Craniopharyngioma Differential Diagnoses

  • Author: George C Bobustuc, MD; Chief Editor: Tarakad S Ramachandran, MBBS, FRCP(C), FACP   more...
 
Updated: Jan 12, 2012
 
 

Diagnostic Considerations

Brainstem syndromes and increased intracranial pressure are among the conditions to consider in the differential diagnosis of craniopharyngioma. Tumors to consider in the differential diagnosis include the following:

  • Brainstem glioma
  • Epidermoid and dermoid tumor
  • Germ cell tumor
  • Hypothalamic-optic pathway glioma
  • Low-grade astrocytoma
  • Medulloblastoma
  • Meningioma
  • Metastasis
  • Hypothalamic hamartoma
  • Pituitary tumor
  • Primitive neuroectodermal tumors of the central nervous system (CNS)

The following infectious or inflammatory processes can be considered in the differential diagnosis:

  • Histiocytosis X
  • Infundibulitis
  • Lymphocytic hypophysitis
  • Sarcoidosis
  • Syphilis
  • Tuberculosis

Vascular malformations to consider in the differential diagnosis include the following:

  • Carotid-cavernous fistula
  • Cavernous sinus hemangioma
  • Giant suprasellar carotid aneurysm

Other congenital defects to consider in the differential diagnosis include the following:

  • Arachnoid cyst
  • Rathke cleft cyst

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

George C Bobustuc, MD  Consulting Staff, Department of Neuro-oncology, MD Anderson Cancer Center of Orlando

George C Bobustuc, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, Society for Neuro-Oncology, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Morris D Groves, MD, JD  Assistant Professor, Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center

Morris D Groves, MD, JD is a member of the following medical societies: American Academy of Neurology, American Medical Association, and Texas Medical Association

Disclosure: Genentech Grant/research funds Other; Genentech Honoraria Consulting; GlaxoSmithKline Grant/research funds Other; AngioChem Grant/research funds Other; Pfizer/Celldex Therapeautics Grant/research funds Other

Gregory N Fuller, MD, PhD  Professor of Pathology, Chief, Section of Neuropathology, Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center

Gregory N Fuller, MD, PhD is a member of the following medical societies: American Association of Neuropathologists, College of American Pathologists, International Academy of Pathology, Society for Neuro-Oncology, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Franco DeMonte, MD, FRCSC, FACS  Professor of Neurosurgery, Mary Beth Pawelek Chair in Neurosurgery, The University of Texas MD Anderson Cancer Center

Franco DeMonte, MD, FRCSC, FACS is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, FRCP(C), FACP  Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine

Disclosure: Abbott Labs None None; Teva Marion None None; Boeringer-Ingelheim Honoraria Speaking and teaching

Additional Contributors

Jorge Kattah, MD Head, Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria

Jorge Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences

Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

Amy A Pruitt, MD Associate Professor of Neurology, University of Pennsylvania; Attending Neurologist, Hospital of the University of Pennsylvania

Amy A Pruitt, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

References

  1. Meuric S, Brauner R, Trivin C, et al. Influence of tumor location on the presentation and evolution of craniopharyngiomas. J Neurosurg. Nov 2005;103(5 Suppl):421-6. [Medline].

  2. Gupta DK, Ojha BK, Sarkar C, Mahapatra AK, Mehta VS. Recurrence in craniopharyngiomas: analysis of clinical and histological features. J Clin Neurosci. May 2006;13(4):438-42. [Medline].

  3. Yoshimoto M, de Toledo SR, da Silva NS, et al. Comparative genomic hybridization analysis of pediatric adamantinomatous craniopharyngiomas and a review of the literature. J Neurosurg. Aug 2004;101(1 Suppl):85-90. [Medline].

  4. Rickert CH, Paulus W. Lack of chromosomal imbalances in adamantinomatous and papillary craniopharyngiomas. J Neurol Neurosurg Psychiatry. Feb 2003;74(2):260-1. [Medline].

  5. Rienstein S, Adams EF, Pilzer D, et al. Comparative genomic hybridization analysis of craniopharyngiomas. J Neurosurg. Jan 2003;98(1):162-4. [Medline].

  6. Oikonomou E, Barreto DC, Soares B, et al. Beta-catenin mutations in craniopharyngiomas and pituitary adenomas. J Neurooncol. Jul 2005;73(3):205-9. [Medline].

  7. Sekine S, Shibata T, Kokubu A. Craniopharyngiomas of adamantinomatous type harbor beta-catenin gene mutations. Am J Pathol. Dec 2002;161(6):1997-2001. [Medline].

  8. Sekine S, Takata T, Shibata T, et al. Expression of enamel proteins and LEF1 in adamantinomatous craniopharyngioma:evidence for its odontogenic epithelial differentiation. Histopathology. Dec 2004;45(6):573-9. [Medline].

  9. Hao J, Li TG, Qi X, et al. WNT/beta-catenin pathway up-regulates Stat3 and converges on LIF to prevent differentiation of mouse embryonic stem cells. Dev Biol. Feb 1 2006;290(1):81-91. [Medline].

  10. Izumoto S, Suzuki T, Kinoshita M, et al. Immunohistochemical detection of female sex hormone receptors in craniopharyngiomas: correlation with clinical and histologic features. Surg Neurol. Jun 2005;63(6):520-5; discussion 525. [Medline].

  11. Ulfarsson E, Karstrom A, Yin S, et al. Expression and growth dependency of the insulin-like growth factor I receptor in craniopharyngioma cells: a novel therapeutic approach. Clin Cancer Res. Jul 1 2005;11(13):4674-80. [Medline].

  12. Darendeliler F, Karagiannis G, Wilton P, Ranke MB, Albertsson-Wikland K, Anthony Price D, et al. Recurrence of brain tumours in patients treated with growth hormone: analysis of KIGS (Pfizer International Growth Database). Acta Paediatr. Oct 2006;95(10):1284-90. [Medline].

  13. Karavitaki N, Warner JT, Marland A, Shine B, Ryan F, Arnold J, et al. GH replacement does not increase the risk of recurrence in patients with craniopharyngioma. Clin Endocrinol (Oxf). May 2006;64(5):556-60. [Medline].

  14. Smith ER, Manfredi M, Scott RM, Black PM, Moses MA. A recurrent craniopharyngioma illustrates the potential usefulness of urinary matrix metalloproteinases as noninvasive biomarkers: case report. Neurosurgery. Jun 2007;60(6):E1148-9; discussion E1149. [Medline].

  15. Bunin GR, Surawicz TS, Witman PA, et al. The descriptive epidemiology of craniopharyngioma. J Neurosurg. Oct 1998;89(4):547-51. [Medline].

  16. Pereira AM, Schmid EM, Schutte PJ, et al. High prevalence of long-term cardiovascular, neurological and psychosocial morbidity after treatment for craniopharyngioma. Clin Endocrinol (Oxf). Feb 2005;62(2):197-204. [Medline].

  17. Piguel X, Abraham P, Bouhours-Nouet N, et al. Impaired aerobic exercise adaptation in children and adolescents with craniopharyngioma is associated with hypothalamic involvement. Eur J Endocrinol. Nov 17 2011;[Medline].

  18. Sands SA, Milner JS, Goldberg J, et al. Quality of life and behavioral follow-up study of pediatric survivors of craniopharyngioma. J Neurosurg. Oct 2005;103(4 Suppl):302-11. [Medline].

  19. Mori M, Takeshima H, Kuratsu J. Expression of interleukin-6 in human craniopharyngiomas: a possible inducerof tumor-associated inflammation. Int J Mol Med. Oct 2004;14(4):505-9. [Medline].

  20. Cavalheiro S, Dastoli PA, Silva NS, et al. Use of interferon alpha in intratumoral chemotherapy for cystic craniopharyngioma. Childs Nerv Syst. Aug 2005;21(8-9):719-24. [Medline].

  21. de Divitiis E, Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A. Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery. Nov 2007;61(5 Suppl 2):219-27; discussion 228. [Medline].

  22. Laufer I, Anand VK, Schwartz TH. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg. Mar 2007;106(3):400-6. [Medline].

  23. Fraioli MF, Moschettoni L, Catena E, Fraioli C. Cystic craniopharyngioma: trans-sphenoidal surgery and intra-cystic apposition of "bleomycin wax". Acta Neurochir (Wien). Apr 24 2009;[Medline].

  24. Waber DP, Pomeroy SL, Chiverton AM, et al. Everyday cognitive function after craniopharyngioma in childhood. Pediatr Neurol. Jan 2006;34(1):13-9. [Medline].

  25. Maiter D, Abs R, Johannsson G, Scanlon M, Jönsson PJ, Wilton P, et al. Baseline characteristics and response to GH replacement of hypopituitary patients previously irradiated for pituitary adenoma or craniopharyngioma: data from the Pfizer International Metabolic Database. Eur J Endocrinol. Aug 2006;155(2):253-60. [Medline].

  26. Curtis J, Daneman D, Hoffman HJ, Ehrlich RM. The endocrine outcome after surgical removal of craniopharyngiomas. Pediatr Neurosurg. 1994;21 Suppl 1:24-7. [Medline].

  27. Lafay-Cousin L, Bartels U, Raybaud C, Kulkarni AV, Guger S, Huang A, et al. Neuroradiological findings of bleomycin leakage in cystic craniopharyngioma. Report of three cases. J Neurosurg. Oct 2007;107(4 Suppl):318-23. [Medline].

  28. Hukin J, Steinbok P, Lafay-Cousin L, Hendson G, Strother D, Mercier C, et al. Intracystic bleomycin therapy for craniopharyngioma in children: the Canadian experience. Cancer. May 15 2007;109(10):2124-31. [Medline].

  29. Takahashi H, Yamaguchi F, Teramoto A. Long-term outcome and reconsideration of intracystic chemotherapy with bleomycinfor craniopharyngioma in children. Childs Nerv Syst. Aug 2005;21(8-9):701-4. [Medline].

  30. Julow J, Lányi F, Hajda M, Szeifert GT, Viola A, Bálint K, et al. Stereotactic intracavitary irradiation of cystic craniopharyngiomas with yttrium-90 isotope. Prog Neurol Surg. 2007;20:289-96. [Medline].

  31. Derrey S, Blond S, Reyns N, Touzet G, Carpentier P, Gauthier H, et al. Management of cystic craniopharyngiomas with stereotactic endocavitary irradiation using colloidal 186Re: a retrospective study of 48 consecutive patients. Neurosurgery. Dec 2008;63(6):1045-52; discussion 1052-3. [Medline].

  32. Ierardi DF, Fernandes MJ, Silva IR, Thomazini-Gouveia J, Silva NS, Dastoli P, et al. Apoptosis in alpha interferon (IFN-alpha) intratumoral chemotherapy for cystic craniopharyngiomas. Childs Nerv Syst. Sep 2007;23(9):1041-6. [Medline].

  33. Savas A, Erdem A, Tun K, Kanpolat Y. Fatal toxic effect of bleomycin on brain tissue after intracystic chemotherapy for a craniopharyngioma: case report. Neurosurgery. Jan 2000;46(1):213-6; discussion 216-7. [Medline].

  34. Van den Berge JH, Blaauw G, Breeman WA, et al. Intracavitary brachytherapy of cystic craniopharyngiomas. J Neurosurg. Oct 1992;77(4):545-50. [Medline].

  35. Kobayashi T, Kida Y, Mori Y, Hasegawa T. Long-term results of gamma knife surgery for the treatment of craniopharyngioma in 98 consecutive cases. J Neurosurg. Dec 2005;103(6 Suppl):482-8. [Medline].

 
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The adamantinomatous craniopharyngioma is a histologically complex epithelial lesion with several very distinctive morphologic features (hematoxylin-eosin, x40).
Adamantinomatous craniopharyngiomas. Peripheral palisading of the epithelium is a pronounced feature (hematoxylin-eosin, x100).
Adamantinomatous craniopharyngiomas. Frequently, the inner epithelium beneath the superficial palisade undergoes hydropic vacuolization and is referred to as the stellate reticulum (hematoxylin-eosin, x100).
Adamantinomatous craniopharyngiomas. Another distinctive feature of the adamantinomatous variant is scattered nodules of keratin. These nodules are referred to as "wet" keratin because of the plump appearance of the keratinocytes; this is in contrast to the flat, flaky keratin seen in epidermoid and dermoid cysts (hematoxylin-eosin, x100).
Adamantinomatous craniopharyngiomas. Nodules of "wet" keratin frequently calcify; in aggregate, this calcification often can be detected on CT scans and is a recognized radiologic feature of craniopharyngiomas (hematoxylin-eosin, x100).
Papillary craniopharyngioma. In contrast to the adamantinomatous variant, papillary craniopharyngiomas do not show complex heterogeneous architecture but rather are composed of simple squamous epithelium and fibrovascular islands of connective tissue (hematoxylin-eosin, x40).
Papillary craniopharyngiomas. Under high power, only simple squamous epithelium is seen in a papillary craniopharyngioma. The distinctive peripheral nuclear palisading, internal stellate reticulum, and nodules of "wet" keratin, which typify the adamantinomatous variant, are not seen in the papillary variant (hematoxylin-eosin, x100).
Rosenthal fibers in neuropils surrounding a craniopharyngioma. The brain parenchyma that surrounds both variants of craniopharyngioma is typically gliotic and often shows profuse numbers of eosinophilic Rosenthal fibers. The latter structures are composed of densely compacted bundles of glial filaments and typically are seen in astrocytic cell processes of neuropils that have been subjected to chronic compression from slowly expanding mass lesions. Rosenthal fibers are a characteristic feature of juvenile pilocytic astrocytomas (JPAs), which also may arise in the suprasellar/third ventricular region. Hence, a biopsy that samples only the surrounding neuropil of a craniopharyngioma may yield an erroneous diagnosis of JPA if the pathologist is unaware of the close association of craniopharyngioma with Rosenthal fiber formation (hematoxylin-eosin, x100).
 
 
 
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