PMC8825802_01
(A) Brain magnetic resonance imaging (MRI), November 2006, at the time of the first diagnosis; (B) Brain MRI, November 2019, at the time of recurrence; (C) Brain MRI, February 2020, showing residual disease after post-second surgery, before starting medical therapy with BRAF- and MEK-inhibitors; (D) Brain MRI, June 2020, at the time of partial response after 4 months of medical therapy; (E) Brain MRI, August 2021, after 18 months of medical therapy.
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MRI, advised by a family doctor to investigate the persistency of memory loss and headaches unresponsive to pain killers medications. MRI evidenced a previously unknown infra- and supra-sellar mass of 3.5 x 2.6 cm, with high pressure on the third ventricle and on the interpenducular cistern; with MRI contrast, peripheral highlighting and an 8 mm enhanced solid nodule were found; the imaging was consistent with a diagnosis of cystic craniopharyngioma (Figure 2A). PCP, being identified in most, but not all, PCP and never in adamantinomatous craniopharyngioma (ACP). Post-operative brain MRI performed in February 2020 revealed residual tissue with dimensions of 19 x 22 x 19 mm, and after contrast, an inhomogeneous increase in this lesion occurred (Figure 2C). First radiological evaluation with MRI after 4 months of treatment showed not only a significant volume reduction of the tumor (14 x 9 x 5 mm vs. 19 x 22 x 19 mm) but also a reduction of the mass effect on the surrounding tissue, for example, realignment of chiasmatic structure (Figure 2D). The last radiological evaluation, performed in August 2021 with MRI after 1 year of treatment, showed overall stability of tumor burden compared to November 2020 (Figure 2E).