April 1, 2014

Sellar Mass with Calcification

Sagittal images (upper left = CT, upper right = T2W MR, lower left = T1W MR, lower right = T1W post-contrast MR) of the pituitary region of an elderly individual show a large sellar/suprasellar mass with internal calcification (hyperdense on CT, signal loss on MR). The mass is mostly solid and reveals heterogeneous enhancement. Note ballooning of the sella.
Differential diagnosis of a calcified sellar mass:

  • Craniopharyngioma (most likely)
  • Pituitary adenoma (unlikely, 0.2% - 8% have calcification)
  • Rathke's cleft cyst (rare disease)
  • Chordoma (rare disease)
Associated findings that help DDx:
  • Nodular appearance of calcification --> craniopharyngioma
  • Calcifications in a cystic mass --> craniopharyngioma
  • Curvilinear appearance of calcification --> pituitary adenoma or Rathke's cleft cyst
  • Bone destruction --> chordoma
This is a rare case of sellar/suprasellar chondrosarcoma confirmed with histology. 

Kasliwal MK, Sharma BS. A rare case of pituitary adenoma with calcification: a case report. Turkish Neurosurg 2008;18:232-235
Glezer A, et al. Rare sellar lesions. Endocrinol Metab Clin N Am 2008;37:195-211. 

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