2. CLINICAL PRESENTATION
A male child of about eight months was brought
by his parents to CT room for head CT scan
Parents noticed the bulging of left eye for few
weeks
Vision was poor/ blind left eye
There was no other constitutional symptoms
3. CLINICAL EXAMINATION
Apparently child was found normal except
PROPTOSIS Left eye
Routine laboratory exam were with in normal
limit
32. CT FINDINGS IN OUR CASE
An about 22x22mm hypodense globular mass,
highly enhanced slightly heterogeneous in
suprasellar region
Mass is extending to left frontal lobe and
deepening the floor of sella
Mass is markedly entering to left orbital fossa
through optic chiasma, encasing optic nerve
sparing extra ocular muscles
33. DIFFERENTIAL DIAGNOSIS
In contrary to adult age most common
suprasellar tumor in child are with
decreasing frequency ……
: Craniopharyngioma
:Chiasmatic/ Hypothalamic low grade
glioma
: Germinoma
: Lesion attributed to langerhans cell
histiocytosis
35. CRANIOPHARYNGIMA
Large intra and supra sellar mass with
cystic& enhancing component as well as
calcification in children are virtually
pathognomonic for Craniopharyngioma……
perhaps with only Dermoid in the D/D
**Our case shows no calcification at all
37. EPIDEMIOLOGY
There is Bimodal age presentation with 1st
peak
between 10-14 age almost exclusively of
Admantinomatous type
2nd
peak young to middle aged mostly papillary
sub type
Incidence about 6% of all expanding lesion in
childhood
38. CLINICAL SIGNS/ SYMPTOMS
Increased intracranial tension (headache)
Endocrine dysfunction (Delayed puberty, short
stature)
Visual problem
39. RADIOLOGICAL FEATURES
95% suprasellar, frequently distorting optic
chiasma or compressing mid brain causing
hydrocephalus
Occasionally intraventricular homogenous soft
tissue mass with calcification commonly at 3rd
ventricle
40. CT SCAN FINDINGS
Cystic near CSF density
Soft tissue density vivid enhancement
Calcification in 90% cases
**calcification is uncommon in papillary
variety
41. CHIASMATIC HYPOTHALAMIC
GLIOMA
4-8% childhood intracranial tumor, rare in
adults
Common in first decade less than 1yr
Male: Female incidence is equal
20-30% children are associated with
neurofibromatosis
Progress rapidly
42. CH GLIOMA CONTD…..
Chiasmatic glioma can involve anything between
optic nerve to visual cortex
Almost 25% optic pathways gliomas are confined
to optic disc and nerve
40-75% may involve optic chiasma
43. CLINICAL SIGNS/ SYMPTOMS
Painless PROPTOSIS
Hydrocephalus if involving foramen of monro
**HISTOLOGICALLY: Low grade Glioma
44. PITUITARY ADENOMA
Rarely present in children
Pituitary micro adenoma: less than 10mm in
size
Pituitary macro adenoma: more than 10mm
in size expansion of sella is common
Most pediatric pituitary adenomas present after
the onset of puberty and present with frequent
headaches, changes in visual acuity and, in
females, menstrual dysfunction.
Most (19/20) were secretory, with prolactinomas
being the most common type.
45. SUPRASELLAR MENINGIOMA
Benign tumor of meninges usually solid may
contain necrotic/ cystic lesion and calcification
Frequently invade the sella turcica
Such tumor can also encase the optic nerve
with in optic canal and fossa orbitalis
46. ARACHNOID CYST AND RATHKE’S
CLEFT CYST
Rarely in suprasellar region in children
Clinical symptom:
visual symptom, hydrocephalus,
macrocephaly, pyramidal tract sign, precocious
puberty
47. MISCELLANEOUS LESION
A. Hypothalamic hemartoma:
usually small and asymptomatic presenting
in two decades
Clinical symptom:
hyperactivity syndrome with hyperplasia,
behavior disorder, precocious puberty,
gelastie seizure
48. CONTD…..
B. Lesion of INFUNDIBULUM:
: Germinoma
: Hypophysitis
: Histiocytosis X
49. SUPRASELLAR GERMINOMA
20% of all Germ cell tumor
Hypo intense on T1, Hyper intense on T2 and
extremely intense contrast enhancement
It can create diagnostic dilemma on imaging ,
can get easily confused with optic/ chiasmatic
glioma.
If serum and CSF studies for tumor marker are
negative , surgical exploration for biopsy and
histological confirmation helps differentiation
50. FINAL DIAGNOSIS
Our probable diagnosis:
Suprasellar germinoma OR Chiasmatic
Hypophyseal Glioma
Patient was sent to advanced center for final
diagnosis and further management
Unfortunately there was no feed back
51. CONCLUSION
Paediatric brain tumor have always been a
challenge
They are heterogeneous set of pathologies
involving different age groups in childhood and
also differ widely from their adult counterparts
as far as adjuvant therapies are concerned
Unlike Meningioma and Pituitary Adenoma in
adults, Craniopharyngioma, Optic Glioma and
Germinoma form the main lesions in paediatric
age group
52. CONTD…..
While safe surgery is the Key in most of adult
tumors, Chemo and Radiotherapy are the chief
modality in some of these paediatric tumor like
GERMINOMA and OPTICO- CHIASMATIC
GLIOMA
As epidemiology and management of these
tumors is different that’s why it requires
dedicated multidisciplinary team approach
53. REFERENCES
1. Differential Diagnosis of suprasellar mass in
children: Warmnth Metz M, Gnekow AK,
Muller H, Solynosi L K.Klin Paediatri 2004
Nov Dec 216(6):323;30
2. Pituitary region mass: Dr Ayush Goel and
Dr Frank Gaillard etal.
Radiopaedia.org/article/Pituitary
3. Sella turcica and parasellar region: Walter
Kucharezyk and Marieke Hazewinkel The
Radiology assistant
4. Cranipharyngioma: Dr Frank Gaillard etal.
Radiopaedia.org/article/craniopharyngioma
54. REF……CONTD.
5. Suprasellar Meningioma_ a case report: MG
Kgoro, A Speclman The south African
Radiographer vol.51 no 2 Nov 2013
6. Pituitary macro adenoma: Dr Henry Knipe and
Yuranga W etal. Radiopaedia.orgt
7. Paediatric Suprasellar Lesion:. CE Deopujari,
Ashish Kumar, VS Karmarkar, NK Biyani,
M Mhatre and NJ shah
Journal of Paediatric Neurosciences 2011 Oct(6
supple): 546-555
