PMC4168541_01
Initial coronal (a-c) and sagittal (d) magnetic resonance imaging results showing a cystic tumor in the right hypothalamus, pituitary stalk and posterior pituitary lobe as a low-/iso-intensity area on a T1-weighted image (a) and an iso-/high-intensity area on a T2-weighted image (b), with enhancement on T1-weighted images following gadolinium injection (c and d). An edematous area was observed in the right hypothalamus on the T2-weighted image (b). Preoperative Gd-enhanced coronal (e) and sagittal (f) T1-weighted images obtained 3 weeks after the initial examination showing an enlarged lesion infiltrating into the right hypothalamus
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F1
T1-weighted image (WI) and an iso-/high-intensity region on a T2-WI [Figure 1a, b]. The edematous area in the right hypothalamus was evaluated with T2-WI. Gd-DTPA coronal and sagittal T1-WI showed the presence of an enhanced irregular area progressing from the posterior pituitary lobe to the right hypothalamus along the pituitary stalk [Figure 1c, d]. The lesion had become enlarged, infiltrating the hypothalamus by 3 weeks after the initial MRI study [Figure 1e, f], and a biopsy was performed via the transsphenoidal approach through the right nostril under a preoperative diagnosis of a germ cell tumor (GCT).
Initial coronal (a) and sagittal (b) images obtained using computed tomography showing an isodense tumor in the suprasellar region with a small area of calcification
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F2
Computed tomography (CT) disclosed an isodense lesion with a small area of calcification [Figure 2a, b].
Photomicrographs of the tumor. Original magnification x100. Hematoxylin and eosin staining revealed a fragment showing multistratified epithelial tissue with focal palisading of nuclei and myxoid fibrous tissue
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F3
The histological examination showed multistratified epithelial tissue, identifying the tumor to be a papillary craniopharyngioma [Figure 3].
Gd-enhanced coronal (a) and sagittal (c) T1-weighted images obtained 6 days after the biopsy showing involution of the Gd-enhanced lesion in the right hypothalamus. The edema in the right hypothalamus persisted on a coronal T2-weighted image (b). Two months after the biopsy, Gd-enhanced coronal (d) and sagittal (f) T1-weighted images showing further involution of the Gd-enhanced lesion in the right hypothalamus with an improvement in the edema on a coronal T2-weighted image (e)
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F4
The tumor exhibited an atypical postoperative course in that [Figure 4a-c]. To expect furthermore the shrinkage of the tumor, MRI was performed 2 months after the biopsy and showed additional involution of the enhanced area with an improvement in the edema in the hypothalamus [Figure 4d-f].