PMC7495153_01
Initial MRI without gadolinium ordered by primary care provider, revealing a suprasellar mass extending into the anterior portion of the third ventricle and displacing the hypothalamus. There is evidence of a robust septal flap and residual fat graft from prior resection.
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An MRI without gadolinium revealed a heterogeneous 3 cm suprasellar mass extending into the third ventricle, with superior displacement of the hypothalamus and optic chiasm (Figure 1).
CT with contrast obtained by neurosurgery and otolaryngologist the day before surgery revealing a 2.7 cm x 2.3 cm x 1.9 cm suprasellar mass with peripheral calcifications. The mass impinges on the foramen of Monro and the anterior portion of the third ventricles.
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T4. Thereafter, the patient received a CT scan prior to surgery revealing the tumor invading into the third ventricle (Figure 2).
Histological examination revealing collision tumor transition point. The center of the image reveals pituitary adenoma tissue with elongated cells in a pseudorosette pattern. The surrounding tissue reveals the adamantinomatous craniopharyngioma with whorls of keratin and stellate reticulum.
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Subsequent histopathological examination of the surgical specimen revealed two tumor components within the resection: adamantinomatous craniopharyngioma and hypercellular recurrent pituitary adenoma (Figure 3).
This histological section reveals a higher powered magnification of Figure 3 demonstrating the pituitary adenoma with elongated cells in a pseudorosette pattern.
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The pituitary adenoma portion revealed elongated cells in a pseudorosette pattern which was expected for this type of tumor (Figure 4).
This section reveals stellate reticulum in the middle of the image with whorls of keratin diffusely throughout consistent with the adamantinomatous craniopharyngioma.
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Histology of the adamantinomatous craniopharyngioma revealed stellate reticulum with whorls of keratin (Figure 5).