PMC4533391_01
A: Computed tomography scan showing a high density suprasellar lesion indicating hemorrhage, with no gross calcifications. B, C: Preoperative coronal T1-weighted (B) and T2-weighted (C) magnetic resonance (MR) images showing the ventricular craniopharyngioma as isointense and hypointense, respectively. D: Sagittal T1-weighted MR image with gadolinium-diethylene-triaminepenta-acetic acid showing a well enhanced round lesion confined entirely to the third ventricle. E: Sagittal T2-weighted MR image of the thoracolumbar spine showing a hypointense rim surrounding the spinal cord. F: Sagittal [18F]fluorodeoxyglucose (FDG) positron emission tomography scans showing marked extremely high uptake of FDG accumulation in the ventricular tumor compared with previously reported cases of craniopharyngioma.
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F1
Brain computed tomography (CT) revealed a hyperdense lesion in the anterior part of the third ventricle, and dilation of the lateral ventricles (Fig. 1A). Brain MR imaging revealed an intraventricular mass (1.8 x 2.3 x 2.4 cm) in the anterior part of the third ventricle, appearing as isointense with the gray matter on T1-weighted imaging (Fig. 1B), hypointense on T2-weighted imaging (Fig. 1C), and with good enhancement on T1-weighted imaging after administration of gadolinium (Fig. 1D). The lateral ventricles were dilated indicating hydrocephalus. T2-weighted fast spin echo imaging also partially demonstrated the linear hypointense rim around the brain (Fig. 1C), indicating hemosiderin deposition. Spinal T2-weighted MR imaging revealed superficial siderosis over a large part of the spine (Fig. 1E). CT angiography indicated an unruptured anterior communicating artery aneurysm. Cerebral angiography revealed an unruptured 3-mm diameter anterior communicating artery aneurysm, with no tumor stain (data not shown). [18F]fluorodeoxyglucose positron emission tomography was performed using the previously reported method, and revealed extremely high uptake in the lesion compared with previously reported cases of craniopharyngioma (Fig. 1F).
Coronal T2*-weighted gradient echo images showing extensive hemosiderin depositions on the surfaces of cisterns, sylvian fissures, interhemispheric fissure and hemispheric sulci. Hemosiderin depositions are comparatively slight on the cerebral ventricle wall. A, B: The ventricular craniopharyngioma had a diffuse dark appearance. Hemosiderin depositions were also observed on the surfaces of the medial temporal lobe, and basal forebrain. C: Hemosiderin depositions extended over the surfaces of brainstem.
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F2
T2*-weighted GE MR imaging revealed a hypointense rim around the brain particularly marked within the depth of the sulci (Fig. 2A, B). The hypointense rim extended to the surface of brainstem (Fig. 2C). The intraventricular tumor appeared as diffuse hemorrhagic hypointensity (Fig. 2A, B).
A: Photomicrograph of the solid tumor showing mainly papillary proliferation of well-differentiated squamous epithelium around cores of fibrovascular stroma, consistent with papillary craniopharyngioma. Hematoxylin and eosin stain, original magnification x200. B: Photomicrograph showing hemorrhage in papillary craniopharyngioma with thickening and hyalinization of the vessel walls. Hematoxylin and eosin stain, original magnification x200.
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F3
I. Histological examination proved intratumoral hemorrhagic features with thickening and hyalinization of the vessel walls (Fig. 3). Immunohistochemical staining was positive for CAM5.2 and negative for glial fibrillary acidic protein, S-100 protein, CK20, and epithelial membrane antigen.