Pathological Study Of Craniopharyngiomas At The Tumor-hypothalamus Interface And Its Surgical Implication

Objective:1. To analysis the pathological feature of craniopharyngiomas and its histopathological classification.2. To elucidate the pathological difference of the tumor at the site adjoining hypothalamus and its surgical implication.3. To evaluate the growth potential of craniopharyngiomas and to illustrate its important role in tumor recurrence.Methods:1. 63 cases of craniopharyngiomas were reviewed and characterized histopathologically by means of routine light microscopic evaluation of hematoxylin and eosin-stained surgical specimens.2. The pathological characteristics of the tumor-hypothalamus interface in each groups were determined with respect to their pathological type and intraoperative findings.3. Immunohistochemistry technique with specific monoclonal antibody was applied to investigate the difference of the expression of proliferating cell nuclear antigen on recognized pathological type.Results:1. Two distinct pathological variants of craniopharyngioma existthe classic adamantinomatous type and the squamous papillary type,while some of the adamantinomatous craniopharyngiomas mainly present cholesteril granuloma changes.2. There are marked differences in clinical presentation,rediological characteristics,and postoperative outcome between each pathological groups.3. Tumor infiltrative patterns to hypothalamus can be classfied as adjoining,adhering and infiltrative growth pattern according to their pathologic and intraoperative status. Infiltrative growth pattern occur exclusively in adamantinomatous type.4. Proliferating cell nuclear antigen labeling indices (PCNA-LI) was much higher in adamantinous tumors than squamous papillary tumors. The locally invasive growth pattern of the adamantinomatous craniopharyngioma may drived from its high proliferative activity.Conclusion:1. Cholesteril granuloma lesions of the sellsr region represent a clinicopathological entity different from the classical adamantinomatous craniopharyngioma.2. The adamantinomatous craniopharyngiomas pose a worse prognostic result than the squamous papillary craniopharyngiomas,with a tendency of tumor reccurence.3. Adamantinomatous craniopharyngiomas may infiltrate hypothalamus,the finger-like splayed tumor invading to hypothalamus render it impossible for the surgeon to perform a gross total removal of the tumor.4. The aggressive growth potential of the adamantinomatous craniopharyngiomas play a importent role in tumor reccurence.