The spectrum of malignancy in craniopharyngioma

Am J Surg Pathol. 2007 Jul;31(7):1020-8. doi: 10.1097/PAS.0b013e31802d8a96.

Abstract

Craniopharyngiomas are low-grade epithelial neoplasms occurring almost exclusively in the sellar/suprasellar region. Histologic malignancy is extremely rare; the literature consists mostly of isolated case reports. Herein, we report 3 patients with craniopharyngiomas exhibiting histologic malignancy, 2 of which received radiation therapy before its appearance. Hematoxylin and eosin-stained slides and selected immunohistochemical stains were reviewed in all cases. Microvessel density analysis was performed in case 2. The patients included 2 men and 1 woman, age 14, 31, and 58 years at presentation, respectively. All patients expired 3 months to 9 years after first resection and 3 to 9 months after identification of histologic malignancy. The latter developed after multiple recurrences and radiation therapy in 2 cases, but seemed to arise de novo in 1 case resembling odontogenic ghost cell carcinoma and lacking any definite low-grade craniopharyngioma precursor. The malignant component of the other 2 cases resembled squamous cell carcinoma and low-grade myoepithelial carcinoma, respectively. The MIB-1 labeling index was markedly increased in the malignant component in comparison with the low-grade precursor. Malignant transformation in craniopharyngiomas, although rare, does exist. It assumes varied histologic appearances, usually after multiple recurrences and radiation therapy, and has a near uniformly fatal outcome. De novo malignancy in odontogenic tumors of the sella is even more unusual, but also has an ominous prognosis.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Biomarkers, Tumor / analysis
  • Carcinoma, Squamous Cell / pathology
  • Cell Transformation, Neoplastic
  • Combined Modality Therapy
  • Craniopharyngioma / chemistry
  • Craniopharyngioma / pathology*
  • Craniopharyngioma / therapy
  • Fatal Outcome
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Neoplasms, Second Primary / pathology*
  • Pituitary Neoplasms / chemistry
  • Pituitary Neoplasms / pathology*
  • Pituitary Neoplasms / therapy
  • Radiotherapy, Adjuvant
  • Ubiquitin-Protein Ligases / analysis

Substances

  • Biomarkers, Tumor
  • MIB1 ligase, human
  • Ubiquitin-Protein Ligases