Presentation
Headache for 1 month. Previously treated as migraine headache.
Patient Data
Ill-defined, hypodense lesion (mean HU 28) in the suprasellar region extending towards the intrasellar area. It shows peripheral and stippled type of calcification. The lesion has involved the third ventricle with dilatation of bilateral lateral ventricles, resulting in obstructive hydrocephalus. There is effacement of the basal cisterns and fourth ventricle appears normal. No hemorrhagic foci or bony erosion is noted.
An ill-defined, T1 low and T2 high signal intensity lesion which is mildly suppressed on FLAIR is noted in the supra-sellar region extending into the intra-sellar area. There are a few, small, intra-lesional low signal intensities noted on FLAIR, suggestive of cystic spaces. DWI shows no diffusion restriction. On SWI, a few peripheral linear blooming artifacts could be appreciated which correspond to dark areas on SWI-Phase images, suggestive of calcifications. T1 fat sat postcontrast study shows avid enhancement of the solid components of the lesion with few, small, non-enhancing areas within the lesion denoting small cysts.
Anteriorly, it has involved the optic chiasm. Inferiorly, it appears to compress the pituitary gland. It is encasing the surrounding vessels including M1 segments of bilateral MCAs and A1 segments of bilateral ACAs. Postero-superiorly, it has involved the third ventricle leading to dilatation of bilateral lateral ventricles causing obstructive hydrocephalus.
The histopathological report from the excisional biopsy of this lesion showed Rosenthal fibers and revealed it to be pilocytic astrocytoma.
Case Discussion
Given the solid nature of the lesion and the location, the major differential is papillary craniopharyngioma, which was given in the radiology report. Other differentials could be meningioma and chordoid glioma. However, the histopathological report of its excisional biopsy revealed it to be pilocytic astrocytoma.
Unable to process the form. Check for errors and try again.