Love on his mind
This benign little guy has love on his mind. His name is craniopharyngioma and he is a type of brain/pituitary tumor that is derived from the embryonic tissues of the pituitary gland. Namely the epithelial remnants of Rathke’s pouch which develop as an up-growth of the ectoderm that lines the oral cavity.
The tumor grows slowly and compresses the overlying region of the brain damaging the hypothalamus (causing endocrine abnormalities), compressing the optic chiasm (resulting in visual disturbances) or blocking the third ventricle (causing hydrocephalus).
With regards to histology, craniopharyngiomas are composed of sheets of squamous epithelial cells and keratin, set in a loose connective tissue stroma that can be traced back to their ectoderm embryological origins.
The tissue from which this tumor is derived is capable of forming teeth in its normal location within the oral cavity. It is not surprising therefore that craniopharyngiomas may have the appearance of dental tumors like ameloblastomas, which are a cancerous growth of enamel forming cells. In these types, the resulting calcification of the tissue makes the tumor easy to identify radiographically.
The lesions often contain epithelial lined cysts that are filled with keratin and cholesterol crystals (formed from keratin breakdown)that impart an iridescent pearl-like appearance.
Despite his loving thoughts, this tumor is destined to be removed…transphenoidally (a procedure that allows the surgeon to access the pituitary gland and therefore tumor via the nasal cavity). However, the chances are he will be back as craniopharyngiomas have a high rate of recurrence after removal.
Histology image source: www.neuropathology-web.org