Malignant Transformation of Radiotherapy-Naïve Craniopharyngioma

World Neurosurg. 2016 Apr:88:690.e1-690.e5. doi: 10.1016/j.wneu.2015.11.031. Epub 2015 Nov 30.


Background: Craniopharyngioma is a rare benign intracranial neoplasm that is successfully managed with surgery or adjuvant radiotherapy. The malignant transformation of craniopharyngioma has seldom been reported.

Case description: A 30-year-old woman presented with a 5-month history of amenorrhea and was admitted to the hospital. She underwent surgical resection for three times and died at last. MRI revealed a new solid component of craniopharyngioma. Pathologic examination revealed malignant changes in the craniopharyngioma. In addition, We analyzed the expression of Ki-67, p53, VEGF, and MMP-9 in this malignant case after the third operation and in samples from 9 benign craniopharyngiomas. Immunohistochemical analysis showed that the Ki-67 index was higher in malignant craniopharyngiomas (50%) compared with benign craniopharyngiomas (3.0% ± 1.5%; range, 1.0%-6.0%). The p53, MMP-9, and VEGF protein levels were higher in the malignant craniopharyngioma compared with the benign craniopharyngiomas.

Conclusions: Patients with a high Ki-67 index and high p53, MMP-9, and VEGF protein levels and a new solid component of craniopharyngioma on MRI may benefit from aggressive treatment and close surveillance.

Keywords: Craniopharyngioma; Electron microscope; Immunohistochemistry; Malignant transformation; Radiotherapy.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cranial Irradiation
  • Craniopharyngioma / diagnosis*
  • Craniopharyngioma / radiotherapy
  • Craniopharyngioma / surgery*
  • Diagnosis, Differential
  • Female
  • Humans
  • Neoplasm Recurrence, Local / diagnosis*
  • Neoplasm Recurrence, Local / surgery*
  • Neoplasm, Residual
  • Pituitary Neoplasms / diagnosis*
  • Pituitary Neoplasms / radiotherapy
  • Pituitary Neoplasms / surgery*
  • Treatment Outcome