Page Contents
OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is craniopharyngioma. While this may seem a odd practice, it is useful to see multiple examples of how craniopharyngioma will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for craniopharyngioma.
Chief Complaints:
- Headaches are a common complaint (due to increased intracranial pressure).
- Vision changes: such as double vision can be experienced by the patient.
- Hormone deficiency related complaints: growth issues, decreased libido, etc.
Patient History:
- Patent is a young child: this is more common, however older patients may also have this condition.
Clinical Workup:
- Bitemporal hemianopsia is the classic finding on a neurological exam. Double vision during the eye exam might be observed.
- Incidental mass on imaging: often contains calcifications and is suprasellar in location (compresses optic chiasm)
- Cystic mass (gross histology): often filled with thick brownish-yellowish fluid that contains protein and cholesterol crystals. Likened to “machine oil”.
QUESTION EXAMPLES
Question # 1
A 14 year old male comes to the clinic because he has been experiencing chronic headaches and changes to his vision. He explains that the headaches have worsened over this past year, and also are associated with nausea. His parents are very concerned because they feel that the patient’s coursework has suffered from his symptoms, and they want him to do well in high school so that he will go to a good college. His head is imaged and an intracranial mass is identified that possesses calcifications. The mass is removed surgically and gross histological examination revel as the presence of cystic spaces that are filled with thick cholesterol rich fluid that is brownish-yellowish. What is the likely diagnosis in this patient?
Explanation # 1
Young child + headaches + vision changes + calcified intracranial mass + cystic mass filled with thick cholesterol rich fluid = craniopharyngioma
Question # 2
A 9 year old male is being worked up in the pediatric clinic because he has not been growing as quickly as expected. A brain MRI shows a 5 cm cystic suprasellar lesion. It is impinging on surrounding strictures in the brain. Calcifications are present within the lesion. What is the likely diagnosis in this patient?
Explanation # 2
Young child + growth retardation + calcified suprasellar cystic intracranial mass = craniopharyngioma
Question # 3
A 10 year old female is brought to the clinic because she has had poor growth since her last annual checkup. She currently is below the 5th percentile for both height and weight. A physical exam is unremarkable, expect for visual field testing that reveals a bitemporal hemianopia. Labs are collected and revel that she has a growth hormone deficiency. An MRI of the cranium is performed and reveals the presence of a calcified cystic mass in the suprasellar region. What is the likely diagnosis in this patent?
Explanation # 3
Young child + growth retardation + bitemporal hemianopia + calcified suprasellar cystic intracranial mass = craniopharyngioma
Question # 4
A 50 year old taxi driver comes to the office because he has been suffering from impaired vision for the past 10 months. He explains that he has difficulty seeing sideways, and has to turn his head to look at his side. He also complains of headaches that bother him intermittently throughout the day. A patient history reveals that the patent has also been suffering from a decreased libido, which he attributes to working longer hours more recently. He denies any fever, chills, chest pain, weakness, decrease sensation, or urinary/bowel incontinence. A physical exam revel as decreased vision on his temporal fields bilaterally, however the rest of his exam is non-contributory. What is the likely diagnosis in this patient?
Explanation # 4
Vision changes + headaches + decreased libido (hormonal changes) + bitemporal hemianopia = craniopharyngioma (Suprasellar mass)
Question # 5
A 12 year old female is brought to the clinic because she has been experiencing a 6 month history of blurred vision, frequent headaches, and also urinary frequency. The patient has not yet begun to menstruate. The patient’s vital signs are currently within normal limits, and her visual acuity is 20/20 bilaterally. A neurological exam reveals a bitemporal visual field defect. There is also papilledema noted on a funduscopic exam. A CT scan of the head is performed, and shows a large suprasellar mass with multiple areas of calcification. What is the likely diagnose in this patient?
Explanation # 5
Young child + headaches + vision changes + bitemporal hemianopia + papilledema + calcified intracranial mass = craniopharyngioma
Question # 6
A 13 year old male is brought to the clinic because he has been experiencing headaches for the past 5 months. Sometimes these headaches are associated with vomiting. He also complains of visual difficulty that has been noticeable for the past 5 weeks. His growth charts reveal that his growth has slowed over the course of the past few years. A physical exam reveasl the presence of papilledema. What diagnosis must be considered in this patient?
Explanation # 6
Young child + headaches + vision changes + growth retardation + papilledema = craniopharyngioma
TESTABLE FACTS ABOUT THIS CONDITION (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clincial implications that are commonly asked. Some of these are listed below:
Cause:
- What is the tumor derived from? Rathke’s pouch (structure that gives rise to the anterior pituitary)
Page Updated: 04.02.2017