Yonsei Med J.  2009 Oct;50(5):729-731. 10.3349/ymj.2009.50.5.729.

Isolated Petroclival Craniopharyngioma with Aggressive Skull Base Destruction

• Lee YH
• Kim SD
• Lim DJ
• Park JY
• Chung YG
• Kim YS

• KMID: 1103832
• DOI: http://doi.org/10.3349/ymj.2009.50.5.729

Abstract

We report a rare case of petroclival craniopharyngioma with no connection to the sellar or suprasellar region. MRI and CT images revealed a homogenously enhancing retroclival solid mass with aggressive skull base destruction, mimicking chordoma or aggressive sarcoma. However, there was no calcification or cystic change found in the mass. Here, we report the clinical features and radiographic investigation of this uncommon craniopharyngioma arising primarily in the petroclival region.

Keyword

Craniopharyngioma; skull base; petroclival

MeSH Terms

Cranial Fossa, Posterior/*pathology/radiography/surgery
Craniopharyngioma/*diagnosis/radiography/surgery
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Pituitary Neoplasms/*diagnosis/radiography/surgery
Skull Base Neoplasms/*diagnosis/radiography/surgery
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Axial T2-weighted (upper left), T1-weighted (upper center), contrast-enhanced T1-weighted axial (Upper right), coronal (lower left), and sagittal (lower center, right) MR images show a large well-enhancing solid mass occupying the petroclival region with intracranial extension. It dose not show sellar or suprasellar extension. Compared with the brain cortex, it is isointense on both T1-weighted and T2-weighted images.

• 

  Fig. 2 Bone-algorithm axial and coronal CT images reveal an extensive, permeative destruction, especially affecting temporal petromastoid and occipital condyle. Left carotid bony canal and jugular foramen were also destroyed. Sclerotic change of left temporal bone might be caused by chronic otomastoiditis. Left vertebral artery is medially displaced by the tumor (lower right) on angiogram.

• 

  Fig. 3 Photomicrographs of tumor sections demonstrating irregular nests of multistratified squamous cells with peripheral palisading of nuclei (A), and expressing high- and low-molecular weight cytokeratin (B) (original magnifications, ×200).

Reference

1. McLendon RE, Rosenblum MK, Bigner DD. Russell and Rubinstein's pathology of tumors of the nervous system. 1998. 6th ed. London: A Hodder Arnold Publication.

2. Ragoowansi AT, Piepgras DG. Postoperative ectopic craniopharyngioma. Case report. J Neurosurg. 1991. 74:653–655.

3. Tomita S, Mendoza ND, Symon L. Recurrent craniopharyngioma in the posterior fossa. Br J Neurosurg. 1992. 6:587–590.

4. Goldberg GM, Eshbaugh DE. Squamous cell nests of the pituitary gland as related to the origin of craniopharyngiomas. A study of their presence in the newborn and infants up to age four. Arch Pathol. 1960. 70:293–299.

5. McGrath P. Aspects of the human pharyngeal hypophysis in normal and anencephalic fetuses and neonates and their possible significance in the mechanism of its control. J Anat. 1978. 127:65–81.

6. Cooper PR, Ransohoff J. Craniopharyngioma originating in the sphenoid bone. Case report. J Neurosurg. 1972. 36:102–106.

7. Benitez WI, Sartor KJ, Angtuaco EJ. Craniopharyngioma presenting as a nasopharyngeal mass: CT and MR findings. J Comput Assist Tomogr. 1988. 12:1068–1072.

8. Kanungo N, Just N, Black M, Mohr G, Glikstein R, Rochon L. Nasopharyngeal craniopharyngioma in an unusual location. AJNR Am J Neuroradiol. 1995. 16:1372–1374.

9. Solarski A, Panke ES, Panke TW. Craniopharyngioma in the pineal gland. Arch Pathol Lab Med. 1978. 102:490–491.

10. Linden CN, Martinez CR, Gonzalvo AA, Cahill DW. Intrinsic third ventricle craniopharyngioma: CT and MR findings. J Comput Assist Tomogr. 1989. 13:362–363.

11. Jiang RS, Wu CY, Jan YJ, Hsu CY. Primary ethmoid sinus craniopharyngioma: a case report. J Laryngol Otol. 1998. 112:403–405.

12. Altinörs N, Senveli E, Erdoğan A, Arda N, Pak I. Craniopharyngioma of the cerebellopontine angle. Case report. J Neurosurg. 1984. 60:842–844.

13. Bashir EM, Lewis PD, Edwards MR. Posterior fast craniopharyngioma. Br J Neurosurg. 1996. 10:613–615.

14. Gökalp HZ, Egemen N, Ildan F, Bacaci K. Craniopharyngioma of the posterior fossa. Neurosurgery. 1991. 29:446–448.

15. Link MJ, Driscoll CL, Giannini C. Isolated, giant cerebellopontine angle craniopharyngioma in a patient with Gardner syndrome: case report. Neurosurgery. 2002. 51:221–225. discussion 225-6.

16. Sener RN. Giant craniopharyngioma extending to the anterior cranial fossa and nasopharynx. AJR Am J Roentgenol. 1994. 162:441–442.

17. Eldevik OP, Blaivas M, Gabrielsen TO, Hald JK, Chandler WF. Craniopharyngioma: radiologic and histologic findings and recurrence. AJNR Am J Neuroradiol. 1996. 17:1427–1439.