Ectopic clival craniopharyngioma with intratumoral hemorrhage: A case report

Abstract

Craniopharyngiomas located outside the intra/suprasellar region are rare and the incidence of intratumoral hemorrhage is also rare. A 45-year-old woman with visual field defect underwent subtotal resection of the tumor located in the skull base. CT revealed a well-defined mass with calcifications involving the clivus, and MRI showed anterior displacement of a normal pituitary gland by the mass consisting cystic portions with some fluid-fluid levels and enhancing solid portions. Surgery and histopathological examination revealed an ectopic adamantinomatous craniopharyngioma arising from the clivus with intratumoral hemorrhage. Though this condition is rare, detailed analysis of symptoms in association with imaging findings should alert the physician to the possibility of craniopharyngiomas.

Keywords: Clivus; Craniopharyngioma; Ectopic; Intratumoral hemorrhage.

Fig. 1

Sagittal unenhanced CT images. Brain window image (A), bone window image (B), showing a well-defined mass (arrows) involving the skull base and clivus with peripheral calcifications. Bone windowing (B) shows a bulge in the clivus (arrowhead) adjacent to the mass.

Fig. 2

Magnetic resonance imaging (MRI) showing a well-defined mass (3.7 × 2.1 × 2.4 cm) involving the clivus, the mass being heterogeneously hyperintense with some fluid-fluid levels (A: arrow) on T1-weighted images (A,B), and heterogeneously hypointense on T2-weighted images (C). The mass consists of cystic and solid portions with contrast enhancement of some of the solid parts (arrows) on T1-weighted images with gadolinium enhancement (D). Sagittal images showing a normal pituitary gland and stalk (B,D: arrowheads) that have been displaced anteriorly by the lesion.

Fig. 3

Hematoxylin and eosin-stained sections (A: × 200, B: × 400) showing nodules of wet keratin (A) and macrophages containing hematoidin and hemosiderin deposition (B).