Suprasellar Teratoma in a Young Adult: A Case Report

Abstract

Background: Intracranial germ cell tumours are uncommon neoplasms that often arise along midline structures, including the pineal and suprasellar regions. Teratomas are non-germinomatous germ cell tumours and may produce visual, neurological and endocrine manifestations when located in the suprasellar region. Case Presentation: A 20-year-old male with medically managed hypothyroidism and hypogonadism was evaluated after cranial magnetic resonance imaging demonstrated a sellar lesion with suprasellar extension. He had experienced progressive right-sided visual loss and severe holocranial headache for six months. Examination showed phenotypic features of hypogonadism and a relative afferent pupillary defect in the right eye, while motor, sensory, language, memory, praxis and gnosis functions were preserved. Magnetic resonance imaging revealed a large heterogeneous solid-cystic sellar lesion with suprasellar extension, measuring approximately 3.5 × 4.2 × 4 cm, with distortion of adjacent ventricular structures. The patient underwent frontal craniotomy using a microsurgical interhemispheric approach. The tumour was extra-axial, thick-capsulated and adherent to major neurovascular structures. Approximately 80% subtotal resection was achieved to preserve adjacent anatomy. Histopathological examination confirmed teratoma with mature tissue elements, including fibrous wall, bone, adipose tissue, microcalcifications and cholesterol clefts in this patient. Conclusion: This case supports careful clinicoradiological and histopathological correlation when evaluating suprasellar lesions associated with visual and endocrine manifestations.