Distinction of papillary and adamantinomatous craniopharyngioma: Clinical features, surgical nuances and hypothalamic outcomes.

in Neoplasia (New York, N.Y.) by Le Yang, Yi Liu, ChaoHu Wang, ZhanPeng Feng, Lei Yu, Jun Pan, JunXiang Peng, Jing Nie, MingFeng Zhou, YiChao Ou, Tao Liu, Songtao Qi, Jun Fan

TLDR

  • The study compared two types of tumors in the brain called craniopharyngiomas. The study found that the two types of tumors had different features and outcomes. The study suggests that one type of tumor, called suprasellar papillary craniopharyngioma (PCP), is less invasive to the brain and has better outcomes after surgery. The study also suggests that future research should focus on understanding the differences between the two types of tumors and developing targeted treatments for PCP.

Abstract

Understanding the differences of suprasellar papillary and adamantinomatous craniopharyngiomas (PCPs/ACPs) is pivotal for target therapy, surgical strategy or postoperative management. Here, the clinical features, surgical nuances and postoperative hypothalamic outcomes of PCPs were systematically recapitulated. 24 PCPs and 52 ACPs underwent initial surgery were retrospectively reviewed. Clinical data, quantified third ventricle (3rd V) occupation and optic chiasm distortion were compared, as well as intra-operative findings, operating notes and prognosis. Moreover, analysis of tumor/3rd V relationship and hypothalamic outcomes were also performed. Tumors were more likely to occupies the 3rd V cavity in PCPs. Chiasm distortion of "compressed forward" was the most common pattern (45.8 %) in PCPs, whereas "stretched forward" pattern accounted the highest (42.5 %) in ACPs. Besides, round-shaped with less calcification, duct-like recess, solid consistency, rare subdiaphragmatic invasion, visible lower stalk and improved postoperative visual outcome were more frequently observed in PCPs. The basal membranes of the tumor epithelium and the reactive gliosis were separated by a layer of collagen fibers in most PCPs, which differs from ACPs in the morphological examination of tumor/3rd V floor interface. In daytime sleepiness and memory difficulty, the PCPs showed significantly better outcomes than the ACPs groups, and PCPs suffered less postoperative weight gain (p < 0.05) than ACPs among adult-onset cases. PCPs are different from ACPs regards the clinical features, operative techniques and outcomes. If necessary, PCPs are suggested more amenable to total removal since its less invasiveness to the 3rd V floor and better hypothalamic outcomes.

Overview

  • The study aims to compare the clinical features, surgical nuances, and postoperative hypothalamic outcomes of suprasellar papillary craniopharyngiomas (PCPs) and adamantinomatous craniopharyngiomas (ACPs).
  • The study retrospectively reviewed 24 PCPs and 52 ACPs who underwent initial surgery. Clinical data, quantified third ventricle (3rd V) occupation, optic chiasm distortion, intra-operative findings, operating notes, and prognosis were compared. Additionally, the tumor/3rd V relationship and hypothalamic outcomes were analyzed.

Comparative Analysis & Findings

  • PCPs were more likely to occupy the 3rd V cavity than ACPs. The chiasm distortion pattern of
  • PCPs had a round-shaped tumor with less calcification, duct-like recess, solid consistency, rare subdiaphragmatic invasion, visible lower stalk, and improved postoperative visual outcome compared to ACPs. The basal membranes of the tumor epithelium and the reactive gliosis were separated by a layer of collagen fibers in most PCPs, which differs from ACPs in the morphological examination of tumor/3rd V floor interface. In daytime sleepiness and memory difficulty, PCPs showed significantly better outcomes than the ACPs groups, and PCPs suffered less postoperative weight gain (p < 0.05) than ACPs among adult-onset cases.

Implications and Future Directions

  • The study highlights the differences between PCPs and ACPs in terms of clinical features, surgical nuances, and postoperative hypothalamic outcomes. The findings suggest that PCPs are more amenable to total removal since their less invasiveness to the 3rd V floor and better hypothalamic outcomes. Future research should focus on identifying the molecular mechanisms underlying the differences between PCPs and ACPs and developing targeted therapies for PCPs.
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