Adamantinomatous craniopharyngioma

The patient underwent an endoscopic transphenoidal debulking of the recurrent craniopharyngioma, followed by post-operative radiotherapy.

MACROSCOPIC DESCRIPTION:

1.  "Pituitary lesion":  An irregular shaped fragment of rubbery fawn tissue 6mm.  All submitted for frozen section/smear.

FS DIAGNOSIS:  Craniopharyngioma (MFG).

MICROSCOPIC DESCRIPTION:

Histology

Paraffin sections show small fragments of craniopharyngioma. These consist of epithelial islands within a loose fibrous stroma. The epithelial islands show a peripheral basaloid layer, central squamous epithelium and a stellate reticulum layer.  Several cystic spaces filled with loose amorphous eosinophilic material are noted and there are several foci of dystrophic calcification.  No mitotic figures or areas of necrosis are identified.

Final diagnosis

DIAGNOSIS: Pituitary lesion:  Craniopharyngioma.

The patient underwent a right-sided pterional craniotomy and resection of the suprasellar mass.

Histology:

Microscopic findings:

Frozen section diagnosis: Craniopharyngioma

Macroscopic findings:

In both specimens, there are sheets of epithelium with regular peripheral palisading of nuclei and a loosely reticular central arrangement. Numerous small cystic spaces are formed. The nuclei are uniform, lacking pleomorphism and mitoses are inconspicuous. Focally, there is dystrophic calcification. There is no evidence of necrosis.

Final Diagnosis:

Suprasellar Craniopharyngioma (adamantinomatous type).

Follow-up

Post-operatively, the patient’s recovery complicated by hypopituitarism, medically managed with thyroxine and hydrocortisone. His vision, however, improved markedly, returning to normal visual acuity (6/6 bilaterally) and normal visual fields. Follow-up imaging at the post-operative 8 week juncture demonstrated adequate debulking of the tumor, and less pronounced stretching and displacement of the optic chiasm and optic nerves.