Distant supratentorial recurrence of craniopharyngioma

The patient's visual symptoms improved but he had persistent diabetes insipidus and hypothyroidism (thyroxine (T) 4: 3.5 nmg/dl; T3: 10 nmg/dl; thyroid-stimulating hormone: 0.2 mIU/dl; and, cortisol: 12 μg/dl) in the postoperative period. {Figure 5} Histopathological examination showed a cystic lesion lined by stratified squamous epithelium and wet keratin, that on a higher magnification showed nests and trabeculae of cells with peripheral palisading and central stellate reticulum, which was characteristic of an adamantinomatous craniopharyngioma (the same histological type as the primary tumor) [Figure 6]. There are two defined mechanisms for the ectopic recurrences viz., seeding along the surgical route during the primary resection, the most common route of ectopic spread, or the spillage into the cerebrospinal fluid (CSF), which may allow viable tumor cells to migrate within the subarachnoid and even the intraventricular space.