Spontaneous rupture of malignant papillary craniopharyngioma with CSF seeding and metastatic deposits: A case report and literature review

• Published in: Brain & spine 2022, Vol.2, p.100921, Article 100921
• Main Authors: Baig Mirza, Asfand, Akhbari, Melika, Murphy, Christopher, Connor, Steve, Howard, Mark R., Reisz, Zita, Barazi, Sinan, Thomas, Nick, Bodi, Istvan, Maratos, Eleni C.
• Format: Article
• Language: English
• Subjects: BRAF V600K mutation; Brain tumour; Breast carcinoma; Malignant craniopharyngioma; Metastasis; Papillary; Spontaneous rupture
• ISSN: 2772-5294; 2772-5294
• DOI: 10.1016/j.bas.2022.100921

Craniopharyngiomas are benign tumours mainly confined to the cranial cavity in the suprasellar region. We present a rare case of an aggressive papillary craniopharyngioma with disseminated spinal intradural disease. A 67-year-old woman presented with a 4-month history of headache, visual disturbance, acute confusion and radicular leg pain. Previous history of breast carcinoma (ER ​+ ​PR ​+ ​HER2-) was noted. The importance of histological diagnosis prior to treatment of sellar or suprasellar lesions with atypical or aggressive features is explored. MRI demonstrated a partly solid and partly cystic pituitary mass lesion in the sellar and suprasellar region with chiasmal compression and hypothalamic involvement. The sella was mildly enlarged and there were no calcifications. Whole neuraxis MRI revealed intradural deposits involving the ventricular system, spinal cord and conus. Within a month, the lesion rapidly increased in size. The patient underwent a craniotomy and transventricular resection of the sellar and suprasellar mass. Cranial lesion histology favoured papillary craniopharyngioma, confirmed by BRAF V600 mutation. Lumbar puncture CSF cytology confirmed craniopharyngioma with BRAF mutation and no evidence of metastatic breast cancer. The patient remained confused postoperatively without focal neurological deficit and underwent palliative whole brain radiotherapy. She died 4 months later. A review of the literature identified 29 reports of ruptured craniopharyngioma. Ruptured craniopharyngioma presents with a suprasellar mass and drop lesions in the spinal canal, characteristics radiologically indistinguishable from metastatic disease. The importance of histological diagnoses in directing the management of these cases is highlighted. •Ruptured craniopharyngioma presents with a suprasellar mass and drop lesions in the spinal canal.•The characteristics of ruptured craniopharyngiomas can be radiologically indistinguishable from metastatic cancer.•Histological diagnoses are important in directing the management of sellar/suprasellar lesions with atypical features.