Craniopharyngioma

Findings:
The lateral skull film shows marked expansion of the sella and a large faint rimlike area of calcification projecting over the suprasellar region. Axial CT images show a large sellar region mass with internal low density and thick rimlike calcification, associated with hydrocephalus. No central enhancement is present.

Differential Diagnosis:
This constellation of findings is highly consistent with craniopharyngioma, and this is by far the most likely diagnosis. Germ cell tumor could be considered if there were more enhancing solid component, and teratoma could be considered also but would be less likely.

Discussion:
-present clinically with increased intracranial pressure, hypothalamic dysfunction, or chiasmatic compression symptoms
-origin: cranio from pars tuberalis, Rathke's from pars intermedia
-location: 70% intra and suprasellar, 10% suprasellar only, 10% intrasellar only
-age peaks: 5-10 and less so at 50-60
-most common suprasellar mass in children (50%)
-imaging: 80% Ca++ in children, 40% Ca++ adults, 90% cystic, 90% rim enhance, hyper T1/T2 (cholesterol), +/- optic tract signal abn
-main ddx is Rathke's cleft cyst (RCC enhances minimally or not at all)

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