Pathological Findings -- Headaches, Lethargy and a Sellar/Suprasellar Mass


Intraoperative frozen sections showed cholesterol clefts and fragments of reactive squamous-appearing epithelium suggestive of a craniopharyngioma; however, a descriptive diagnosis was made in the absence of definitive histologic features. Routine histology utilizing hematoxylin and eosin staining revealed an epithelial-lined cyst with a thickened wall adjacent to a portion of benign adenohypophysis (Images 2a and 2b). The cyst lining consisted of one to two layers of ciliated cuboidal epithelium (Image 2c), with a focal simple squamous component. The thickened fibrous wall of the cyst displayed scattered foci of mixed acute and chronic inflammation with areas resembling granulation tissue. A small cluster of microscopic cysts lined by simple cuboidal epithelium was embedded in one portion of the wall. Another area of the cyst wall displayed prominent collections of cholesterol clefts associated with multinucleated giant cells, non-caseating granulomatous inflammation, hemosiderin-laden macrophages, disruption of the epithelial lining, and hemorrhage into the cyst lumen (Image 2d). Special stains for acid fast bacilli, fungi, and bacteria were negative.



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