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. 

Reference:

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.