Artikel
New developed craniopharyngioma after a normal CT
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Veröffentlicht: | 27. Januar 2009 |
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Gliederung
Text
Case report
A 63-year-old woman presented with worsening of her common headache and visual impairment, with severe visual acuity decrease in right eye and superior temporal quadrantanopsia in left eye. She has been followed for almost 20 years for episodes compatible with epileptic attacks. A brain CT, without contrast, performed 8 years before present episode was considered normal. Present MRI revealed a supra and retrosellar mass that was surgically approached. The lesion was a well delimited extra-axial mass partially solid and partially cystic, filled with a yellow fluid and cholesterol crystals. Pathological study was compatible with craniopharyngioma.
Discussion
Craniopharyngiomas are histologically benign tumors that are thought to arise from embryonic remnants of Rathke’s pouch and sac and manifest clinically after a steady growth that begins in fetal life. It’s difficult to understand how the tumor reported was not detected 8 years before by a CT; we know that MRI, specially in the sagittal plane, is thought to be the most sensitive test so perhaps it was there but not in a volume to be detected and, certainly, it has grown enough in that time to become visible and symptomatic. This kind of growing is remarkable in such an indolent tumor as this is believed to be. We should suppose that this tumor has originated de novo, having found some precedent cases in the literature. Some authors have said that this kind of tumor may have been dormant through the patient’s lifetime and suddenly some factor or cellullar mutation may have trigger the tumor’s growth.
We believe this case bring out attention to a further understanding of the natural history of these tumors and perhaps this kind of knowledge may lead to advances in the therapy, difficult nowadays.
References
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- Arginteanu MS, Haghe K, Zimmerman R, et al. Craniopharyngioma arising de novo in middle age. Case report. J Neurosurg. 1997;86:1046-8.
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- Pascual-Piazuelo MC, Bestué-Cardiel M, Serran-Ponz M. Estudio epidemiologico de craneofaringiomas en Aragon y La Rioja. Rev Neurol. 2002;34:796.
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- Jain SK, Chopra S, Mathur P. Craniopharyngioma in a 82-year-old male. Neurol India. 2003;51:133-4.