Differential Diagnosis for a Multicystic Mass within the Sella on MRI
- Single most likely diagnosis
- Pituitary adenoma with cystic degeneration: This is the most common tumor of the sellar region, and cystic degeneration can occur, especially in larger adenomas. The presence of a thin enhancing septation and the absence of normal pituitary gland tissue support this diagnosis.
- Other Likely diagnoses
- Rathke's cleft cyst: These are benign cysts that can occur in the sellar region, often containing a single cyst or multiple cysts with a thin wall. However, the presence of an enhancing septation is less typical for Rathke's cleft cysts.
- Craniopharyngioma: Although more commonly seen in the suprasellar region, craniopharyngiomas can occur within the sella and may have a multicystic appearance with enhancing septations.
- Do Not Miss diagnoses
- Pituitary apoplexy: Although typically presenting with acute symptoms, a pituitary apoplexy can result in a multicystic appearance due to hemorrhage and necrosis of a pre-existing adenoma. It's crucial to consider this diagnosis due to its potential for serious complications if not promptly treated.
- Lymphocytic hypophysitis: This inflammatory condition can cause enlargement of the pituitary gland and can sometimes have a cystic appearance on imaging. It's essential to consider this diagnosis, especially in pregnant or postpartum women, due to its potential impact on hormonal balance.
- Rare diagnoses
- Dermoid or epidermoid cyst: These are rare, benign cysts that can occur in the sellar region, although they are more commonly found in other locations. They might appear multicystic and could have enhancing walls or septations, but this would be an uncommon presentation.
- Arachnoid cyst: Although rare in the sellar region, arachnoid cysts can occur and may appear as multicystic lesions. However, they typically do not have enhancing septations.
- Chordoma: A rare malignant tumor that can occur in the sellar region, chordomas might have a multicystic appearance but are typically more aggressive and have a different clinical presentation.