This document provides an anatomical approach and differential diagnosis for lesions in and around the pituitary gland and sellar region. It outlines key points such as identifying the pituitary gland and sellar turcica to determine if the lesion is intrasellar, suprasellar, or lateral to the sella. Common pathologies are then discussed based on their location, such as pituitary adenomas, craniopharyngiomas, meningiomas, and other lesions that can occur in the pituitary stalk, hypothalamus, cavernous sinus, sphenoid sinus, and carotid artery. Imaging characteristics and distinguishing features between pathologies are provided.

1. At IDKD from Walter Kucharczyk

2. Key points
• Known the anatomy
• Identify pituitary gland and sellar turcica
• Determine epicenter of lesion
– Is the sellar enlarged?
– If not, above, below or lateral to the sella
• Then analyzed the signal

3. Anatomic approach to
Ddx

4. Pituitary gland
• Adenoma
• Rathke cleft cyst
• Craniopharyngioma

5. Pituitary stalk
• Rathke
• Craniop
• Germinoma
• EG
• metastasis
Optic tract, infundibulum, tuber cinerum and mammary body

6. Optic chiasm
• Glioma
• Demyelination
Optic tract, infundibulum, tuber cinerum and mammary body

7. Hypothalamus
• Glioma
• Hamartoma
• Germinoma
• EG
Optic tract, infundibulum, tuber cinerum and mammary body

8. Cavernous sinus wall
• Meningioma
• Inflammation: TB, Fungus, Sarcoidosis

9. Sphenoid sinus
• SCCA
• Chordoma
• Sarcoma
• Metastasis
• Inflammation: sinusitis

10. Carotid artery
• Aneurysm
• Ectasia
• Anomalies

11. Cavernous sinus
• Mostly venous spaces
• Schwannoma
• Inflammation
– Pseudotumor, Tolosa Hunt syndrome
• Carotid cavernous fistula

13. Pituitary gland
• Adenoma
• Rathke cleft cyst
• Craniopharyngioma

14. Pituitary microadenoma
• <10 mm.
• T1 sensitivity 70%, T2w sense 60%

15. Pituitary Macroadenoma
• Usually soft
• Elevate diaphargma selle
• Often contrasted at diaphargmatic hiatus as
tumor growth into the suprasellar cistern
• Snowman shape
• *commonest large tumor of the skull base

16. Meningioma
• Different shape from adenoma
• Diaphargma sellar = depressed

20. • #Craniopharyngioma
– Ddx dermoid (less likely)
• Bimodal distribution 5-15, 40-60
• 2 types
– Adamantinomatous : child with cal
– papillary
• Benign but adhere tightly
• Suprasellar, intrasellar, 3rd vent, sphenoid sinus,
nasopharynx
• Cystic solid, calcified mixed

26. Pituitary apoplexy
• Predisposing by: pre-existing macroadenoma,
pregnancy (Shehan syndrome)
• Associated with SDH, SAH, visual loss, acute
pituitary insufficiency.

28. Rathke cleft cyst
• Very common and very few are symptomatic
• Importation to not over treat them

34. #Germinoma
• 5-25 yrs
• AKA dysgeminoma, intracranail seminoma
• MC at stalk and hypothalamus and pineal
region
• Crawls along floor of the 3rd vent
• Ddx: LCH, craniopharyngioma
• Adult: sarcoid, lymphoma

40. • #LCH
– Ddx sarcoidosis

41. • If no posterior bright spot  Look at the stalk
and hypothalamus
• Must inject contrast
• DI
– If normal at first
– Please follow up.

50. # chordoma
• Locally agreesive never metas
• Clivus, upper C, lower L, sacrum
• 70% at the midline
• Expansile, calcification, bright T2
• Ddx chondrosarcoma

55. • #meningioma with hyperostosis
• The larger part signal drop on T1FS+Gd  fat
marrow of the bone

60. Olier disease
• Enchondromatosis
• No hereditary sporadic skeletal disorder
• Ddx
– Maffucci = plus hemangioma
– Metachondromatosis = plus osteochondromas