Hypothalamic glioma masquerading as craniopharyngioma

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Abstract

Hypothalamic glioma account for 10-15% of supratentorial tumors in children. They usually present earlier (first 5 years of age) than craniopharyngioma. Hypothalamic glioma poses a diagnostic dilemma with craniopharyngioma and other hypothalamic region tumors, when they present with atypical clinical or imaging patterns. Neuroimaging modalities especially MRI plays a very important role in scrutinizing the lesions in the hypothalamic region. We report a case of a hypothalamic glioma masquerading as a craniopharyngioma on imaging along with brief review of both the tumors.

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Most cited references 12

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Optic pathway glioma: correlation of imaging findings with the presence of neurofibromatosis.

L Kornreich, S I Blaser, M. Schwarz … (2016)

Despite the benign histology of optic pathway glioma (OPG) (low-grade astrocytoma), its biological behavior is unpredictable, and it is unclear whether specific morphologic or anatomic patterns may be predictive of prognosis. It is also unclear whether OPG associated with neurofibromatosis (NF) is a distinct entity from non-NF-OPG. Our purpose was to describe the MR imaging features of OPG, compare the findings between patients with and those without NF, and identify prognostic imaging signs. MR examinations of 91 patients with OPG (47 with NF and 44 without) were reviewed at presentation and during follow-up. The images were evaluated for size and extension of tumor, and imaging parameters. Statistical bivariate analysis was used to compare the patients with and those without NF, and Pearson correlation was used to evaluate the correlation between the different imaging parameters and prognosis. Kappa values were calculated to determine intraobserver and interobserver variability. The most common site of involvement in the NF group was the orbital nerve (66%), followed by the chiasm (62%). In the non-NF group, the chiasm was the most common site of involvement (91%); the orbital nerves were involved in only 32%. Extension beyond the optic pathway at diagnosis was uncommon in the NF group (2%) but frequent in the non-NF group (68%). In the NF group, the tumor was smaller and the original shape of the optic pathways was preserved (91% vs. 27% in the non-NF group). The presence of cystic components was significantly more common in the non-NF patients (66% vs. 9% in the NF group). During follow-up, half the NF patients remained stable, in contrast to 5% of the non-NF group. No statistical correlation was found between imaging features and biological behavior of the tumor. NF-OPG is a separate entity from non-NF-OPG, with different imaging features and prognosis, thereby warranting a specific diagnostic, clinical, and therapeutic approach.

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MR differentiation of adamantinous and squamous-papillary craniopharyngiomas.

W Wichmann, A Valavanis, S Sartoretti … (1996)

To determine MR criteria for differentiating adamantinous from squamous-papillary craniopharyngiomas. The MR imaging features of 42 histologically proved craniopharyngiomas (25 adamantinous, 15 squamous-papillary, and two mixed subtypes) were examined with multiplanar T2-weighted and noncontrast and contrast-enhanced T1-weighted imaging. Differences in the mR features of both subtypes were evaluated retrospectively. The adamantinous craniopharyngioma is a mixed solid-cystic or mainly cystic lobulated suprasellar or intrasellar/suprasellar tumor occurring in children and adults, typically with large nonenhancing hyperintense cysts on T1-weighted images. The squamous-papillary craniopharyngioma is a predominantly solid or mixed solid-cystic suprasellar tumor occurring in adults, appearing as a hypointense cyst on noncontrast T1-weighted images. Calcifications and recurrent tumors are more often observed in adamantinous tumors but can be seen in squamous-papillary tumors as well. Statistically significant parameters useful for differentiating the two tumor subtypes are the encasement of vessels, the lobulated shape, and the presence of hyperintense cysts in adamantinous tumors, and the round shape, the presence of hypointense cysts, and the predominantly solid appearance in squamous-papillary tumors. Craniopharyngiomas can be divided into two clinically, histologically different subtypes, which suggests a different pathogenesis of these two types of tumor.

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Neuroimaging of childhood craniopharyngioma.

D. Nash (1993)

The imaging of craniopharyngioma may include plain skull x-rays, computer tomography (CT) scans, magnetic resonance imaging (MRI) and angiography. Coronal studies are essential to properly define the regional anatomy. The solid or cystic character of the lesion is especially apparent with contrast enhancement. MRI adds a sagittal projection which is useful, and its increasing sophistication may eventually make angiography superfluous in these tumours. The appearance of craniopharyngiomas in each modality is described, including 3D, and an ideal imaging strategy presented. Postoperative imaging is best done with both MRI and CT, and enhanced studies done within 48 h to avoid the effect of surgical trauma.

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Author and article information

Journal

Journal ID (nlm-ta): J Neurosci Rural Pract

Journal ID (iso-abbrev): J Neurosci Rural Pract

Journal ID (publisher-id): JNRP

Title: Journal of Neurosciences in Rural Practice

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0976-3147

ISSN (Electronic): 0976-3155

Publication date (Print): Jul-Sep 2013

Volume: 4

Issue: 3

Pages: 323-325

Affiliations

[1] Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India

[1 ] Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

[2 ] Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Author notes

Address for correspondence: Dr. Sameer Vyas, Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India. E-mail: sameer574@ 123456yahoo.co.in

Article

Publisher ID: JNRP-4-323

DOI: 10.4103/0976-3147.118790

PMC ID: 3821425

PubMed ID: 24250172

SO-VID: ec8b5454-7100-4fcf-a5ae-0ff6992a0910

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Hypothalamic glioma masquerading as craniopharyngioma

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Most cited references 12

Optic pathway glioma: correlation of imaging findings with the presence of neurofibromatosis.

MR differentiation of adamantinous and squamous-papillary craniopharyngiomas.

Neuroimaging of childhood craniopharyngioma.

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