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Tartuci IT, Junior NADS, Rogerio F, Dal Fabbro M, Garmes HM, Reis F. Intrasellar xanthogranuloma mimicking macroadenoma. Neuroradiol J 2024; 37:123-125. [PMID: 36951613 PMCID: PMC10863574 DOI: 10.1177/19714009231166075] [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] [Indexed: 03/24/2023] Open
Abstract
Intracranial xanthogranulomas (XGs) have been found at various sites, but xanthogranuloma of the sellar region is extremely rare. We report about a case of sellar XG in a 34-year-old female. Magnetic resonance imaging showed a solid-cystic mass located at the sella turcica. The cystic component was hyperintense on the T1-weighted image (WI) and T2WI. The solid component was hyperintense on T1WI and hypointense on T2WI. There was peripheral enhancement after gadolinium administration. The diagnosis of cystic macroadenoma was considered before surgery. Final diagnosis of XG was confirmed by histopathological examination after surgical resection. Gross total resection of the lesion was achieved using the microscope through endoscopic endonasal transsphenoidal approach. The patient had a good outcome and no symptom of diabetes insipidus, hormonal evaluation did not show any alterations compatible with hypopituitarism and prolactin levels were normal XG should receive diagnostic consideration for the sellar mass lesions with cystic components hyperintense on T1WI and T2WI, solid components hyperintense on T1WI and hypointense on T2WI, and CT without evidence of calcifications. It is important to consider the possibility of XG when pertinent, as it facilitates a proper surgical approach strategy.
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Affiliation(s)
- Iago Toledo Tartuci
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Nivaldo Adolfo da Silva Junior
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Fabio Rogerio
- Department of Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Mateus Dal Fabbro
- Department of Neurology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Heraldo Mendes Garmes
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
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Uccella S, Dottermusch M, Erickson L, Warmbier J, Montone K, Saeger W. Inflammatory and Infectious Disorders in Endocrine Pathology. Endocr Pathol 2023; 34:406-436. [PMID: 37209390 PMCID: PMC10199304 DOI: 10.1007/s12022-023-09771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Abstract
A variety of inflammatory conditions may directly involve the endocrine glands, leading to endocrine dysfunction that can cause severe consequences on patients' health, if left untreated. Inflammation of the endocrine system may be caused by either infectious agents or other mechanisms, including autoimmune and other immune-mediated processes. Not infrequently, inflammatory and infectious diseases may appear as tumor-like lesions of endocrine organs and simulate neoplastic processes. These diseases may be clinically under-recognized and not infrequently the diagnosis is suggested on pathological samples. Thus, the pathologist should be aware of the basic principles of their pathogenesis, as well as of their morphological features, clinicopathological correlates, and differential diagnosis. Interestingly, several systemic inflammatory conditions show a peculiar tropism to the endocrine system as a whole. In turn, organ-specific inflammatory disorders are observed in endocrine glands. This review will focus on the morphological aspects and clinicopathological features of infectious diseases, autoimmune disorders, drug-induced inflammatory reactions, IgG4-related disease, and other inflammatory disorders involving the endocrine system. A mixed entity-based and organ-based approach will be used, with the aim to provide the practicing pathologist with a comprehensive and practical guide to the diagnosis of infectious and inflammatory disorders of the endocrine system.
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Affiliation(s)
- Silvia Uccella
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanule, Milan, Italy
- Pathology Service IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Matthias Dottermusch
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lori Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Julia Warmbier
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kathleen Montone
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA USA
| | - Wolfgang Saeger
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Guerrero-Pérez F, Marengo AP, Vilarrasa N, Vidal N, Ruiz-Roig N, Sánchez-Fernández JJ, Torres-Díaz A, Sanmillán JL, Pérez-Maraver M, Villabona C. Xanthogranuloma of the sellar region: a systematic review. Hormones (Athens) 2023; 22:199-210. [PMID: 36695986 DOI: 10.1007/s42000-023-00432-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
Knowledge of xanthogranuloma (XG) of the sellar region comes from short series or single cases. We performed a systematic review, using the PubMed, Web of Science, Embase, Scopus, eLibrary, and BIOSIS Preview databases, of all cases reported from 2000 to the present. We also describe one unreported patient treated in our institution. A search of the literature revealed that of 71 patients 50.7% were male and that mean age at diagnosis was 34.7 ± 19.2 years old. Median time from clinical onset until diagnosis was 7 (3-21) months. Hypopituitarism (70.4%), visual disorders (64.7%), headache (53.5%), and polyuria-polydipsia (28.2%) were the most common symptoms. On MRI, median tumor size was 20 (16-29) mm, while 71.8% were sellar/suprasellar and less frequently exclusively suprasellar (15.5%) or sellar (12.7%). On T1-weighted imaging, XG was hyperintense in 76.3% of patients, while it showed variable appearance on T2-weighted imaging. The tumor showed cystic features in 50.7%, gadolinium enhancement in 45.1%, and calcification in 22.5% of patients. All patients underwent surgery (77.4% transphenoidal approach and 18.3% craniotomy), with hypopituitarism (56.4%), diabetes insipidus (34.5%), and visual defects (7.3%) being the most common complications. Total/subtotal resection was achieved in 93.5%, while the tumor was partially removed in 6.6%. Median follow-up was 24 (6-55) months and no tumor recurrence or remnant growth was reported in 97.5% of cases. In conclusion, XG affects the younger population, manifested by hormonal deficit and mass effect symptoms. Surgery is safe and offers excellent outcomes, though hypopituitarism is frequent post-surgery. Tumor recurrence or remnant growth is rare and radiological surveillance is a good option for patients with remnant lesions.
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Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology, Bellvitge University Hospital-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | | | - Nuria Vilarrasa
- Department of Endocrinology, Bellvitge University Hospital-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
| | - Noemi Vidal
- Department of Pathology, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Neuro-Oncology Unit-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Ruiz-Roig
- Department of Pathology, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan José Sánchez-Fernández
- Institut de Diagnòstic per la Imatge, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Torres-Díaz
- Department of Neurosurgery, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Sanmillán
- Department of Neurosurgery, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Pérez-Maraver
- Department of Endocrinology, Bellvitge University Hospital-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
| | - Carles Villabona
- Department of Endocrinology, Bellvitge University Hospital-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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Xanthogranuloma of the Sellar Region: A Comprehensive Review of Neuroimaging in a Rare Inflammatory Entity. J Pers Med 2022; 12:jpm12060943. [PMID: 35743728 PMCID: PMC9225214 DOI: 10.3390/jpm12060943] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 11/17/2022] Open
Abstract
Xanthogranuloma of the sellar region is a rare chronic inflammatory lesion resulting from secondary hemorrhage, inflammation, infarction, and necrosis of an existing Rathke’s cleft cyst, craniopharyngioma, or pituitary adenoma. Sellar xanthogranulomas are challenging to differentiate from other cystic lesions preoperatively due to the lack of characteristic imaging features. We performed a literature overview of the clinical and paraclinical features, treatment options, and long-term outcomes of patients with sellar xanthogranuloma, focusing on the preoperative radiological diagnosis. The hyperintense signal in both T1- and T2-weighted sequences, cystic or partially cystic morphology, ovoid shape, sellar epicenter, intra- and suprasellar location, intratumoral calcifications, linear rim contrast enhancement, and the absence of cavernous sinus invasion suggest xanthogranuloma in the preoperative differential diagnosis. An endoscopic endonasal gross total resection without radiotherapy is the preferred first-line treatment. Given the low rate of recurrence rate and low chance of endocrinological recovery, a mass reduction with decompression of the optic apparatus may represent an appropriate surgical goal. Identifying the xanthogranulomas’ mutational profile could complement histopathological diagnosis and give insight into their histo-pathogenesis. A better preoperative neuroimagistic diagnosis of sellar xanthogranulomas and differentiation from lesions with a poorer prognosis, such as craniopharyngioma, would result in an optimal personalized surgical approach.
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Alharbi A, Alkhaibary A, Alaglan A, Khairy S, Alkhunaizi Z, AlSufiani F, Alassiri AH, Alkhani A. Sellar xanthogranuloma: A diagnostic challenge. Surg Neurol Int 2022; 13:76. [PMID: 35399894 PMCID: PMC8986709 DOI: 10.25259/sni_1180_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/12/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Sellar xanthogranulomas are rare intracranial lesions comprising <1% of all sellar lesions. They were described as a separate entity by the World Health Organization in 2000. Because of the paucity of sellar xanthogranuloma cases reported in the literature, they remain a diagnostic challenge with indefinite origin, clinical course, and outcome. The present study reports a case of sellar xanthogranuloma describing the clinical presentation, radiological/pathological characteristics, and outcome.
Case Description:
A 43-year-old female, known to have diabetes, hypothyroidism, and polycystic ovarian syndrome, presented with a 2-week history of sudden right-sided facial deviation, periorbital pain, and moderate-intensity headache. The patient also reported amenorrhea not improving with polycystic ovarian syndrome treatment. Neurologic examination showed bilateral visual field defects and impaired visual acuity. Computed tomography scan, without contrast, revealed a hypodense sellar lesion with areas of hyperdensity. Magnetic resonance imaging showed a well-defined sellar lesion, exhibiting high signals on T1-weighted and T2-weighted images. The patient underwent microscopic trans-nasal trans-sphenoidal excision of the lesion. Histological sections of the sellar lesion revealed fibrous connective tissue with chronic inflammatory cells and cholesterol clefts, suggestive of xanthogranuloma. The patient is currently followed up at neurosurgery, endocrinology, and ophthalmology clinics with periodic laboratory/radiological investigations.
Conclusion:
Sellar xanthogranulomas remain rare intracranial lesions with few cases reported in the literature. Patients mostly present with severe hypopituitarism and visual dysfunction. They show no characteristic radiological features. The diagnosis is confirmed histopathologically, and the prognosis is generally favorable.
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Affiliation(s)
- Ahoud Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ali Alkhaibary
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Abeer Alaglan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Sami Khairy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Zahra Alkhunaizi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Fahd AlSufiani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ali H. Alassiri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Alkhani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Fernández-Gallego A, Del-Pozo J, Boag A, Maxwell S, Pérez-Acino J. Xanthogranulomatous Pituitary Adenoma in a Dog with Typical Hyperadrenocorticism. J Comp Pathol 2020; 180:115-121. [PMID: 33222868 DOI: 10.1016/j.jcpa.2020.09.006] [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: 04/27/2020] [Revised: 07/16/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022]
Abstract
Xanthogranuloma of the sellar region has been reported in both humans and animals. The lesion is rare, and its aetiology and pathogenesis are not fully understood. The association of sellar xanthogranuloma with an adenoma, known as xanthogranulomatous pituitary adenoma (XPA), is an extremely rare condition in humans and is usually associated with anterior pituitary insufficiencies, headache, vomiting and visual deficits. We present the first report of XPA in an animal. A 7-year-old male neutered Labrador Retriever was presented for investigation of progressive lethargy, vomiting and hyporexia, having been previously diagnosed with chronic kidney disease, pituitary-dependent hyperadrenocorticism and hypoparathyroidism. The dog was euthanized due to lack of response to medical treatment and post-mortem examination revealed XPA. Although rare, xanthogranulomatous lesions should be considered in patients with pituitary disease.
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Affiliation(s)
- Ana Fernández-Gallego
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, UK.
| | - Jorge Del-Pozo
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Alisdair Boag
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Scott Maxwell
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Jorge Pérez-Acino
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, UK
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Abstract
RATIONALE Xanthogranuloma of the sellar region is exceedingly rare, and described in only a handful of case reports. Herein, we present a case of xanthogranuloma of the sellar region to improve our knowledge for the diagnosis and management of this unusual disease. PATIENT CONCERNS A 50-year-old female presented with the symptoms of intermittent vomiting, occasional head discomfort, and diabetes insipidus of 1 month duration. DIAGNOSES Magnetic resonance imaging showed a large well-defined, vase-like, heterogeneous mass in the sellar region. The lesion showed mixed signal with hierarchical signal presentation. Fluid-fluid level sign can be found within the lesion. The upper part of the lesion was hyperintense, and the lower part was hypointense on both T1-weighted images and T2-weighted images. The lesion showed no enhancement following the intravenous administration of gadolinium. The normal pituitary tissue was not clearly visible. Optic chiasm was compressed and displaced by the lesion. Initial diagnosis of pituitary macroadenoma with hemorrhage in the sellar region was made before surgery. Final diagnosis of sellar xanthogranuloma was confirmed by histopathological examination after surgical resection. INTERVENTIONS Gross total resection of the lesion was achieved using the microscope through endonasal transsphenoidal approach. OUTCOMES The patient recovered well with improved binocular vision and no symptom of diabetes insipidus, and was discharged 5 days after operation. LESSONS Sellar xanthogranuloma should receive diagnostic consideration for the lesion that is a heterogeneously mixed mass with a degree of T1-weighted images hyperintense in the sellar region.
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Pilonieta M, Martin M, Revuelta Barbero JM, Hardesty DA, Carrau RL, Otto BA, Otero J, Ghalib L, Prevedello DM. Sellar Cholesterol Granuloma Mimicking Cystic Sellar Lesions: A Report of Three Cases and Literature Review. World Neurosurg 2020; 144:250-255. [PMID: 32781144 DOI: 10.1016/j.wneu.2020.07.234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cystic lesions in the sellar region include a variety of entities, such as craniopharyngioma, Rathke cleft cyst (RCC), intrasellar arachnoid cyst, cystic pituitary adenomas, cholesterol granulomas (CGs), and xanthogranulomas (XGs). The distinction among them remains a preoperative challenge due to similarities in their clinical and radiologic findings. CASE DESCRIPTION We describe 3 cases with cystic sellar lesions. The first patient is a woman who presented with headache and hormonal disturbances, including high levels of prolactin, with a sellar and suprasellar cystic lesion discovered on magnetic resonance imaging. She was initially treated with dopamine agonists with normalization of prolactin levels but no changes on the size of the lesion. She underwent an endoscopic endonasal resection and the histology resulted in a CG/XG. The second patient is a woman who consulted for an incidentally discovered sellar cyst. During the follow-up, the lesion demonstrated enlargement with compression of the optic chiasm. With a preoperative diagnosis of RCC, the lesion was removed through an endoscopic endonasal transsellar approach. Final pathologic diagnosis was consistent with CG/XG. The third case was that of a man who presented with refractory headaches and vision loss, with a sellar/suprasellar cystic lesion on magnetic resonance imaging. He underwent endoscopic endonasal transsellar surgery for resection of what preoperatively was thought to be a giant RCC; final pathology again was consistent with CG/XG. CONCLUSIONS CG/XG is an uncommon pathology with unspecific clinical and radiologic features. However, this pathology should be considered in the differential diagnosis of mixed cystic/solid lesions in the sellar region.
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Affiliation(s)
- Martin Pilonieta
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Monica Martin
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Juan M Revuelta Barbero
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Douglas A Hardesty
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Bradley A Otto
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Jose Otero
- Department of Pathology, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Luma Ghalib
- Department of Endocrinology, Diabetes, and Metabolism, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.
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Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
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Fujio S, Takajo T, Kinoshita Y, Hanaya R, Arimura H, Sugata J, Sugata S, Bohara M, Hiraki T, Yoshimoto K, Arita K. Sellar Xanthogranuloma: A Quest Based on Nine Cases Assessed with an Anterior Pituitary Provocation Test. World Neurosurg 2019; 130:e150-e159. [DOI: 10.1016/j.wneu.2019.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
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Vasquez CA, Downes A, Kleinschmidt-DeMasters BK, Youssef AS. Functioning Pituitary Adenoma with Xanthogranulomatous Features: Review of Literature and Case Report. J Neurol Surg B Skull Base 2019; 80:449-457. [PMID: 31534885 DOI: 10.1055/s-0038-1675232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022] Open
Abstract
Objectives We present a patient with a prolactin-secreting adenoma with extensive secondary, noninfectious, xanthogranulomatous changes due to remote intratumoral bleeding and provide a literature review of xanthogranulomas (XGs) of the sellar region with emphasis on prolactinomas with xanthogranulomatous features. Design Case report, with PubMed search of cases of sellar XG, focusing on neuroimaging and surgical approach. Results A 35-year-old male was found to have a large sellar/suprasellar calcified/cystic mass. Endoscopic transsphenoidal approach for extradural resection was performed and diagnosis made. Review generated 31 patients with the diagnosis of sellar XG. In a minority (6 patients), the underlying lesion for the XG was a pituitary adenoma. Headache was the most common presenting symptom and panhypopituitarism the most common endocrinological abnormality. Examples of hyperprolactinemia associated with sellar XG are also uncommon and due to stalk effect. Neuroimaging of XG on T1-weighted magnetic resonance imaging (MRIs) showed 18 cases (56.3%) were hyperintense, 1 case (3.13%) was isointense, 4 (12.5%) had mixed-signal intensity, and 2 (6.25%) were hypointense. On T2-weighted MRIs, five lesions (15.6%) were hyperintense, three (9.38%) were isointense, nine (28.1%) were heterogeneous, and nine (28.1%) were hypointense. Only one case (3.1%) had calcifications on computed tomography scan similar to ours. In 14 cases (43.7%), the lesions enhanced with contrast administration on MRI. Conclusion Prolactinomas with secondary xanthogranulomatous change represent a rare cause of XG of the sella. With no radiological or clinical signs specific for XG of the sellar region, preoperative diagnosis can be challenging, if not impossible.
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Affiliation(s)
| | - Angela Downes
- University of Colorado, Aurora, Colorado, United States
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12
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La Rocca G, Rigante M, Gessi M, D'Alessandris QG, Auricchio AM, Chiloiro S, De Marinis L, Lauretti L. Xanthogranuloma of the sellar region: A rare tumor. Case illustration and literature review. J Clin Neurosci 2019; 59:318-324. [DOI: 10.1016/j.jocn.2018.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022]
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13
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Cho SM, Cho HR, Park YS, Chang HG. Giant Sellar Xanthogranuloma after Surgical Treatment of Symptomatic Rathke's Cleft Cyst. Brain Tumor Res Treat 2018; 6:82-85. [PMID: 30381922 PMCID: PMC6212686 DOI: 10.14791/btrt.2018.6.e10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/10/2018] [Accepted: 09/18/2018] [Indexed: 11/20/2022] Open
Abstract
Extremely massive sellar xanthogranuloma (XG) are rare, and the surgical outcome and prognosis are not well known. XG remain unknown whether they are derived from Rathke's cleft cysts (RCCs) or craniopharyngiomas (CPs) following extensive inflammation and metaplasia, to the point that no epithelium is readily identifiable. These lesions usually tend to occur in younger patients (mean 28.3 years), have a smaller diameter, and remain primarily intrasellar region with infrequent calcification. This 36-year-old man presented our hospital with visual deterioration. At the time of visit, there were no neurological problems other than visual field defect and hormonal disorder. He visited our hospital in 2007 due to headache and decreased vision, and underwent transphenoid surgery for pituitary RCC. Since then, he has received treatment at our hospital for postoperative hormonal disorders. Through preoperative imaging study, the author suspected CP and underwent surgery. During the operation, the adhesion of the tumor to the surrounding major neurovascular structures was severe in the naked eyes, but the tumor could be removed more easily than expected. The postoperative histological findings were confirmed as XG. The postoperative course was uneventful. Compared to the previous literature, this case is a case where the size of XG is very large in a sellar region and it can be proved that it originated from the RCC. And regular follow-up is necessary to confirm the prognosis after surgery.
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Affiliation(s)
- Sung Min Cho
- Department of Neurosurgery, Kosin University Gospel Hospital, Busan, Korea
| | - Hyok Rae Cho
- Department of Neurosurgery, Kosin University Gospel Hospital, Busan, Korea.
| | - Yong Seok Park
- Department of Neurosurgery, Kosin University Gospel Hospital, Busan, Korea
| | - Hee Gyeong Chang
- Department of Pathology, Kosin University Gospel Hospital, Busan, Korea
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14
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Ved R, Logier N, Leach P, Davies JS, Hayhurst C. Pituitary xanthogranulomas: clinical features, radiological appearances and post-operative outcomes. Pituitary 2018; 21:256-265. [PMID: 29363000 PMCID: PMC5942345 DOI: 10.1007/s11102-017-0859-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Xanthogranulomas are inflammatory masses most commonly found at peripheral sites such as the skin. Sellar and parasellar xanthogranulomas are rare and present a diagnostic challenge as they are difficult to differentiate from other sellar lesions such as craniopharyngiomas and Rathke's cleft cysts pre-operatively. Their radiological imaging features are yet to be clearly defined, and clinical outcomes after surgery are also uncertain. This study reviews clinical presentation, radiological appearances, and clinical outcomes in a cohort of patients with pituitary xanthogranulomas. METHODS A prospectively maintained pituitary surgery database was screened for histologically confirmed pituitary xanthogranulomas between May 2011-December 2016. Retrospective case note assessments were then performed by three independent reviewers. Patient demographics, clinical presentations, imaging, and clinical outcomes were analysed. RESULTS During the study period 295 endoscopic endonasal pituitary surgeries were performed. Six patients had confirmed pituitary xanthogranulomas (2%). Patients most commonly presented with visual field deficits and/or endocrine dysfunction. Common imaging features included: a cystic consistency, hyperintensity on T1-weighted MR images, and contrast enhancement either peripherally (n = 3) or homogenously (n = 3). The most common pre-operative endocrine deficits were hyperprolactinaemia and hypoadrenalism (at least one of which was identified in 4/6 patients; 66%). Thirty-three percent (2/6) of patients presented with diabetes insipidus. The most common post-operative endocrinological deficits were adrenocortical dysfunction (66%) and gonadotropin deficiency (66%). Visual assessments normalised in all six patients post-operatively. Gross total resection was achieved in all patients, and at median follow up of 33.5 months there were no cases of tumour recurrence. CONCLUSIONS The prevalence of pituitary xanthogranulomas in our series is higher than that suggested in the literature. Surgery restored normal vision to all cases, however four patients (67%) required long-term hormonal replacement post-operatively. Imaging features such peripheral rim enhancement, a suprasellar tumour epicentre, and the absence of both calcification or cavernous sinus invasion were identified as potential indicators that together should alert clinicians to the possibility of pituitary xanthogranuloma when assessing patients with cystic sellar and parasellar tumours.
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Affiliation(s)
- R Ved
- B4 Office, Department of Neurosurgery, University Hospital of Wales, Cardiff, CF 14 4XW, UK.
| | - N Logier
- B4 Office, Department of Neurosurgery, University Hospital of Wales, Cardiff, CF 14 4XW, UK
| | - P Leach
- B4 Office, Department of Neurosurgery, University Hospital of Wales, Cardiff, CF 14 4XW, UK
| | - J S Davies
- Department of Endocrinology, University Hospital of Wales, Cardiff, CF 14 4XW, UK
| | - C Hayhurst
- B4 Office, Department of Neurosurgery, University Hospital of Wales, Cardiff, CF 14 4XW, UK
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15
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Pediatric Case of Xanthogranuloma in the Sellar Region Presenting a Visual Disturbance Successfully Treated with Endoscopic Endonasal Surgery. World Neurosurg 2018. [PMID: 29524707 DOI: 10.1016/j.wneu.2018.02.155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Xanthomatous pituitary diseases rarely occur in childhood. We report a rare pediatric case of a xanthogranuloma that developed in the sellar region, resulting in a visual disturbance that was treated successfully with endoscopic endonasal surgery. CASE DESCRIPTION A 13-year-old boy came to us with a headache and visual disturbance that occurred 1 month prior. Clinical examination findings showed that he was alert with signs of bitemporal hemianopsia. An endocrinologic examination showed partial hypopituitarism, and brain magnetic resonance imaging revealed a cystic mass in the sellar turcica compressing the optic apparatus. Endoscopic endonasal surgery was performed to decompress the optic apparatus, and the mass was removed. Histopathologic analysis of the tumor demonstrated granulomatous tissue with cholesterol clefts, foamy macrophages, and multinucleated giant cells, with no epithelial component. The diagnosis was xanthogranuloma of the sellar region. The patient gradually recovered from the visual disturbance and was free from any neurologic signs or symptoms 6 months after surgery. CONCLUSIONS Xanthogranuloma, although rare, should be considered as a differential diagnosis of a sellar or suprasellar lesion, even in children.
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Hernández-Estrada RA, Kshettry VR, Vogel AN, Curtis MT, Evans JJ. Cholesterol granulomas presenting as sellar masses: a similar, but clinically distinct entity from craniopharyngioma and Rathke's cleft cyst. Pituitary 2017; 20:325-332. [PMID: 27837386 DOI: 10.1007/s11102-016-0775-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Cholesterol granulomas in the sella are rare and can mimic the appearance of craniopharyngioma or Rathke's cleft cysts. Information regarding the clinical presentation, imaging characteristics, and clinical course of sellar cholesterol granulomas can help clinicians to differentiate these lesions from other sellar cystic lesions. METHODS We present three cases of sellar cholesterol granulomas. A literature review was performed for all cases of sellar cholesterol granulomas with individual patient data reported. RESULTS We identified 24 previously reported cases in addition to our three cases. Mean age was 36.6 years (range 5-68). There were 16 (59%) females. The most common (74%) presenting symptom was endocrinological deficits, typically either isolated diabetes insipidus (DI) or panhypopituitarism. Location was intrasellar in 3 (11%), suprasellar in 6 (22%), and intrasellar/suprasellar in 18 (67%) patients. Lesions were most commonly (83%) T1 hyperintense. Gross total resection was achieved in 16 (64%) and subtotal resection in 9 (36%) patients. Of the seventeen (63%) patients presenting with varying degrees of bitemporal hemianopsia, all had improvement in vision postoperatively. It is worth noting that no cases of preoperative hypopituitarism or DI improved postoperatively. Even though gross total resection was only achieved in 64%, there was only one recurrence reported. CONCLUSION Sellar cholesterol granulomas are characterized by T1 hyperintensity, younger age, and more frequent and severe endocrinological deficits on presentation. Our review demonstrates high rates of improvement of visual deficits, but poor rates of endocrine function recovery. Recurrence is uncommon even in cases of subtotal resection.
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Affiliation(s)
- Raúl A Hernández-Estrada
- Department of Neurosurgery, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA, 19107, USA
- Department of Neurosurgery, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Dominguez 1000, Independencia Oriented, 44340, Guadalajara, Jal., Mexico
| | - Varun R Kshettry
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH, 44195, USA.
| | - Ashley N Vogel
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, 132 10th Street, Main Building Suite 262, Philadelphia, PA, 19107, USA
| | - Mark T Curtis
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, 132 10th Street, Main Building Suite 262, Philadelphia, PA, 19107, USA
| | - James J Evans
- Department of Neurosurgery, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA, 19107, USA
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17
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Kleinschmidt-DeMasters BK, Lillehei KO, Hankinson TC. Review of xanthomatous lesions of the sella. Brain Pathol 2017; 27:377-395. [PMID: 28236350 DOI: 10.1111/bpa.12498] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 12/28/2022] Open
Abstract
Xanthomatous lesions of the sellar region have traditionally been divided into two separate categories, xanthomatous hypophysitis (XH) and xanthogranuloma (XG) of the sellar region. The seminal article on XH, a condition typified by foamy histiocytes and lymphoplasmacytic infiltrates in the pituitary gland/sellar region, but usually little or no hemosiderin pigment, detailed three patients. However, most reports since that time have been single cases, making understanding of the entity difficult. In contrast, the seminal report on XG, characterized by sellar region cholesterol clefts, lymphoplasmacytic infiltrates, marked hemosiderin deposits, fibrosis, multinucleated giant cells around cholesterol clefts, eosinophilic granular necrotic debris, and accumulation of macrophages, included 37 patients, allowing more insights into etiology. Few examples could be linked to adamantinomatous craniopharyngioma, and although ciliated epithelium similar to that of Rathke cleft cyst (RCC) was identified up to 35% of the 37 cases, it could not be proven that XG was related to hemorrhage into RCC. Case reports since that time, however, occasionally linked XG to RCC when an etiology could be identified at all, and a few recognized that a spectrum exists in xanthomatous lesions of the sella. They review literature, adding 23 cases from our own experience, to confirm that overlap occurs between XH and XG, and that the majority-but not all-can be linked to RCC leakage/rupture/hemorrhage. It was suggested that progressive accumulation of hemosiderin pigment in the lesion, possibly caused by the multiple episodes of bleeding, could account for the transition of at least some cases of XH to XG.
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Affiliation(s)
- B K Kleinschmidt-DeMasters
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kevin O Lillehei
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO.,Morgan Adams Foundation Pediatric Brian Tumor Research Program
| | - Todd C Hankinson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO
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Céspedes MT, Vargas JP, Yañez FA, León LS, Arancibia PÁ, Putz TS. Remarkable Diagnostic Magnetic Resonance Imaging Findings in Sellar Xanthogranuloma: Report of Three First Cases in Latin America. J Neurol Surg Rep 2017; 78:e26-e33. [PMID: 28286725 PMCID: PMC5344796 DOI: 10.1055/s-0037-1598203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The sellar xanthogranuloma is a rare lesion of the sellar–parasellar region difficult to differentiate from other tumors such as craniopharyngiomas or Rathke's cleft cyst in the preoperative evaluation. As they are recently recognized as a separate entity and the few number of reports in the literature, its etiology is unknown and its impact remains uncertain. This article will describe the first three cases reported in Latin America, identified in one of them an imaging feature that may be helpful to elucidate an imaging growth pattern. Current evidence will be described regarding to the clinicopathological features, imaging diagnosis, and etiology origin theories.
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Affiliation(s)
- Mario Tapia Céspedes
- Department of Otorhinolaryngology - Head and Neck Surgery, Regional Hospital of Concepción, Concepción, Chile
| | - Jaime Pinto Vargas
- Department of Neurosurgery, Regional Hospital of Concepción, Concepción, Chile
| | | | | | | | - Thomas Schmidt Putz
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Concepción, Chile
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19
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Clinicoradiologic Features and Surgical Outcomes of Sellar Xanthogranulomas: A Single-Center 10-Year Experience. World Neurosurg 2017; 99:439-447. [DOI: 10.1016/j.wneu.2016.12.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/04/2016] [Accepted: 12/05/2016] [Indexed: 11/23/2022]
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20
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Bao SS, Rapp R. Xanthogranuloma as an unsuspected cause of idiopathic central diabetes insipidus. Endocr Pract 2016; 20:e42-6. [PMID: 24246337 DOI: 10.4158/ep13116.cr] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To demonstrate that xanthogranuloma is a rare cause of idiopathic central diabetes insipidus in the early phase of the disease and that it presents as a suprasellar mass at a later stage. In addition, we emphasize the importance of identifying the cause of idiopathic central diabetes insipidus and review the literature concerning endocrine disturbance in central xanthogranuloma. METHODS Review of recently published case reports of central xanthogranuloma with endocrine disorders. The case of a 35-year-old man who presented with a very large suprasellar mass is also reported. The patient was diagnosed with idiopathic central diabetes insipidus 20 years ago with normal brain magnetic resonance imaging. RESULTS Most cases of this disease present as supra- or parasellar masses with endocrine involvement, the most common of which (in approximately 75% of patients) is sex hormone deficiency. Diabetes insipidus was found in 65% of patients. CONCLUSION Xanthogranuloma should be in the differential diagnosis of idiopathic central diabetes insipidus and sellar and parasellar masses. A detailed skin examination is very important in making the diagnosis of central diabetes insipidus.
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Affiliation(s)
| | - Richard Rapp
- Little Rock Diagnostic Clinic, Little Rock, Arkansas
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21
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Chen Y, Hamilton AM, Parkins KM, Wang JX, Rogers KA, Zeineh MM, Rutt BK, Ronald JA. MRI and histopathologic study of a novel cholesterol-fed rabbit model of xanthogranuloma. J Magn Reson Imaging 2016; 44:673-82. [PMID: 26921220 DOI: 10.1002/jmri.25213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 02/10/2016] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To develop a rabbit model of xanthogranuloma based on supplementation of dietary cholesterol. The aim of this study was to analyze the xanthogranulomatous lesions using magnetic resonance imaging (MRI) and histological examination. MATERIALS AND METHODS Rabbits were fed a low-level cholesterol (CH) diet (n = 10) or normal chow (n = 5) for 24 months. In vivo brain imaging was performed on a 3T MR system using fast imaging employing steady state acquisition, susceptibility-weighted imaging, spoiled gradient recalled, T1 -weighted inversion recovery imaging and T1 relaxometry, PD-weighted and T2 -weighted spin-echo imaging and T2 relaxometry, iterative decomposition of water and fat with echo asymmetry and least-squares estimation, ultrashort TE MRI (UTE-MRI), and T2* relaxometry. MR images were evaluated using a Likert scale for lesion presence and quantitative analysis of lesion size, ventricular volume, and T1 , T2 , and T2* values of lesions was performed. After imaging, brain specimens were examined using histological methods. RESULTS In vivo MRI revealed that 6 of 10 CH-fed rabbits developed lesions in the choroid plexus. Region-of-interest analysis showed that for CH-fed rabbits the mean lesion volume was 8.5 ± 2.6 mm(3) and the volume of the lateral ventricle was significantly increased compared to controls (P < 0.01). The lesions showed significantly shorter mean T2 values (35 ± 12 msec, P < 0.001), longer mean T1 values (1581 ± 146 msec, P < 0.05), and shorter T2* values (22 ± 13 msec, P < 0.001) compared to adjacent brain structures. The ultrashort T2* components were visible using UTE-MRI. Histopathologic evaluation of lesions demonstrated features of human xanthogranuloma. CONCLUSION Rabbits fed a low-level CH diet develop sizable intraventricular masses that have similar histopathological features as human xanthogranuloma. Multiparametric MRI techniques were able to provide information about the complex composition of these lesions. J. Magn. Reson. Imaging 2016;44:673-682.
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Affiliation(s)
- Yuanxin Chen
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Amanda M Hamilton
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Katie M Parkins
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Jian-Xiong Wang
- Advanced Imaging Research Center and Radiology Department, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kem A Rogers
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Michael M Zeineh
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Brian K Rutt
- Department of Radiology, Stanford University, Stanford, California, USA
| | - John A Ronald
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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22
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Rahmani R, Sukumaran M, Donaldson AM, Akselrod O, Lavi E, Schwartz TH. Parasellar xanthogranulomas. J Neurosurg 2015; 122:812-7. [DOI: 10.3171/2014.12.jns14542] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Xanthogranulomas are rare inflammatory masses most often found in the skin and eye. The incidence of intracranial xanthogranulomas is 1.6%–7%, with those found in the sellar and parasellar region being exceedingly rare and their etiology controversial. Sellar and parasellar xanthogranulomas are rarely reported in the western hemisphere, and their incidence in Western countries is unknown.
METHODS
A prospectively acquired database of all endonasal endoscopic transsphenoidal surgeries performed at Weill Cornell Medical College was queried. Patients with histologically confirmed xanthogranulomas who were diagnosed and treated between 2003 and 2013 were included in the study. Patient history, demographic data, histological findings, and surgical approach were also evaluated.
RESULTS
A total of 643 endonasal endoscopic procedures had been performed at the time of this study. Four patients (0.6%) were identified as having a histologically confirmed xanthogranuloma of the parasellar region, compared with an incidence of 6.7% for craniopharyngioma (CP) and 2% for Rathke cleft cyst (RCC). The most common symptom was visual loss, followed by headache. Preoperative diagnosis was CP in all cases. All patients underwent extended endonasal endoscopic transsphenoidal surgery with gross-total resection. Two patients developed panhypopituitarism after surgery. There were no CSF leaks. The mean follow-up was 61 months, at which time there were no recurrences. The key histological features differentiating xanthogranulomas from CPs were accumulation of foamy macrophages, multinucleated foreign body giant cells, cholesterol clefts, and hemosiderin deposits without stratified squamous epithelium. These histological features appear commonly as part of the spectrum of a secondary inflammatory response in an RCC.
CONCLUSIONS
Parasellar xanthogranulomas most closely approximate CPs clinically but pathological evidence may suggest an RCC origin. Gross-total resection can be achieved through extended endonasal endoscopic transsphenoidal approaches, and is curative.
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Affiliation(s)
- Redi Rahmani
- 1Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Madhav Sukumaran
- 2Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Angela M. Donaldson
- 6Otolaryngology–Head and Neck Surgery, Weill Cornell Medical College, New York, New York
| | | | | | - Theodore H. Schwartz
- Departments of 3Neurological Surgery,
- 5Neuroscience, and
- 6Otolaryngology–Head and Neck Surgery, Weill Cornell Medical College, New York, New York
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Amano K, Kubo O, Komori T, Tanaka M, Kawamata T, Hori T, Okada Y. Clinicopathological features of sellar region xanthogranuloma: correlation with Rathke’s cleft cyst. Brain Tumor Pathol 2013; 30:233-41. [DOI: 10.1007/s10014-012-0130-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/20/2012] [Indexed: 11/28/2022]
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