Case History
30-year-old with sellar/suprasellar mass
What testing should be ordered to properly diagnose the lesion?
A. Beta-Catenin
B. BRAF
C. Synaptophysin
D. GFAP
Answer: B. BRAF Testing
Discussion
•This is a papillary craniopharyngioma, CNS WHO grade 1
•They microscopically consist of compact, monomorphic sheets of well-differentiated squamous epithelium without surface keratinization which line fibrovascular cores.
•The inflammatory component consists of T cells, macrophages and neutrophils
•They show BRAF V600E mutations which can be detected with immunohistochemistry or molecular testing
•Beta-catenin has nuclear positivity in adamantinomatous craniopharyngioma
•Synaptophysin will be positive in pituitary neoplasms
•GFAP will highlight astrocytic lineage cells and astrocytic neoplasms.
Case contributed by: Michael Williams, M.D., M.Sc., Neuropathology Fellow, UAB Pathology