Differentials
Pituitary adenoma
SIGNS / SYMPTOMS
Rare in children and adolescents, although quite common in adults.
Rarely extend into (as opposed to compressing) the third ventricle and rarely cause hydrocephalus.
May be hormone secreting with symptoms consistent with prolactinoma, Cushing's disease, or acromegaly.
INVESTIGATIONS
MRI/CT: tumour arises from the sella with suprasellar extension, or is confined to the sella (unlike most craniopharyngiomas) and is nearly always solid and enhancing.
Endocrine tests show elevated hormones (dependent upon tumour type).
Histopathology provides a definitive diagnosis.
Diaphragmatic meningioma
SIGNS / SYMPTOMS
Rare in children and adolescents, more common in older adults.
May be no differentiating signs or symptoms.
INVESTIGATIONS
MRI/CT: homogeneous enhancement, enhancing dural 'tail', bony hyperostosis.
Histopathology provides a definitive diagnosis.
Chiasmatic epidermoid
SIGNS / SYMPTOMS
Paramidline tumours seen in children and young adults.
May be no differentiating signs or symptoms.
INVESTIGATIONS
MRI/CT: lesion off midline, cystic, MRI shows restricted water movement.
Histopathology provides a definitive diagnosis.
Chiasmatic glioma
SIGNS / SYMPTOMS
Most common in infants and children; often seen in association with neurofibromatosis type 1.
May be no differentiating signs or symptoms.
INVESTIGATIONS
MRI/CT: intra-axial tumour of the optic chiasm or nerve, usually non-cystic and may or may not enhance.
Histopathology provides a definitive diagnosis.
Rathke's pouch cyst, pars intermedia cyst
SIGNS / SYMPTOMS
Uncommon benign embryological malformation.
May be no differentiating signs or symptoms.
INVESTIGATIONS
Histopathology provides a definitive diagnosis.
Primary germ cell neoplasm
SIGNS / SYMPTOMS
A malignant central nervous system neoplasm seen in children, adolescents, and young adults.
May be no differentiating signs or symptoms.
INVESTIGATIONS
Elevated serum and cerebrospinal fluid onco-fetal proteins (alpha-fetal protein or beta-human chorionic gonadotrophin).
Histopathology provides a definitive diagnosis.
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