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Wang G, Shen H, Chu Z, Shen J, Wang Y. Endoscopic transsphenoidal approach to a sphenoid sinus inverted papilloma combined with pituitary adenoma: a case report. Br J Neurosurg 2024; 38:202-204. [PMID: 32940105 DOI: 10.1080/02688697.2020.1820944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/05/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
Sphenoid sinus inverted papilloma (IP) is a very infrequent tumor, and the combination of sphenoidal IP with pituitary tumor is extremely rare. In this report, the authors describe the case of a 63-year-old male with oculomotor nerve palsy in the left eye due to sellar region tumor. After endoscopic transsphenoidal surgery, the postoperative pathological examination confirmed the co-occurrence of an sphenoidal IP and pituitary adenoma. To our knowledge, the present case is the second reported case of an IP with a pituitary adenoma.
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Affiliation(s)
- GengHuan Wang
- Neurosurgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - HePing Shen
- The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - ZhengMin Chu
- Neurosurgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - JianGuo Shen
- Neurosurgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - YiFei Wang
- Neurosurgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
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2
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Chatain GP, Chee K, Driscoll M, Kleinschmidt-DeMasters B, Lillehei KO. Pituitary Adenoma Coexistent with Sellar Clear Cell Meningioma Unattached to the Dura: Case Report and Treatment Considerations. J Neurol Surg Rep 2024; 85:e1-e10. [PMID: 38213880 PMCID: PMC10776412 DOI: 10.1055/s-0043-1777792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/05/2023] [Indexed: 01/13/2024] Open
Abstract
Collision tumors involving the sella are rare. Intrasellar collision tumors are most commonly composed of a combination of pituitary adenomas and pituitary neuroendocrine tumors; however, collision tumors consisting of a pituitary adenoma and intrasellar meningioma are exceedingly rare. The authors present the case of a 47-year-old man who presented with progressive right eye vision loss. Magnetic resonance imaging showed a large, heterogeneously enhancing sellar mass with suprasellar extension. Using a transcranial approach with a right subfrontal craniotomy, near-total resection of the mass was achieved. Histologic analysis confirmed a diagnosis of a gonadotroph adenoma with concomitant clear cell meningioma (CCM). This patient was discharged with improvement in visual acuity and no signs of diabetes insipidus. Given the indistinguishable radiographic characteristics of pituitary adenoma and CCM, a preoperative diagnosis of a collision tumor was difficult. This case was uniquely challenging since the CCM component lacked the classic dural attachment that is associated with meningiomas on neuroimaging. CCMs are classified as central nervous system (CNS) World Health Organization (WHO) grade 2 tumors and tend to behave more aggressively, therefore warranting close surveillance for signs of tumor recurrence. This is the first case to report a collision tumor consisting of pituitary adenoma and CCM.
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Affiliation(s)
- Grégoire P. Chatain
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Keanu Chee
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Meghan Driscoll
- Department of Pathology, University of Colorado, School of Medicine, Aurora, Colorado, United States
| | - B.K. Kleinschmidt-DeMasters
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, United States
- Department of Pathology, University of Colorado, School of Medicine, Aurora, Colorado, United States
| | - Kevin O. Lillehei
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, United States
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Gong L, Chen H, Zhang W, Liu X, Wang Y, Mu X, Zhang F, Li Q, Heng L, Zhang W. Primary collision tumors of the sellar region: Experience from a single center. J Clin Neurosci 2022; 100:204-211. [PMID: 35489256 DOI: 10.1016/j.jocn.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/06/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
Collision tumors are extremely rare in the sellar region, and their features have not been fully characterized. Here, we report our single-center experience in the diagnosis and management of these tumors, focusing primarily on their clinicopathological features. We first performed a retrospective study of pathological reports from patients who had undergone surgery for pituitary adenoma (PA) or craniopharyngioma (CP) at our hospital. Next, to identify collision tumors, patients with a second pathological diagnosis-such as Rathke's cleft cyst (RCC), gangliocytoma (GC), meningioma, or atypical teratoid/rhabdoid tumor (AT/RT)-were considered. Finally, the clinicopathological characteristics of these tumors were reviewed and analyzed. The results demonstrated that eleven of 2359 PA or CP cases (0.47 %) were found to exhibit sellar collision tumors; the patient cohort had a median age of 52 years (23-71) and was predominantly female (63.6 %, 7/11). In details, of the 2092 cases of PA, 10 were diagnosed with concurrent lesions (seven of RCC and one each of CP, meningioma, and GC). Of the 267 CP cases, a single patient presented with associated AT/RT. To our knowledge, this is the first reported adult case of this subtype. Notably, the preoperative CT and/or MRI of each patient revealed solely PA or CP. The endoscopic endonasal approach was the preferred surgery. In conclusion, the sellar collision tumors occur with low incidence, and the primary subtype is PA and RCC. Their definitive diagnosis depends primarily on pathological findings.
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Affiliation(s)
- Li Gong
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Huangtao Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Wendong Zhang
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Xiaoyan Liu
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Yuanyuan Wang
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Xiaorong Mu
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Fuqin Zhang
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Qing Li
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China; State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
| | - Lijun Heng
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, PR China.
| | - Wei Zhang
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China.
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Gezer E, Cantürk Z, Selek A, Çetinarslan B, Tarkun İ, Sözen M, Kiraz U, Gürbüz YS, Ceylan S, Çabuk B. Cushing's disease due to a pituitary adenoma as a component of collision tumor: A case report and review of the literature. J Med Case Rep 2020; 14:59. [PMID: 32423480 PMCID: PMC7236304 DOI: 10.1186/s13256-020-02382-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/25/2020] [Indexed: 01/15/2023] Open
Abstract
Background The coexistence of two morphologically different tumors attached to each other creates a very rare type of tumor called a collision tumor. Collision tumors containing pituitary adenoma–sellar meningioma have only been described in four cases to date; we discuss a fifth case harboring a collision tumor comprising a pituitary corticotroph adenoma and a sellar meningioma in the same anatomic position. Case presentation A 34-year-old Caucasian woman presented with menstrual irregularity, severe weakness of the proximal muscles, and 10–15 kg weight gain within a year. Basal plasma cortisol and adrenocorticotrophic hormone levels were 17.7 mg/dL and 58 pg/mL, respectively. Her diurnal cortisol rhythm was impaired (plasma cortisol at 23:00, 18.2 mg/dL) and after a 48-hour, 2-mg dexamethasone suppression test, plasma cortisol level was 13.6 mg/dL. The results were consistent with a diagnosis of Cushing’s syndrome. We then performed a nocturnal 8-mg dexamethasone suppression test and the suppression of cortisol was not greater than 50% (21.4 to 19.3). A pituitary magnetic resonance imaging revealed a tuberculum sellae meningioma arising from within the sellar region. An operation was chosen in order to examine whether the tumor was an adrenocorticotrophic hormone/corticotropin-releasing hormone-secreting lesion or if there were any microadenomas that could be observed during the operation. Via an extended endoscopic endonasal approach the meningioma was resected successfully. Unexpectedly, our patient complained of nausea and vomiting postoperatively. Plasma cortisol was 2.6 mg/dL and orally administered hydrocortisone treatment was initiated immediately. Histopathological examination revealed that the tumor generally consisted of a pituitary corticotroph adenoma infiltrated by meningioma. Our patient maintained hydrocortisone treatment for 11 months. At the latest visit, she had lost 12 kg, and her hypertension, menstrual irregularity, and weakness of the proximal muscles had disappeared. Her mental and physical wellbeing were restored. Conclusions To the best of our knowledge, this is the first report of Cushing’s disease due to a pituitary corticotroph adenoma adjacent to a meningioma. Even if a high-dose dexamethasone suppression test fails to suppress basal cortisol level, the importance of considering a suprasellar/sellar meningioma a possible component of a collision tumor presenting as adrenocorticotrophic hormone-dependent Cushing’s syndrome is highlighted here.
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Affiliation(s)
- Emre Gezer
- Department of Endocrinology and Metabolism, Kocaeli University, Faculty of Medicine, 41380, Kocaeli, Turkey.
| | - Zeynep Cantürk
- Department of Endocrinology and Metabolism, Kocaeli University, Faculty of Medicine, 41380, Kocaeli, Turkey
| | - Alev Selek
- Department of Endocrinology and Metabolism, Kocaeli University, Faculty of Medicine, 41380, Kocaeli, Turkey
| | - Berrin Çetinarslan
- Department of Endocrinology and Metabolism, Kocaeli University, Faculty of Medicine, 41380, Kocaeli, Turkey
| | - İlhan Tarkun
- Department of Endocrinology and Metabolism, Anadolu Medical Center, Kocaeli, Turkey
| | - Mehmet Sözen
- Department of Endocrinology and Metabolism, Kocaeli University, Faculty of Medicine, 41380, Kocaeli, Turkey
| | - Umay Kiraz
- Department of Pathology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Yeşim Saliha Gürbüz
- Department of Pathology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Savaş Ceylan
- Department of Neurosurgery, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Burak Çabuk
- Department of Neurosurgery, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
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Simultaneous Resection of Pituitary Macroadenoma and Sphenoid Sinus Inverted Papilloma: The Challenge of Operating Sinonasal and Skull Base Pathologies Through a Single-Stage Endoscopic Endonasal Approach. World Neurosurg 2019; 133:260-265. [PMID: 31605847 DOI: 10.1016/j.wneu.2019.09.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Coexistence of sinonasal and skull base tumors is uncommon but possible, and the endonasal route seems to be the best option to manage both lesions simultaneously. We report the first case in the English literature of concomitant sphenoid sinus inverted papilloma and pituitary macroadenoma treated through an endoscopic endonasal approach. CASE DESCRIPTION A 68-year-old man presented with a history of progressive visual loss and nasal obstruction. Clinical examination disclosed bitemporal hemianopsia. Computed tomography scan and magnetic resonance imaging obtained on admission showed a large sellar/suprasellar enhancing lesion with a marked mass effect on the optic chiasm. Imaging also showed a second mass extending from the sphenoid sinus to the left nasal cavity with obstruction of the maxillary sinus ostium and development of maxillary sinus mucocele. Both tumors were entirely resected by an endoscopic endonasal approach. Additionally, middle meatal antrostomy and marsupialization with drainage of the maxillary mucocele was performed. Biopsy confirmed the coexistence of a pituitary macroadenoma and sphenoid sinus inverted papilloma. CONCLUSIONS This case and the literature suggest that patients with concomitant nasal and skull base pathologies can be simultaneously managed. The otolaryngologist plays an essential role in removing the sinonasal lesion to ensure a safe surgical corridor before entering the intracranial cavity and for planning for the skull base reconstruction.
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Pituitary Adenoma and Craniopharyngioma Collision Tumor: Diagnostic, Treatment Considerations, and Review of the Literature. World Neurosurg 2019; 121:211-216. [DOI: 10.1016/j.wneu.2018.10.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 12/19/2022]
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Syed S, Karambizi DI, Baker A, Groh DM, Toms SA. A Comparative Report on Intracranial Tumor-to-Tumor Metastasis and Collision Tumors. World Neurosurg 2018; 116:454-463.e2. [PMID: 29704691 DOI: 10.1016/j.wneu.2018.04.109] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The incidence of 2 distinct tumor types occupying the same anatomic location is rarely observed and may be accounted for by 2 separate mechanisms: tumor-to-tumor metastasis and collision tumors, where 2 adjacent tumors invade one another. These rare phenomena arise from distinct mechanisms, which may affect their preoperative recognition, surgical approach, and postoperative care. We review 2 cases, highlighting their identification and perioperative management. CASE DESCRIPTIONS In case 1, a 71-year-old patient with a history of sphenoid wing meningioma presented with headache, nausea, and vomiting and was found to have a mass with meningioma and glioblastoma (GBM) characteristics. In case 2, a 61-year-old man with worsening dysmetria in the setting of unintentional weight loss presented with multiple masses in the pelvis, abdomen, lung, and brain. The brain masses were classified as meningioma with intratumoral metastatic adenocarcinoma foci. CONCLUSIONS Preoperative recognition of collision tumor and tumor-to-tumor metastasis is imperative for surgical planning, including selecting regions for tissue biopsy and goals of care. Meticulous evaluation of history and imaging and thorough pathologic analysis allow for effective diagnosis and optimal patient outcomes.
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Affiliation(s)
- Sohail Syed
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
| | - David I Karambizi
- Warren Alpert Medical School of Brown University, Brown University, Providence, Rhode Island, USA
| | - Amanda Baker
- Department of Radiology, Brown University, Providence, Rhode Island, USA
| | - Darren M Groh
- Department of Neuropathology, Brown University, Providence, Rhode Island, USA
| | - Steven A Toms
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA; Normal Prince Neurosciences Institute, Brown University, Providence, Rhode Island, USA; Warren Alpert Medical School of Brown University, Brown University, Providence, Rhode Island, USA.
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Hattori Y, Tahara S, Nakakuki T, Takei M, Ishii Y, Teramoto A, Morita A. Sellar Chondroma with Endocrine Dysfunction that Resolved after Surgery: Case Report. J NIPPON MED SCH 2015; 82:146-50. [PMID: 26156668 DOI: 10.1272/jnms.82.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chondromas originating from the sella turcica are rare, and the most common initial symptoms are headache and visual disturbance. We describe a case of sellar chondroma with endocrine impairment as an initial manifestation that completely resolved after surgery. A 40-year-old Japanese woman with amenorrhea and galactorrhea for the last 2 years was referred to our department of neurosurgery for the evaluation of high prolactin levels and a tumor in the sella turcica. A biochemical assessment indicated endocrine dysfunction. Magnetic resonance imaging and computed tomography indicated a tumor in the sella turcica. The patient's presentation favored the preoperative diagnosis of pituitary adenoma or Rathke's cleft cyst. However, because calcification was detected, other types of tumors, such as craniopharyngioma, meningioma, and chordoma, were also considered. Endoscopic transsphenoidal surgery was performed, and the possibility of a bony tumor was recognized. Finally, the tumor was completely removed, and the histopathological findings confirmed chondroma. The postoperative course was uneventful, and endocrine function improved. Five years after surgery, the patient is doing well without pituitary insufficiency, pituitary hormone medications, or signs of tumor recurrence. In cases of sellar chondroma, endocrine dysfunction sometimes precedes other symptoms, such as headache and visual disturbance. When examining a patient with an intrasellar tumor harboring calcification, clinicians must consider the possibility of sellar chondroma. Furthermore, to the best of our knowledge, this case is the first of sellar chondroma treated with endoscopic surgery to be reported.
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Qiu L, Zhu Y, Wang H, Wang Y, Wu Q, Yang J. Giant Chondroma of the Saddle Area: Case Report and Literature Review. Neuroophthalmology 2013; 37:231-238. [PMID: 28167992 DOI: 10.3109/01658107.2013.830626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/04/2013] [Accepted: 07/07/2013] [Indexed: 11/13/2022] Open
Abstract
A 63-year-old man presented with sexual dysfunction of 6-year duration, 5-year history of bilateral vision loss, and left nasal obstruction for 3 years. Brain computed tomography and magnetic resonance imaging showed a large mass lesion in the saddle area and extending upward to the dorsum sellae, bilateral cavernous sinus, and suprasellar region, and down into the sphenoid sinus and nasal cavity; the optic nerves and optic chiasm were elevated upward and compressed. Endocrine tests indicated that all serum level of anterior pituitary hormones decreased. The preoperative diagnosis included invasive pituitary adenoma, chordoma, osteosarcoma, chondrosarcoma, and craniopharyngioma. The tumour was subtotally removed through transsphenoidal approach. Histopathology examination revealed a chondroma. Postoperatively, the patient was stable and his visual acuity and visual field defect improved and his pituitary function return to normal except for hypothyroidism.
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Affiliation(s)
- Lubin Qiu
- Department of Otorhinolaryngology, the Second Hospital of Anhui Medical University Hefei People's Republic of China
| | - Yongjun Zhu
- Department of Otorhinolaryngology, the Second Hospital of Anhui Medical University Hefei People's Republic of China
| | - Haijun Wang
- Department of Neurosurgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou People's Republic of China
| | - Yatang Wang
- Department of Otorhinolaryngology, the Second Hospital of Anhui Medical University Hefei People's Republic of China
| | - Qiang Wu
- Department of Pathology, the Second Hospital of Anhui Medical University Hefei People's Republic of China
| | - Jianming Yang
- Department of Otorhinolaryngology, the Second Hospital of Anhui Medical University Hefei People's Republic of China
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