PMC6664541_01
Coronal view of initial CT (a). Initial MRIs: T1-weighted (b), T2-weighted (c), and Gd-enhanced T1-weighted (d) coronal images.
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fig1
Part of the cyst wall was calcified on the CT scan (Figure 1(a)). T1-weighted (Figure 1(b)) and T2-weighted (Figure 1(c)) images, respectively. The suprasellar cyst showed low and high intensities on T1-weighted (Figure 1(b)) and T2-weighted (Figure 1(c)) images, respectively. A gadolinium-diethylenetriaminepentaacetic acid-enhanced T1-weighted image showed the sellar tumor mass as homogenously enhanced and the wall of the suprasellar cyst as slightly enhanced (Figure 1(d)).
Intraoperative view showing the calcified cyst wall between the left internal carotid artery ( ) and left optic nerve (*) (a). The cyst contents were a motor-oil-like fluid, which indicated a typical craniopharyngioma (b). Postoperative MRI showing reduction of the suprasellar cyst and recovery of the midline structure (c). Photomicrograph of the pathological specimen at the first operation showing features of craniopharyngioma (hematoxylin-eosin staining, magnification ratio 100-fold) (d). The presence of sheets of squamous epithelial cells, calcification ( ), and brightly eosinophilic cytoplasm, termed wet keratin ( ), indicates an adamantinomatous type of craniopharyngioma.
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A left frontoparietal craniotomy and wide open of the left Sylvian fissure exposed the yellowish-white bulging wall of the suprasellar cyst (Figure 2(a)). A yellowish semitransparent fluid was aspirated during the excision (Figure 2(b)). Postoperative imaging showed marked cyst shrinkage and decompression of the midbrain and hypothalamus (Figure 2(c)). Histological examination disclosed adamantinomatous CP as expected (Figure 2(d)).
A Gd-enhanced T1-weighted image after transsphenoidal surgery showing reduction of the sellar tumor and enough gain between the sellar tumor and optic chiasma (a). Photomicrograph of the pathological specimen at the second operation showing features of the pituitary adenoma. (b) Hematoxylin-eosin staining, (c) immunostaining for LH, and (d) FSH. The optical magnification ratio of all photomicrographs is 100-fold.
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fig3
In consideration of the diagnosis, removal of the intrasellar tumor except for parts of the cavernous sinus invasion was performed (Figure 3(a)). The final histological diagnosis after the second operation was PA (Figure 3(b)). The immunostaining for LH (Figure 3(c)) and FSH (Figure 3(d)) was both negative.
Follow-up MRI of T2-coronal (a), T1-sagittal (b), and T2-sagittal (c) at 10 years after the initial operation showing that the suprasellar cyst and sellar tumor were still completely controlled.
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After a 10-year follow-up at our outpatient clinic, both lesions were still completely controlled (Figures 4(a)-4(c)).