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Large suprasellar mass: question
Journal of Clinical Neuroscience 22 (2015) 1183
Contents lists available at ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Images in Neuroscience: Question
Large suprasellar mass: question Kenneth Sim a,⇑, Andrew Morokoff b, Alpha Tsui c, Frank Gaillard a a
Department of Radiology, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia Department of Neurosurgery, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia c Department of Pathology, The Royal Melbourne Hospital, Parkville, VIC, Australia b
1. Clinical background B
A
A 25-year-old Caucasian woman presented with headache, drowsiness, weight gain and discordant gaze palsy. She had no previous significant past medical history and was not on any regular medications. Her initial brain CT scan (Fig. 1A–C) demonstrated a large suprasellar region mass with cystic and solid enhancing components. Small foci of calcific density and fat density were also noted adjacent to the right posterior clinoid process. Obstructive hydrocephalus was present. Emergency ventricular shunting as well as shunting of the cystic component of the mass was performed which improved both her drowsiness and visual symptoms, and the patient proceeded to MRI (Fig. 1D–F). 2. The most likely diagnosis is: A. B. C. D. E.
C
D
E
F
Cystic pituitary macroadenoma Craniopharyngioma Dermoid cyst Intracranial teratoma Epidermoid cyst
Answer on page 1218. Conflicts of Interest/Disclosures The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
DOI of answer: http://dx.doi.org/10.1016/j.jocn.2015.03.001
⇑ Corresponding author. Tel.: +61 3 9342 7000.
E-mail address: [email protected] (K. Sim). http://dx.doi.org/10.1016/j.jocn.2015.01.027 0967-5868/Ó 2015 Elsevier Ltd. All rights reserved.
Fig. 1. Axial post-contrast CT scan (A) through a large suprasellar region mass. Window and levelling (B, C) highlights the area of pathological interest superior to the right posterior clinoid process (arrow). Coronal pre- (D) and post-contrast (E) T1-weighted MRI demonstrates vivid homogeneous enhancement of the solid component of the tumour. The area of intrinsic high T1 signal superior to the right posterior clinoid process, demonstrates chemical shift artefact on the coronal T2weighted MRI (F, arrow).
Contents lists available at ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Images in Neuroscience: Question
Large suprasellar mass: question Kenneth Sim a,⇑, Andrew Morokoff b, Alpha Tsui c, Frank Gaillard a a
Department of Radiology, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia Department of Neurosurgery, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia c Department of Pathology, The Royal Melbourne Hospital, Parkville, VIC, Australia b
1. Clinical background B
A
A 25-year-old Caucasian woman presented with headache, drowsiness, weight gain and discordant gaze palsy. She had no previous significant past medical history and was not on any regular medications. Her initial brain CT scan (Fig. 1A–C) demonstrated a large suprasellar region mass with cystic and solid enhancing components. Small foci of calcific density and fat density were also noted adjacent to the right posterior clinoid process. Obstructive hydrocephalus was present. Emergency ventricular shunting as well as shunting of the cystic component of the mass was performed which improved both her drowsiness and visual symptoms, and the patient proceeded to MRI (Fig. 1D–F). 2. The most likely diagnosis is: A. B. C. D. E.
C
D
E
F
Cystic pituitary macroadenoma Craniopharyngioma Dermoid cyst Intracranial teratoma Epidermoid cyst
Answer on page 1218. Conflicts of Interest/Disclosures The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
DOI of answer: http://dx.doi.org/10.1016/j.jocn.2015.03.001
⇑ Corresponding author. Tel.: +61 3 9342 7000.
E-mail address: [email protected] (K. Sim). http://dx.doi.org/10.1016/j.jocn.2015.01.027 0967-5868/Ó 2015 Elsevier Ltd. All rights reserved.
Fig. 1. Axial post-contrast CT scan (A) through a large suprasellar region mass. Window and levelling (B, C) highlights the area of pathological interest superior to the right posterior clinoid process (arrow). Coronal pre- (D) and post-contrast (E) T1-weighted MRI demonstrates vivid homogeneous enhancement of the solid component of the tumour. The area of intrinsic high T1 signal superior to the right posterior clinoid process, demonstrates chemical shift artefact on the coronal T2weighted MRI (F, arrow).