Dynamics of the dynamic enhancement in a suprasellar lesion: Diagnostic dilemmas and literature review

Brain tumors with high vascularity show dynamic enhancement on magnetic resonance contrast imaging owing to their rapid blood flow. This principle is used to differentiate highly vascular lesions in sellar/suprasellar area from the non-vascular or mildly vascular ones. We report a case of suprasellar lesion affecting a 35-year-old female, lesion exhibiting dynamic enhancement on contrast magnetic resonance imaging. The imaging and intra-operative findings have created a diagnostic dilemma about the nature of the lesion and the histopathology revealed it to be a Rathke′s cleft cysts (R.C.C). R.C.C have varied imaging manifestations. They can create diagnostic dilemma in a surgeon′s mind when they present with such extremes of variations including dynamic contrast enhancement. One should be aware of these atypical imaging findings before approaching these lesions at surgery for an optimal outcome