A rare case of intratumoral hemorrhage in a young adult with adamantinomatous craniopharyngioma

Craniopharyngiomas are rare, slow growing tumors arising along the craniopharyngeal duct. The incidence of craniopharyngioma was 0.13 per 100,000 persons per year. Intratumoral hemorrhage is a serious complication that can mimic pituitary tumor apoplexy, a life-threatening condition. In this report, We presented a case of a 20-year-old male with 3 days of decreased consciousness, with a history of worsening headaches, vomiting, blurry vision, bitemporal hemianopia, and right-sided limb weakness. MRI findings revealed a mixed cystic and solid suprasellar mass with blooming artifacts and fluid-fluid levels on SWI strongly suggest craniopharyngiomas with intratumoral hemorrhage. Trans-petrosal surgery was performed, the lesion appeared intraoperatively as a firm, elastic mass with a hemorrhagic component. Further histopathological testing confirmed the diagnosis of craniopharyngioma with adamantinomatous subtype, which typically occurs in children and adults over 45. While in this patient's diagnosis at age 20 falls outside the usual range. This study highlights the possibility of adamantinomatous craniopharyngioma occurring in young adulthood and the role of imaging in diagnosing craniopharyngioma, including its detailed characteristics and the presence of intratumoral hemorrhage for early management and better patient outcome.