ID #883 Clinicopathological Characterization of Adamantinomatous versus Papillary Subtypes in 327 Craniopharyngioma Patients

Objective Although craniopharyngiomas (CPs) are histologically benign, they exhibit significant clinical aggression and subtype-specific biological behavior. This study aims to delineate the clinicopathological heterogeneity between the adamantinomatous (ACP) and papillary (PCP) subtypes using a large-scale cohort of 327 patients to optimize diagnostic accuracy and individualized management strategies. Methods A retrospective analysis was conducted on 327 patients with histologically confirmed CP treated at The First Affiliated Hospital of Sun Yat-sen University between 2005 and 2023. Patients were categorized into ACP, PCP, mixed-type, and unclassified groups. Clinical data, including age at diagnosis and gender, along with histopathological features (microscopic calcification and ossification), were compared using Kruskal-Wallis and Fisher’s exact tests. Results Of the 327 cases, 145 (44.3%) were ACP, 41 (12.5%) were PCP, and 2 (0.6%) were mixed-type. Histological subtyping could not be definitively assigned in 139 cases (42.5%). The mean age at diagnosis was significantly lower in the ACP group compared to the PCP group (32.1 ± 18.9 vs. 42.3 ± 13.9 years; p = 0.018). Microscopic calcification or ossification was identified in 41.4% (60/145) of ACP cases, which was significantly higher than the 4.9% (2/41) observed in the PCP group (p < 0.001). Male patients accounted for 60% (196/327) of the total cohort, but no significant correlation was found between gender and histological subtype (p = 0.3). Conclusion Our results underscore the significant clinicopathological heterogeneity between craniopharyngioma subtypes. In this large-scale cohort, ACP presented at a significantly earlier age and exhibited a markedly higher prevalence of calcification compared to PCP. These findings confirm that age and microscopic calcification remain the most robust indicators for precise histological differentiation.