Pathology of craniopharyngiomas: clinical import of pathological findings

Craniopharyngiomas are benign neoplasms, thought to be of maldevelopmental origin, which occur in both children and adults in the sella and suprasellar regions. There are two distinctive histologic patterns, 'adamantinomatous' and 'squamous papillary', but transitional or mixed examples occur. Prior suggestions that squamous papillary tumors are found 'only' in adults, 'never' calcify, do not invade brain, and are associated with a better outcome ('no' recurrences, better clinical status) are partially correct, but rare pediatric examples occur, rare examples have calcification, and in our study of 56 patients with craniopharyngiomas treated at New York University there was no statistically significant difference in brain invasion or recurrence rates for squamous papillary as compared to adamantinomatous types. Brain invasion, commonly seen in craniopharyngioma specimens, is not a predictor of recurrence.