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Case Study: Intracranial Mass in a 71-Year-Old Male

Explore the clinical history, MRI findings, differential diagnoses, biopsy & histology results of a 71-year-old male with visual disturbances. Unveil the final diagnosis of a Papillary Craniopharyngioma.

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Case Study: Intracranial Mass in a 71-Year-Old Male

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  1. Case Study 34 Henry Armah, M.D., M.Phil.

  2. Question 1 Clinical history: 71-year-old white male with history of headache and visual field changes, and no endocrine abnormalities. He was a non-smoker, occasionally used alcohol socially, and did not use illicit drugs. Describe the abnormal cranial MRI findings?

  3. Sag T1

  4. Cor T1

  5. Sag T1+C

  6. Cor T1+C

  7. Answer • Suprasellar lesion which is isointense on T1 images and heterogeneous mildly enhancing on the postcontrast (T1+C) images. • There is loss of visualization of the infundibulum, indicating that the mass may be arising from the infundibulum.

  8. Question 2 What are your differential diagnoses based on the patients’ age and the radiological findings?

  9. Answer • Craniopharyngioma. • Rathke’s Cleft Cyst. • Xanthogranuloma. • Granular Cell Tumor of the Neurohypophysis. • Pituicytoma. • Pituitary adenoma

  10. Question 3 The neurosurgeon performs a transnasal endoscopic biopsy of the mass and requested an intraoperative consultation. Describe the microscopic findings on this smear slide? Click here to view slide.

  11. Answer Fragments of sheets of vaguely columnar epithelial cells and scattered cell debris.

  12. Question 4 What is your intraoperative diagnosis? (A: Category such as Defer, Reactive/Non-neoplastic, or Neoplastic; B: More specific diagnosis or statement)

  13. Answer • Neoplastic. • Craniopharyngioma.

  14. Question 5 Subsequently, the mass was completely resected. The permanent section has returned from histology. Describe the microscopic findings on this H&E slide? Click here to view slide.

  15. Answer Fragments of tumor composed of solid sheets of well-differentiated epithelial cells with vague columnar basal layer and distinct fibrovascular cores. There is modest inflammation in the fibrovascular cores. The epithelial cells have abundant finely granular eosinophilic cytoplasm and nuclei with delicate chromatin. There is no evidence of microcyst formation, nuclear palisading, keratin pearls, wet keratin, or calcification.

  16. Question 6 What is your final diagnosis in this case?

  17. Answer Papillary Craniopharyngioma.

  18. Question 7 What is the corresponding WHO grade of this lesion?

  19. Answer WHO Grade 1.

  20. Question 8 True or False. This tumor is usually immunoreactive for cytokeratin 7 (CK7)?

  21. Answer True

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