This patient has a craniopharyngioma. These tumors typically exhibit dystrophic calcification, cyst formation, and hemorrhage.
Craniopharyngioma is a benign pituitary tumor derived from the remnants of Rathke's pouch and is the most common cause of hypopituitarism in children. The tumor is typically suprasellar but can extend into the sella turcica and damage the pituitary gland. Craniopharyngioma causes bitemporal hemianopia and can cause central diabetes insipidus (preventing ADH release from the posterior pituitary).
Nwosu et al. emphasize the importance of a thorough evaluation of children and adolescents whose heights deviate from normal percentiles on standard growth charts; failure to thrive may be associated with hypopituitarism or a wide range of other endocrine disorders. A complete evaluation includes a basic metabolic panel, complete blood count, erythrocyte sedimentation rate, liver function tests, and urinalysis. An abnormal test result may warrant a referral to an endocrinologist.
Rucka et al. present a retrospective analysis of symptoms accompanying the diagnosis of pediatric craniopharyngioma. The authors conclude that endocrine symptoms appear early and precede neurological and ophthalmological symptoms. Craniopharyngiomas may cause growth disorders; therefore, it is important to track growth charts.
Illustration A depicts the characteristic cystic spaces and calcification in a craniopharyngioma.
Answer 1: Liquifactive necrosis is more commonly associated with focal bacterial or fungal infections.
Answer 3: Lymphocytic infiltration is a characteristic finding in inflammatory conditions.
Answer 4: Immune complex deposition is seen with a type III hypersensitivity reaction.
Answer 5: Branching papillae are more consistent with papillary fibroelastoma (primary tumor of the heart).
Nwosu BU, Lee MM. Evaluation of short and tall stature in children. Am Fam Physician. 2008 Sep 1;78(5):
PMID:18788236 (Link to Abstract)
Rucka E, Wedrychowicz A, Zygmunt-Górska A, Starzyk J. [Clinical symptoms at the diagnosis of the craniopharyngioma]. Pediatr Endocrinol Diabetes Metab. 2012;18(2)
PMID:22781882 (Link to Abstract)