A 55-year-old man presents with progressive bitemporal hemianopia, hypopituitarism, and calcified suprasellar mass on CT. MRI shows a heterogeneous solid-cystic sellar-suprasellar lesion with 'eggshell' calcification. Histology shows wet keratin nodules, palisading epithelium, and stellate reticulum. What is the diagnosis?

• A Pituitary macroadenoma
• B Craniopharyngioma (adamantinomatous type) ✓
• C Meningioma of the tuberculum sellae
• D Rathke's cleft cyst

Explanation

Adamantinomatous craniopharyngioma classically presents in children and middle-aged adults with a calcified, solid-cystic suprasellar mass causing visual field defects and hypopituitarism. Histology shows wet keratin nodules, peripheral palisading of squamous epithelium, and stellate reticulum (outer layer resembling developing enamel organ). Pituitary adenomas are not calcified. Tuberculum sellae meningiomas enhance homogeneously without wet keratin. Rathke's cleft cysts lack calcification and wet keratin (WHO CNS Tumours, 5th ed.; Robbins, 10th ed.).

Reference: WHO Classification of Tumours of the CNS, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.