A 38-year-old woman presents with progressively worsening headaches and bitemporal hemianopia. MRI shows a sellar mass with suprasellar extension, cystic and solid components, calcification ('machine oil' contents on aspiration), and Rathke's pouch origin. Histology shows 'wet keratin' (adamantinomatous type). This is consistent with which tumor?
- A Craniopharyngioma ✓
- B Pituitary macroadenoma
- C Optic pathway glioma
- D Germinoma
Explanation
Craniopharyngioma is a benign epithelial tumor arising from remnants of Rathke's pouch (craniopharyngeal duct). The adamantinomatous subtype (more common in children) shows characteristic 'wet keratin' (ghost cells), cholesterol crystals giving machine-oil cyst fluid, and peripheral palisading epithelium with calcification on imaging. The papillary subtype occurs in adults and lacks calcification. Bitemporal hemianopia results from optic chiasm compression. Pituitary macroadenomas do not calcify and have uniform enhancement. Optic pathway gliomas involve the nerve/chiasm without sellar origin. Germinomas lack calcification and wet keratin.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.