[An elderly case of recurrent craniopharyngioma suffering from hemorrhage]

A case of a 63-year-old female with craniopharyngioma is reported. She first suffered from occult pituitary apoplexy and had recurrent enlargement and characteristic changes of a tumor during short periods. This patient was hospitalized after suddenly developing bitemporal hemianopsia. An intra-and suprasellar hematoma was revealed on computed tomography (CT) and magnetic resonance imaging (MRI). At the first operation, the hematoma was removed totally by the transsphenoidal approach, but tumor tissues were not identified. During the following 12 months, operations were repeated three times due to the recurrence and/or enlargement of a tumor associated with visual symptoms. Pathological diagnosis was squamous-type craniopharyngioma without any malignancy. Microscopic appearance of the tumor apparently changed during the clinical course. The characteristic findings were revealed respectively on MRI and CT. On the first preoperative MRI, a lesion of diffuse high signal intensity was observed on both T1 and T2 weighted images. At the second operation, the lesion was also revealed as having high signal intensity on T1 and T2 weighted images but the tumor had a large cyst with serous-yellowish fluid contents. A differential diagnosis was made on CT. At the third and fourth operations, the tumor was solid and had atheromatous contents. The lesion was revealed as having low signal intensity on T1 image and high on T2 respectively. Occult pituitary apoplexy with intra and suprasellar hemorrhage is very rare in cases of craniopharyngioma and only nine cases have been reported until now. It is also interesting with this high-aged patient that repeated recurrence and/or enlargement of a tumor with different microscopic appearances occurred during such short periods.(ABSTRACT TRUNCATED AT 250 WORDS)