Presentation
Headache and diminution of vision of the left eye.
Patient Data
A fairly defined globular supra-sellar mass lesion is seen showing to be hypointense on T1 and hyperintense on T2, with some small peripheral cysts, and intense rather homogenous post-contrast enhancement.
The lesion is seen widening and splaying the arteries of circle of Willis with indentation and widening of the cerebral peduncles. The lesion is seen abutting the inferior frontal and temporal lobes. That lesion is seen abutting the optic chiasma and compresses the hypothalamus. It is difficult to determine whether the mass is below the floor or within the body of the 3rd ventricle.
The lesion is seen compressing and significantly attenuating the A1 segment of the left ACA. The pituitary gland is identified intact within the sella turcica below the lesion.
Case Discussion
This case illustrates a well-defined, solid-cystic, and vivid enhancing suprasellar tumor that spares the pituitary gland. In this age group the differential diagnosis depends on the location relative to the third ventricle.
If suprasellar (below the floor of the third ventricle) consider:
-
meningioma (favored)
epicenter is usually outside the pituitary fossa
dural tail common
enhancement is homogeneous and vivid
-
papillary subtype is more frequently solid, although cystic components are still more common than entirely solid lesions
epicenter is in ~90% of cases in the suprasellar region
If intraventricular (within the third ventricle) consider:
craniopharyngioma (can be intraventricular)
Although lymphoma could have this appearance on many sequences the low signal on DWI argues strongly against this.
Unfortunately follow up is not available.
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