case_images: PMC11227683_01
case_images: Contrast-enhanced CT scan (a), sagittal T1-WI (b), and axial T2-WI (c) show solid-cystic suprasellar mass with posterior extension into the interpeduncular cistern. The ventral cystic portion is hypointense on T1-WI and hyperintense on T2-WI, while the dorsal solid portion is isointense to grey matter in both T1- and T2-WIs, and enhances intensely in CECT (a) and sagittal T1 fat-sat post-contrast image (d). The optic chiasma is not seen separately from the lesion. T2 hyperintensity is seen in the right optic tract on the right side (1c). Proton MR spectroscopy at TE of 35 msec (e) from the solid component of the lesion shows a prominent lipid peak and reduced choline, creatinine, and NAA, corresponding to the Chernov type III(b) spectrum.
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case_images: F1
case_images: Contrast-enhanced brain CT (Fig. 1a) and MRI scans revealed a lobulated, mixed solid-cystic mass in the suprasellar region. T2 hyperintense signal intensity was noted in the right optic tract due to the mass effect (Fig. 1C). The cystic part of the mass displayed increased signal intensity on FLAIR imaging and had a rim of enhanced tissue along its cyst walls (Fig. 1d). T2 imaging and exhibited intense enhancement after contrast injection (Fig. 1d). TE (echo time) of 35 msec showed a significant lipid peak in the solid part of the mass, along with reduced levels of NAA and choline, consistent with a Chernov's type III B spectrum (Fig. 1e). The patient underwent a surgical procedure involving a left pterional craniotomy and subtotal excision of the mass.
case_images: Hematoxylin and eosin stained sections (a & b) from the tumor show classical histomorphological features of a papillary craniopharyngioma comprising sheets of well-differentiated nonkeratinizing squamous epithelium arranged in papillary configurations around hyalinized fibrovascular cores
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case_images: F2
case_images: Subsequent histopathological examination confirmed the diagnosis of papillary craniopharyngioma, classified as WHO grade-1 (Fig. 2).
case_images: PMC11227683_02
case_images: Sagittal T2-WI (a) and axial T1-WI (b) show a predominantly solid iso to mildly T2-hyperintense and T1-isointense suprasellar mass lesion; separate from optic chiasma (arrow in b) with associated oedema in the right temporal lobe. Post-gadolinium sagittal (c) and axial (d) T1 fat-sat images show intense enhancement in the lesion. Multivoxel Proton MR spectroscopy at 35 TE (e) shows a Chernov type III(b) spectrum with a prominent lipid peak and reduced choline, creatinine, and NAA.
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case_images: F3
case_images: The mass was iso-hyperintense on T2-WI and had intense enhancement following gadolinium administration (Fig. 3).
case_images: PMC11227683_03
case_images: Axial T2-WI (a) shows a spherical, predominantly solid iso-hyperintense retrochiasmatic mass lesion separate from the chiasma (arrow in a). Post-gadolinium axial T1-WI (b) shows intense, solid, nearly homogeneous enhancement of the lesion. Single voxel Proton MRS at TE 144 (c) shows a prominent lipid peak at 1.3 ppm.
case_images: amed-31-068-g004.jpg
case_images: PMC11227683_03_amed-31-068-g004.jpg
case_images: F4
case_images: MRI revealed that a predominantly solid suprasellar mass remained, showing similar signal intensity to the surrounding tissue on T2-WI and intense enhancement on post-contrast T1-WI (Fig. 4). MRS conducted with a short echo time of 35 milliseconds indicated elevated lipid peaks alongside a decrease in other metabolites.