solid and enhancing pituitary region mass

Solid lesions with enhancement are by far the most commonly encountered appearance of pituitary region masses.

Differential diagnosis

  • macroadenoma
    • by far the most common entity
    • typically enhances less vividly than other entities
    • elevates the dura of the diaphragma sella (as the origin is within the pituitary)
    • the sella is expanded and remodeled
    • non-normal pituitary tissue is usually visible
  • pilocytic astrocytoma
    • children 
    • enlarged optic chiasm or nerve
    • variable enhancement
  • craniopharyngioma
    • papillary subtype is more frequently solid, although cystic components are still more common than entirely solid lesions
    • epicenter is in ~85-95% of cases in the suprasellar region
    • in ~20% of cases, there is extension into the pituitary fossa
  • meningioma
    • epicenter is usually outside the pituitary fossa
    • dural tail common
    • enhancement is homogeneous and vivid
    • if the carotid is encased, then it is usually narrowed
  • metastasis
    • uncommon
    • irregular margins
    • may have erosion/destruction of bony margins without expansion (rapid rather the slow growth)
  • inflammation / infiltration
  • germinoma
    • usually pediatric population
    • often involves inferior recesses of the third ventricle
    • often also involves pineal region
  • pituicytoma
  • granular cell tumor of the pituitary (pituitary choristoma)
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