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| T1 coronal pre gad | T1 coronal post gad | T1 sagittal post gad |
Diagnosis: Langerhans cell histiocytosis
Langerhans cell histiocytosis is the disease formerly known as histiocytosis X. Disseminated disease is more common in children with lytic skeletal lesions characteristic . With CNS involvement, diabetes insipidus is a classic complication. Pituitary infundibular enlargement and enhancement are characteristic. Treatment consists of radiation and chemotherapy. At follow-up a year later this lesion was unchanged. Germinoma may cause an enhancing infundibular mass; however, these are usually seen in young males and would not produce a lytic rib lesion. Germinoma may present with co-existent pineal and suprasellar masses. However, 5 to 10% of germinomas may occur in locations other than the pineal and suprasellar regions. Lymphoma, sarcoidosis, and metastases are potential but much less likely etiologies for enhancing infundibular masses. Hypothalamic glioma is not in the differential since these are typically larger mass lesions with less enhancement. Hamartomas of the tuber cinereum are more focal mass lesions of the hypothalamus but do not enhance. Lymphocytic hypophysitis is not is the differential since it is characterized by an anterior pituitary mass which may have suprasellar extension. It is usually seen in late pregnancy or in the post-partum period. Related Cases
