24x34mm suprasellar and intrasellar mass with cystic and solid parts, including calcification. The mass displaced the chiasm and enlarged and compressed the sella turcica. Post-contrast imaging showed heterogeneous enhancement of the solid portion and strong enhancement of the cyst wall. The diagnosis was craniopharyngioma, a benign epithelial tumor arising from the pituitary gland that is most common in children aged 8-12 and typically appears cystic with calcification and enhancement of the cyst wall on imaging.

1. IMAGING DEPARTMENT
Jan 24th
, 2012
Reported by Dr. Le Giang

2.  Name: Doan Thi Tuyet Nhung
 Sex: Female
 Age: 4 y
 Dept: Outpatient

3. Clinical
 Visual disturbance
 Headache

4. MRI findings
T2WI, Axial
 Suprasellar & intrasellar mass (22x24x34 mm)
 Mixed component: cystic & solid part (calcification)
 Displacement of chiasm

5. MRI findings
T1WI, Sagital
 Sellar enlargement ( AP: 21mm) , hardly compress pituitary
 Heterogenous intensity (iso & hypo signal) calcification & fluid
 Cystic contents hyperintense to cerebrospinal fluid

6. MRI findings
T1WI, Coronal
 Cyst content hyperintense to CSF

7. MRI findings
T1WI, Axial, Post C+
 Solid portion enhance heterogenously
 Cyst wall strong enhances
 Circle of Willis encased by mass

8. MRI findings
T1WI, Post C+
 Compress hardly pituitary

9. MRI findings
T1WI, Post C+
 Solid portion enhance heterogenously
 Cyst wall strong enhances

10. Diagnosis
CRANIOPHARYNGIOMA

11. Background
 CrP is slow- growing & benign tumor.
 Histologically benign epithelial tumor arising from squamous rests along
involuted hypophyseal-Rathke duct.
 2 Types: Adamentinomatous & Papillary
 6-9% of all Ped intracranial tumors.
 Location: Suprasellar (75%), Supra & intrasellar ( 21%), Intrasellar (4%).
 Age: Peak at 8-12 y.
 Imaging findings: Cystic supracellar mass with calcification & enhancement
of a mural nodule of cyst wall. Displacement of chiasm.
 90% are cystic; 90% have calcification; 90% enhancement cyst wall
 Treatment: surgical & radiation therapy.
 Prognosis: 64-96% overall 10 years survival
20% recurrence rate if <5cm
80% recurrence rate if> 5cm
Can recur up to 30 years after resection.

12. Thank you for attention!