title: Pretreatment diagnosis of suprasellar papillary craniopharyngioma and germ cell tumors of adult patients.
abstract: OBJECTIVE
  Suprasellar papillary craniopharyngiomas and germ cell tumors in adults share some clinical and imaging similarities but have different therapeutic strategies and outcomes. This study aimed to evaluate the pretreatment diagnosis of these 2 tumors to improve the therapeutic outcome.
  
  
  METHODS
  We retrospectively enrolled 18 adults with papillary craniopharyngiomas and 17 with germ cell tumors. The MR imaging findings were evaluated, including signal change and anatomic extension. The medical records were reviewed to collect clinical findings, management, and outcomes.
  
  
  RESULTS
  The clinical findings of papillary craniopharyngiomas versus germ cell tumors were as follows: age: 46 ± 13.9 years versus 23 ± 7.1 years (P < .0001); diabetes insipidus: 2/18 (11%) versus 11/17 (65%) (P = .001); recurrence 13/16 (81%) versus 4/17 (24%) (P = .0031). The MR imaging findings of papillary craniopharyngiomas versus germ cell tumors were as follows—pituitary stalk thickening: 1.6 ± 0.4 mm versus 5.4 ± 4.2 mm (P < .0001); vertical infundibular extension: 1/18 (6%) versus 16/17 (94%) (P < .0001); sagittal spheric shape: 17/18 (94%) versus 1/17 (6%) (P < .0001); diffusion restriction: 1/17 (6%) versus 8/12 (67%) (P = .0009).
  
  
  CONCLUSIONS
  Younger age, diabetes insipidus, MR imaging characteristics of restricted diffusion, and vertical infundibular extension favor the diagnosis of germ cell tumors. Spheric shape without infundibular infiltration provides clues to papillary craniopharyngiomas, which originate from the pars tuberalis and are located outside the third ventricle. We suggest that suprasellar germ cell tumor is possibly an intraventricular lesion. Appropriate treatment planning can be initiated according to the diagnosis and anatomic location.
authors.affiliation: From the Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: H-J
authors.identifier: http://orcid.org/0000-0002-9303-7165
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: From the Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Wu
authors.affiliation: From the Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: H-M
authors.initials: HM
authors.lastname: Wu
authors.affiliation: From the Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: S-C
authors.initials: SC
authors.lastname: Hung
authors.affiliation: From the Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: J-F
authors.initials: JF
authors.lastname: Lirng
authors.affiliation: From the Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: C-B
authors.initials: CB
authors.lastname: Luo
authors.affiliation: From the Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; and School of Medicine, National Yang-Ming University, Taipei, Taiwan. fcchang374@gmail.com.
authors.forename: F-C
authors.initials: FC
authors.lastname: Chang
authors.affiliation: From the Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: W-Y
authors.initials: WY
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D003397:Craniopharyngioma / Q000175:diagnosis* / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000473:pathology; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000532:radiotherapy; D012189:Retrospective Studies; D020542:Third Ventricle / Q000473:pathology; D055815:Young Adult