Differential Diagnosis of Suprasellar Tumors in Children

Abstract

In contrary to the adult age the most common suprasellar tumors in children are with decreasing frequency craniopharyngiomas, chiasmatic/hypothalamic low-grade gliomas, germinomas and lesions attributable to a Langerhans cell histiocytosis. For differential diagnostic purposes also the rare hypothalamic hamartoma and meningeal metastases in the infundibular recess of the third ventricle are included. The typical aspects of the various tumors on computed tomography (CT) and magnetic resonance imaging (MRI) together with important clinical differences are illustrated. On the basis of imaging results and clinical symptoms differential diagnosis between the various tumor entities should be feasible in many cases. Of course, only in strictly defined cases like typical chiasmatic/hypothalamic and optic pathway gliomas or bilocular germ cell tumors a histological confirmation is dispensable.

Zusammenfassung

Im Gegensatz zu den histologischen Entitäten bei Erwachsenen finden sich bei Kindern in der suprasellären Region am häufigsten nach absteigender Häufigkeit geordnet Kraniopharyngeome, meist niedriggradige Gliome des Chiasma/Hypothalamus, Germinome und Hypophysenstielläsionen im Rahmen einer Langerhanszell-Histiozytose. Aus Gründen der Differenzialdiagnose wurden zusätzlich die seltenen hypothalamischen Hamartome und meningeale Metastasen im Recessus infundibularis des dritten Ventrikels mit aufgeführt. Das typische Erscheinungsbild dieser Tumoren in der Computertomographie (CT) und Magnetresonanztomographie (MRT) wird zusammen mit wichtigen klinischen Parametern dargestellt. Auf dieser Basis sollte eine differenzialdiagnostische Einordnung der meisten Tumoren dieser Region möglich sein. Nur bei typischen Chiasmahypothalamus- oder Sehbahngliomen und bilokulären Keimzelltumoren kann auf eine histologische Sicherung der Tumorart verzichtet werden.

Suprasellar tumor - brain tumor - children - CT - MRI

Supraselläre Tumoren - Hirntumoren - Kinder - CT - MRT

References

• 1 Arslanoglu A, Cirak B, Horska A, Okoh J, Tihan T, Aronson L, Avellino A M, Burger P C, Yousem D M. MR imaging characteristics of pilomyxoid astrocytomas.  AJNR Am J Neuroradiol. 2003;  24 1906-1908
• 2 Astrup J. Natural history and clinical management of optic pathway glioma.  Br J Neurosurg. 2003;  17 327-335
• 3 Barkovich A J, Edwards M SB. Brain tumors of childhood. In: Pediatric Neuroimaging. Raven Press, New York
• 4 Buschmann U, Gers B, Hildebrandt G. Pilocytic astrocytomas with leptomeningeal dissemination: biological behaviour, clinical course, and therapeutic options.  Child's Nerv Syst. 2003;  19 298-304
• 5 Calaminus G, Bamberg M, Jürgens H, Kortmann R D, Sörensen N, Wiestler O D, Göbel U. Impact of surgery, chemotherapy and irradiation on long term outcome of intracranial malignant non-germinomatous germ cell tumors: results of the German cooperative trial MAKEI 89.  Klin Pädiatr. 2004;  216 141-149
• 6 Cirak B, Unal O, Arslan H, Cinal A. Chiasmatic glioblastoma of childhood. A case report.  Acta Radiol. 2000;  41 375-376
• 7 Dirks P B, Jay V, Becker L E, Drake J M, Humphreys R P, Hoffman H J, Rutka J T. Development of anaplastic changes in low-grade astrocytomas of childhood.  Neurosurg. 1994;  34 68-78
• 8 Dirven C MF, Mooij J JA, Molenaar W M. Cerebellar pilocytic astrocytoma: a treatment protocol based upon analysis of 73 cases and review of the literature.  Child's Nerv Syst. 1997;  13 17-23
• 9 Fernandez C, Figarella-Branger D, Girard N, Bouvier-Labit C, Gouvernet J, Paz Paredes A, Lena G. Pilocytic astrocytoma in children: prognostic factors - a retrospective study of 80 cases.  Neurosurgery. 2003;  53 544-553
• 10 Gajjar A, Bhargava R, Jenkins J J, Heidman R, Sanford R A, Langston J W, Walter A W, Kuttesch J F, Muhlbauer M, Kun L E. Low-grade astrocytoma with neuroaxis dissemination at diagnosis.  J Neurosurg. 1995;  83 67-71
• 11 Grois N G, Favara B E, Mostbeck G H, Prayer D. Central nervous system disease in Langerhans cell histiocytosis.  Hematol Oncol Clin North Am. 1998;  12 287-305
• 12 Ito M, Jamshidi J, Yamanaka K. Does craniopharyngioma metastasize? Case report and review of the literature.  Neurosurgery. 2001;  48 933-936
• 13 Kanagaki M, Miki Y, Takahashi Y A, Shibamoto Y, Takahashi T, Ueba T, Hashimoto N, Konishi J. MRI and CT findings of neurohypophyseal germinoma.  Eur J Radiol. 2004;  49 204-211
• 14 Komotar R J, Burger P C, Carson B S, Brem H, Olivi A, Goldthwait D, Tihan T. Pilocytic and pilomyxoid hypothalamic/chiasmatic astrocytoma.  Neurosurgery. 2004;  54 72-79
• 15 Kornreich L, Blaser S, Schwarz M, Shuper A, Vishne T H, Cohen I J, Faingold R, Michovitz S, Koplewitz B, Horev G. Optic pathway glioma: correlation of imaging findings with the presence of neurofibromatosis.  AJNR Am J Neuroradiol. 2001;  22 1963-1969
• 16 Leger J, Velasquez A, Garel C, Hassan M, Czernichow P. Thickened pituitary stalk on magnetic resonance imaging in children with central diabetes insipidus.  J Clin Endocrinol Metab. 1999;  84 1954-1960
• 17 Leu N H, Chen C Y, Wu C S, Lee K W, Hsiao H S, Zimmerman R A. Primary chiasmal sarcoid granuloma: MRI.  Neuroradiology. 1999;  41 440-442
• 18 Liu G T, Brodsky M C, Philips P C, Blasco J, Janss A, Golden J C, Bilaniuk L L, Burson G T, Duhaime A C, Sutton L N. Optic radiation involvement in optic pathway gliomas in neurofibromatosis.  Am J Opthalmol. 2004;  137 407-414
• 19 Liu G T, Galetta S L, Rorke L B, Bilaniuk L T, Vojta D D, Molloy P T, Phillips P C, Needle M, Duhaime A C, Sutton L N, Volpe N J. Gangliogliomas involving the optic chiasm.  Neurology. 1996;  46 1669-1673
• 20 Madeira Silva M, Goldman S, Keating G, Marymont M A, Kalapuraki J, Tomita T. Optic pathway hypothalamic gliomas in children under three years of age: the role of chemotherapy.  Pediatr Neurosurg. 2000;  33 151-158
• 21 Martinez R, Honegger J, Falbusch R, Buchfelder M. Endocrine findings in patients with optico-hypothalamic gliomas.  Exp Clin Endocrinol Diabetes. 2003;  111 162-167
• 22 Molla E, Marto Bonmati L, Revert A, Arana E, Menor F, Dosda R, Poyatos C. Craniopharyngiomas: identification of different semiological patterns with MRI.  Eur Radiol. 2002;  12 1829-1836
• 23 Osborn A G. Brain Tumors and tumorlike processes. In: Osborn AG (Hrsg). Diagnostic neuroradiology. Mosby, St. Louis 1994
• 24 Perilongo G, Garre M L, Gianaspergo F. Low-grade gliomas and leptomeningeal dissemination: a poorly understood phenomenon.  Child's Nerv Syst. 2003;  19 197-203
• 25 Saeki N, Uchino Y, Murai H, Kubota M, Isobe K, Uno T, Sunami K, Yamaura A. MR imaging study of edema-like change along the optic tract in patients with pituitary region tumors.  AJNR Am J Neuroradiol. 2003;  24 336-342
• 26 Sumida M, Uozumi T, Kiya K, Mukada K, Arita K, Kurisu K, Sugiyama K, Oba J, Satoh H, Ikawa F, Migita K. MRI of intracranial germ cell tumors.  Neuroradiology. 1995;  37 32-37
• 27 Van der Wal E, Azzarelli B, Edwards-Brown M. Malignant transformation of a chiasmatic astrocytoma in a patient with diencephalic syndrome.  Pediatr Radiol. 2003;  33 207-210
• 28 Van Ostenbrugge R J, Twijnstra A. Presenting features and value of diagnostic procedures in leptomeningeal metastases.  Neurology. 1999;  22 382-385
• 29 Warmuth-Metz M, Kühl J. Neuroradiologie bei Medulloblastomen in Differenzialdiagnose zu Ependymomen: Ergebnisse der Hit'91-Studie.  Klin Pädiatr. 2002;  214 162-166
• 30 Wilson J T, Wald S L, Aitken P A, Mastromateo J, Vieco P T. Primary diffuse chiasmatic germinomas: differentiation from optic chiasm gliomas.  Pediatr Neurosurg. 1995;  23 1-6
• 31 Zhang Y Q, Wang C C, Ma Z Y. Pediatric craniopharyngiomas: clinicomorphological study of 189 cases.  Pediatr Neurosurg. 2002;  36 80-84