Ectopic recurrent craniopharyngioma of the frontal bone

Case report

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Ectopic recurrence of craniopharyngioma is a rare phenomenon after transcranial resection of the primary tumor. The authors present a case of ectopic recurrent adamantinomatous craniopharyngioma of the frontal bone resected 16 years after initial transcranial resection of the primary tumor. The lesion was first radiographically described 12 years after surgery and was adjacent to the osteosynthesis plate that had been implanted at the craniotomy site. The recurrent craniopharyngioma was totally resected via a lateral eyebrow approach. No infiltration of the meninges or the brain was detected.

Only 50 cases of ectopic recurrent craniopharyngioma have been described to date, with the present case being the first one with recurrence located at the skull bone. So far 2 mechanisms have been described: contamination with tumor cells alongside the surgical tract and spreading via CSF and the subarachnoid space.

The authors reviewed the literature, provided the largest collection of cases so far, and performed basic statistical analysis regarding ectopic recurrence. Pediatric and adult patients as well as male and female ones are affected equally by this phenomenon. The mean time of ectopic recurrence after initial surgery was 7.1 years. Ectopic recurrence, although rare, should always be considered in a patient with a newly diagnosed intracranial lesion who has undergone transcranial craniopharyngioma resection before.

Abbreviations used in this paper:GTR = gross-total resection; STR = subtotal resection.

Article Information

Address correspondence to: Martin Jakobs, M.D., Department of Neurosurgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany. email: martin.jakobs@med.uni-heidelberg.de.

Please include this information when citing this paper: published online July 13, 2012; DOI: 10.3171/2012.6.JNS111885.

© AANS, except where prohibited by US copyright law.

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Figures

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    Contrast-enhancing lesion of the right frontal bone (supraorbital area) demonstrated on MRI studies obtained in August 2002 (A) and June 2011 (B and C). The tumor was first radiographically diagnosed in 2007 (MRI studies; printed only [nondigital]). In retrospect, a small nodular lesion is already visible by the time of the surgery for local recurrence in 2002 (arrow). Axial CT scans demonstrating an osteolytic lesion of the right supraorbital frontal bone adjacent to the osteosynthesis plate implanted during the initial transcranial surgery. The CT scans show penetration of the external table in December 2009 (D), with full penetration in August 2011 (E).

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    Photomicrographs of histopathological preparations showing epithelium-like tumor cell formations and horn beads, with some polymorphic nuclei and few mitoses. These are classic features of adamantinomatous craniopharyngioma. Tissue samples had a proliferation index of up to 5% (Ki 67). H & E (left) and Ki 67 immunohistochemical staining (right), original magnification × 100.

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