PMC9560665_01
a) Sagittal FLAIR image and one-month later b) Coronal c) Sagittal post-gadolinium T1 weighted images demonstrate the progressive sellar, suprasellar and hypothalamic heterogeneously enhancing mass and d) Comparative axial post-gadolinium images at presentation and one-month later.
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MRI one month later showed progression of the tumour with widespread metastatic lesions in the ventricular system (Fig. 1). MRI spine, performed to investigate the radicular leg pain, demonstrated an intradural extramedullary lesion at the level of L1 with equivocal pial nodules of enhancement (Fig. 2).
a) Sagittal T1 post-gadolinium image of the spine demonstrates fine nodular pial enhancement of the spinal cord with b) Axial post-gadolinium image at L1 level demonstrating a larger intrathecal enhancing lesion adjacent to the conus.
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MRI one month later showed progression of the tumour with widespread metastatic lesions in the ventricular system (Fig. 1). MRI spine, performed to investigate the radicular leg pain, demonstrated an intradural extramedullary lesion at the level of L1 with equivocal pial nodules of enhancement (Fig. 2).
Cytology and histology of the suprasellar cystic lesion. a) The intraoperative smear preparation shows squamous epithelial cells with moderate pleomorphism. 3b) Sections stained by haematoxylin-eosin (H&E) show multiple small tissue fragments mainly composed of haphazardly arranged squamous epithelial cells with focal keratinisation but no lamellar or wet keratin formation (H&E). The squamous epithelial cells (left side) are admixed with granulation tissue and chronic, predominately lymphocytic, inflammatory background (right side). 3c) Immunohistochemistry for pan-cytokeratin (MNF116) is positive and also shows scattered small groups of cells within the granulation tissue, suggesting infiltration. 3d) Ki-67 demonstrates moderately increased proliferation activity but labels both inflammatory and tumour cells (compare with 3b). 3e-f) Cerebrospinal fluid (CSF) cytology specimen from lumbar puncture stained by Papanicolaou (PAP) and H&E also reveals squamous epithelial cells with focal keratinisation.
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The intraoperative smear and the histology showed multiple small tissue fragments mainly composed of haphazardly arranged squamous epithelial cells with moderate pleomorphism and focal keratinisation but no wet keratin formation (Fig. 3a and b). The squamous epithelial cells were admixed with granulation tissue and chronic, predominately lymphocytic, inflammatory background (Fig. 3b). MNF116 also revealed scattered small groups of cells within the granulation tissue, suggesting infiltration (Fig. 3c). The proliferation activity (Ki-67) was moderately increased but included both inflammatory and tumour cells (Fig. 3d). The patient subsequently underwent a lumbar puncture 4 weeks post-surgery, confirming squamous cells compatible with papillary craniopharyngioma (Fig. 3e and f).