Teratom der Hypophyse

A rare case
of persistent hypophyseal canal with ectopic pituitary teratoma. Sagittal CT image shows a well-corticated persistent craniopharyngeal canal associated with a mass in nasopharynx.
www.eurorad.org • CC by-nc-sa-4.0
Cluster of
teeth in brain - Pituitary teratoma an uncommon tumor in common location. T2 WI image axial view – showing a well defined mass in the sella and suprasellar region showing multiple small hypointense foci with central hyperintense linear area and minimal hyperintense intervening tissue.
www.eurorad.org • CC by-nc-sa-4.0
Cluster of
teeth in brain - Pituitary teratoma an uncommon tumor in common location. CT Brain bone window coronal image showing a mass with a cluster of teeth like structures in sella and supra-sellar region. Sella is widened with no evidence of cortical erosion/ destruction.
www.eurorad.org • CC by-nc-sa-4.0
Cluster of
teeth in brain - Pituitary teratoma an uncommon tumor in common location. CT Brain bone window axial image showing a mass with a cluster of teeth like structures in sella and supra-sellar region.
www.eurorad.org • CC by-nc-sa-4.0
Cluster of
teeth in brain - Pituitary teratoma an uncommon tumor in common location. CT Brain scout image showing a cluster of teeth like structures in sella and supra-sellar region.
www.eurorad.org • CC by-nc-sa-4.0
Cluster of
teeth in brain - Pituitary teratoma an uncommon tumor in common location. T1 FS image coronal view – showing a well defined mass in the sella and suprasellar region with multiple non enhancing small hypointense foci and moderately enhancing minimal intervening tissue and capsule.
www.eurorad.org • CC by-nc-sa-4.0
Cluster of
teeth in brain - Pituitary teratoma an uncommon tumor in common location. T1 FS image sagittal view – showing a well defined mass in the sella and suprasellar region with multiple non enhancing small hypointense foci and moderately enhancing minimal intervening tissue and capsule.
www.eurorad.org • CC by-nc-sa-4.0
Cluster of
teeth in brain - Pituitary teratoma an uncommon tumor in common location. T2 Flair image coronal view – showing a well defined mass in the sella and suprasellar region showing multiple small hypointense foci with central isointense linear area and minimal hyperintense intervening tissue.
www.eurorad.org • CC by-nc-sa-4.0
Cluster of
teeth in brain - Pituitary teratoma an uncommon tumor in common location. Showing the sella and suprasellar region mass interface is well defined with bilateral cavernous segment of internal carotid arteries. Minimal isointense intervening tissue seen.
www.eurorad.org • CC by-nc-sa-4.0
A rare case
of persistent hypophyseal canal with ectopic pituitary teratoma. Coronal contrast-enhanced CT image shows mass in nasopharynx containing enhancing soft tissue, osseous and lipomatous components.
www.eurorad.org • CC by-nc-sa-4.0
Cluster of
teeth in brain - Pituitary teratoma an uncommon tumor in common location. CT Brain bone window sagittal image showing a mass with a cluster of teeth like structures in sella and supra-sellar region. Sella is widened with no evidence of cortical erosion/ destruction.
www.eurorad.org • CC by-nc-sa-4.0
Cluster of
teeth in brain - Pituitary teratoma an uncommon tumor in common location. Plain MRI Brain T1 WI sagittal view – showing a well defined mass in the sella and suprasellar region showing multiple small hypointense foci with central isointense lineal area. Optic chiasm is mildly displaced superiorly.
www.eurorad.org • CC by-nc-sa-4.0
A rare case
of persistent hypophyseal canal with ectopic pituitary teratoma. Coronal T2-weighted 3D DRIVE CLEAR images show infundibulum through the craniopharyngeal canal ending into the mass in nasopharynx.
www.eurorad.org • CC by-nc-sa-4.0
A rare case
of persistent hypophyseal canal with ectopic pituitary teratoma. Sagittal T2-weighted 3D DRIVE CLEAR image shows mass in nasopharynx and cerebrospinal fluid filled craniopharyngeal canal with infundibulum extending from the hypothalamus and into the persistent canal.
www.eurorad.org • CC by-nc-sa-4.0
A rare case
of persistent hypophyseal canal with ectopic pituitary teratoma. Axial T2-weighted image shows hyperintense lipomatous and hypointense calcific components within the mass in nasopharynx.
www.eurorad.org • CC by-nc-sa-4.0
A rare case
of persistent hypophyseal canal with ectopic pituitary teratoma. Sagittal T1-weighted image shows hyperintense lipomatous component within the mass in nasopharynx.
www.eurorad.org • CC by-nc-sa-4.0
A rare case
of persistent hypophyseal canal with ectopic pituitary teratoma. Sagittal contrast-enhanced CT image shows pituitary stalk extending into the persistent craniopharyngeal canal.
www.eurorad.org • CC by-nc-sa-4.0
Cluster of
teeth in brain - Pituitary teratoma an uncommon tumor in common location. 3D CT - Volume rendered image of base of skull showing a high density mass in sella and supra-sellar region.
www.eurorad.org • CC by-nc-sa-4.0
Lizenz: CC BY-SA 4.0

Teratom der Hypophyse

intrakraniale Teratome Radiopaedia • CC-by-nc-sa 3.0 • de

Intracranial teratomas are uncommon intracranial neoplasms, which can have a bewildering variety of components and thus a wide range of appearances. They can be divided into two broad categories, intra- and extra-axial, which differ in epidemiology and clinical presentation. Another method of classifying an intracranial teratoma is as mature, immature and mature with malignant transformation.

Epidemiology

Although uncommon in the general population, they account for the largest proportion of fetal intracranial neoplasms (26-50% of fetal brain tumors ).

Clinical presentation

Clinical presentation varies according to whether they are intra- or extra-axial.

Intra-axial 

Intra-axial teratomas typically present either antenatally or in the newborn period. They are large tumors that increase head circumference and therefore often present with difficulty in childbirth. They tend to occur more commonly supratentorially.

Extra-axial 

Extra-axial teratomas usually present in childhood or early adulthood and are typically smaller. They most often arise in the pineal or suprasellar regions, and present due to the mass effect: obstructive hydrocephalus due to impingement on the midbrain, Parinaud syndrome, optic chiasm compression, etc.

Pathology

Teratomas are considered intracranial germ cell tumors,  and are comprised of cells originating from at least two and usually all three embryonic layers: ectoderm, mesoderm and endoderm. The histological subtype may not necessarily determine the biological behavior.

Markers

Sometimes may be associated with elevated levels of:

Radiographic features

Intracranial teratomas are often seen as large lesions at presentation.

Given their extremely variable histological components, imaging also tends to be heterogeneous, with tumors typically demonstrating a mixture of tissue densities and signal intensity. Fat, if present, is helpful in narrowing the differential.

CT

The majority of intracranial teratomas demonstrate at least some fat and some calcification, which is usually solid / "clump-like" . They usually have cystic and solid components, contributing to an irregular outline. Solid components demonstrate variable enhancement .

MRI
  • T1
    • hyperintense components due to fat and proteinaceous/lipid-rich fluid
    • intermediate components of soft tissue
    • hypointense components due to calcification and blood products
  • T1 C+ (Gd): solid soft tissue components show enhancement
  • T2: again mixed signal from differing components

Treatment and prognosis

Location and size determine prognosis:

  • intra-axial (fetal) lesions: stillbirth occurs relatively frequently, and difficulty with vaginal delivery (if attempted) can occur due to enlarged cranial circumference
  • extra-axial lesions: largely depends on the size and location; smaller lesions can be successfully resected with good prognosis

Differential diagnosis

A meaningful differential depends to a degree on location:

See also

Siehe auch:
Assoziationen und Differentialdiagnosen zu Teratom der Hypophyse:
Tumoren der
Hypophysenregion
Wikipedia • CC BY 3.0
intrakraniale
Teratome
insightsimaging.springeropen.com • Open Access