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Bajagain M, Fujio S, Kirishima M, Yatsushiro K, Hanaya R. Gamma Knife Radiosurgery: An Adjuvant Therapy for Primary Sellar Paraganglioma. Cureus 2024; 16:e56228. [PMID: 38618302 PMCID: PMC11016284 DOI: 10.7759/cureus.56228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Sellar paraganglioma (SP) is a rare benign tumor, usually treated by surgery. SPs are lobulated, firm, adherent, and highly vascular, allowing mostly partial resection. We present the case of a 52-year-old man diagnosed with primary SP, treated with a transcranial-transsphenoidal (TC-TS) surgical approach, followed by adjuvant Gamma Knife stereotactic radiosurgery (GKSR). The tumor has an extra-pituitary origin, with a sellar-suprasellar, right cavernous sinus extension that encroached the bilateral optic nerve and anterior cerebral artery. Histopathology confirmed SP with a Zellballen pattern. Despite postoperative tumor growth observed at four and 10 months, a stable residual tumor was noted at a follow-up two years after GKSR. SP is diagnosed mainly in middle age or in adolescent males. The TC-TS approach offers a bidirectional view that allows greater resection by minimizing blind spots, thus reducing complications. Similar to the paragangliomas of other sites, the efficacy of GKSR was observed for primary SP. SP is a rare differential diagnosis of pituitary diseases; however, it should be considered. After surgical resection of primary SP, GKSR is observed as an effective adjuvant therapy.
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Affiliation(s)
- Madan Bajagain
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, JPN
| | - Shingo Fujio
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, JPN
| | - Mari Kirishima
- Department of Pathology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, JPN
| | | | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, JPN
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Wang Y, Yang X, Ma Q, Nicholas VHL, Sun J, Zhao X, Liu W, Yang C. Case Report: Paraganglioma in the sellar region: longitudinal observation and surgical outcome. Front Oncol 2023; 13:1090615. [PMID: 37287917 PMCID: PMC10242979 DOI: 10.3389/fonc.2023.1090615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 05/05/2023] [Indexed: 06/09/2023] Open
Abstract
Background Paraganglioma in the sellar region is an extremely rare entity, with a limited number of cases reported in the literature. Due to the paucity of clinical evidence, the diagnosis and treatment of paragangliomas in the sellar region remain challenging. Herein, we reported a case of sellar paraganglioma with parasellar and suprasellar extension. Particularly, the dynamic evolution of this benign tumor within a 7-year longitudinal observation was presented. Additionally, the relevant literature regarding sellar paraganglioma was comprehensively reviewed. Case description A 70-year-old woman presented with progressive visual deterioration and headache. Brain magnetic resonance imaging demonstrated a mass in the sellar region with parasellar and suprasellar extension. The patient refused surgical treatment. Seven years later, brain magnetic resonance imaging showed the lesion significantly progressed. Neurological examination revealed bilateral tubular contraction of visual fields. Laboratory examinations showed endocrine hormone levels were normal. Surgical decompression was performed via a subfrontal approach, and subtotal resection was achieved. Histopathological examination confirmed a diagnosis of paraganglioma. Postoperatively, she developed hydrocephalus, and ventriculoperitoneal shunting was performed. Eight months later, cranial CT showed no recurrence of the residual tumor, and the hydrocephalus had been relieved. Conclusion Paraganglioma occurring in the sellar region is rare, and the preoperative differential diagnosis is difficult. Owing to the infiltration to the cavernous sinus and internal carotid, complete surgical resection is usually impracticable. There has been no consensus regarding postoperative adjuvant radiochemotherapy for the tumor residue. In-situ recurrence and metastasis have been reported in the literature, and close follow-up is warranted.
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Affiliation(s)
- Yingjie Wang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
- Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing, China
| | - Xuan Yang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qianquan Ma
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
- Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing, China
| | | | - Jianjun Sun
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
- Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing, China
| | - Xiaofang Zhao
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
- Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing, China
| | - Weihai Liu
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
- Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing, China
| | - Chenlong Yang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
- Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing, China
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Vasoya P, Aryan S, Thakar S, Sivaraju L, Ghosal N, Hegde AS. Sellar-Suprasellar Paraganglioma: Report of 2 Cases and Review of Literature. World Neurosurg 2020; 140:293-300. [PMID: 32413561 DOI: 10.1016/j.wneu.2020.04.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intracranial paragangliomas are infrequent and those occurring in the sellar-suprasellar region are rare, with only 31 cases described in literature. CASE DESCRIPTION We describe 2 cases of sellar-suprasellar paragangliomas in the light of a literature review. The first patient was a 13-year-old boy who presented with an intensely enhancing lesion in the sellar-suprasellar region with multiple flow voids within. Resection of the lesion was limited to a biopsy in view of its hypervascular nature. A second attempt at resection following partial embolization of the lesion was also unsuccessful. The tumor showed progressive reduction in size following radiotherapy. The second case was a 20-year-old man who presented with a similar tumor in the same location. He also had a probable metastatic deposit in the foramen of Magendie. An attempted surgical resection of the suprasellar lesion was abandoned after a biopsy. The patient improved symptomatically after radiotherapy. CONCLUSIONS We report 2 cases of paraganglioma occurring in a rare location. Presence of flow voids within tumors in the sellar-suprasellar location should alert the surgeon to this entity. The hypervascular nature of these tumors may limit the extent of resection. In cases of inadequate tumor decompression, or if there is evidence of growth of residual tumor, radiotherapy can help to stabilize the disease.
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Affiliation(s)
- Pavan Vasoya
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Saritha Aryan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India.
| | - Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Nandita Ghosal
- Department of Pathology, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
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Singh S, Kumar A, Mehrotra A, Rao RN, Behari S. Nonsecretory Paraganglioma in Cavernous Sinus Masquerading as Meningioma. World Neurosurg 2019; 126:399-404. [PMID: 30831293 DOI: 10.1016/j.wneu.2019.02.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/08/2019] [Accepted: 02/09/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Paraganglioma in cavernous sinus is a rare entity often misdiagnosed as meningioma or schwannoma on radiology. The embryological origin, from cells of neural crest, does not explain the location per se. Because of its highly vascular nature and close proximity to the carotid artery, surgical excision is a challenge. We herein report the first case of cavernous sinus paraganglioma, without the characteristic "salt and pepper appearance," excised near completely by the subtemporal approach. CASE DESCRIPTION A 30-year-old woman without a history of any comorbid conditions, particularly hypertension, presented with a 6-month history of progressive headache and double vision. She exhibited upward gaze palsy and hypoesthesia over the right half of her face. There was no papilledema and proptosis. Radiologic imaging revealed an extra-axial T1-weighted isointense, T2-weighted hyperintense lesion with homogenous intense contrast uptake in right parasellar region encasing cavernous internal carotid artery. Furthermore, the tumor was extending along the superior orbital fissure. Suspecting a cavernous sinus meningioma, we performed near-total excision via a subtemporal approach. Postoperative recovery was uneventful, and patient was discharged on fifth postoperative day. The histopathology and immunohistochemistry were consistent with paraganglioma. The patient underwent adjuvant radiotherapy and is under our outpatient follow-up. CONCLUSIONS Paraganglioma must be considered in the differential diagnosis of parasellar tumors, even when secretory symptoms are absent. The radiologic findings are obscure, and it is difficult to differentiate it from more common tumors of this region such as meningioma, schwannoma, and pituitary adenoma. Surgical excision followed by radiotherapy is the mainstay of management.
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Affiliation(s)
- Suyash Singh
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
| | - Ram Naval Rao
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Tan CL, Pang YH, Lim KHC, Sein L, Codd PJ, McLendon RE. Two Extraordinary Sellar Neuronal Tumors: Literature Review and Comparison of Clinicopathologic Features. Am J Clin Pathol 2019; 151:241-254. [PMID: 30551183 DOI: 10.1093/ajcp/aqy155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives The list of tumors involving the pituitary gland has been expanded to include a variety of neuronal and paraneuronal tumors in the 2017 World Health Organization tumor classification of endocrine organs. All the entities included in this category are distinctly rare, with limited case reports in the literature. Methods We illustrate two extraordinary sellar tumors with neuronal differentiation: a sellar paraganglioma and a sellar neurocytoma, with thorough literature review and comparison of the clinicopathologic features of these entities. Results Both entities are exceptionally rare and tend to be misdiagnosed as pituitary adenoma preoperatively. Both entities demonstrate frequent clinical recurrence compared with pituitary adenoma, as well as the rare occurrence of metastatic disease. Conclusions In evaluating a sellar tumor with an uncommon morphology and neuroendocrine differentiation, an increased awareness of the unusual entities that may involve the sellar region and a judicious panel of immunohistochemical studies should improve the diagnosis.
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Affiliation(s)
- Char Loo Tan
- Department of Pathology, National University Health System, Singapore
| | - Yin Huei Pang
- Department of Pathology, National University Health System, Singapore
| | - Keith Hsiu Chin Lim
- Department of Radiation Oncology, National University Health System, Singapore
| | - Lwin Sein
- Neurosurgery, National University Health System, Singapore
| | - Patrick J Codd
- Department of Neurosurgery, Duke University Medical Center, Durham, NC
| | - Roger E McLendon
- Department of Pathology, Duke University Medical Center, Durham, NC
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Asa SL, Ezzat S, Mete O. The Diagnosis and Clinical Significance of Paragangliomas in Unusual Locations. J Clin Med 2018; 7:E280. [PMID: 30217041 PMCID: PMC6162705 DOI: 10.3390/jcm7090280] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022] Open
Abstract
Paragangliomas are neuroendocrine neoplasms, derived from paraganglia of the sympathetic and parasympathetic nervous systems. They are most commonly identified in the head and neck, being most frequent in the carotid body, followed by jugulotympanic paraganglia, vagal nerve and ganglion nodosum, as well as laryngeal paraganglia. Abdominal sites include the well-known urinary bladder tumors that originate in the Organ of Zuckerkandl. However, other unusual sites of origin include peri-adrenal, para-aortic, inter-aortocaval, and paracaval retroperitoneal sites, as well as tumors in organs where they may not be expected in the differential diagnosis of neuroendocrine neoplasms, such as thyroid, parathyroid, pituitary, gut, pancreas, liver, mesentery, lung, heart and mediastinum. The distinction of these lesions from epithelial neuroendocrine neoplasms is critical for several reasons. Firstly, the determination of clinical and biochemical features is different from that used for epithelial neuroendocrine tumors. Secondly, the genetic implications are different, since paragangliomas/pheochromocytomas have the highest rate of germline susceptibility at almost 40%. Finally, the characterization of metastatic disease is unique in these highly syndromic lesions. In this review, we summarize updated concepts by outlining the spectrum of anatomic locations of paragangliomas, the importance of morphology in establishing the correct diagnosis, the clinical implications for management, and the impact of genetics on the distinction between multifocal primary tumors compared with malignant disease.
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Affiliation(s)
- Sylvia L Asa
- Department of Pathology, University Health Network, Toronto, ON M5G 2C4, Canada.
- Endocrine Oncology Site, Princess Margaret Cancer Center, Toronto, ON M5G 2MG, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Shereen Ezzat
- Endocrine Oncology Site, Princess Margaret Cancer Center, Toronto, ON M5G 2MG, Canada.
- Department of Medicine, Division of Endocrinology, University Health Network, Toronto, ON M5G 2C4, Canada.
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Ozgur Mete
- Department of Pathology, University Health Network, Toronto, ON M5G 2C4, Canada.
- Endocrine Oncology Site, Princess Margaret Cancer Center, Toronto, ON M5G 2MG, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada.
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8
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Ruzevick J, Koh EK, Gonzalez-Cuyar LF, Cimino PJ, Moe K, Wright LA, Failor R, Ferreira M. Clival paragangliomas: a report of two cases involving the midline skull base and review of the literature. J Neurooncol 2017; 132:473-478. [PMID: 28299533 DOI: 10.1007/s11060-017-2396-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/26/2017] [Indexed: 11/28/2022]
Abstract
Head and neck paragangliomas are rare neuroendocrine tumors that arise from paraganglion cells of the parasympathetic nervous system. Paragangliomas arising from the midline skull base have only rarely been reported. Surgery is the mainstay of treatment and adjuvant radiation is often recommended. These tumors can rarely secrete metanephrines and normetanephrines which can complicate operative management. Here we present two cases of clival paragangliomas with unique clinical presentations and review the previous literature on skull base paragangliomas.
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Affiliation(s)
- Jacob Ruzevick
- Department of Neurological Surgery, The University of Washington, 908 Jefferson St, Seattle, WA, 98104, USA.
| | - Eun Kyung Koh
- Division of Endocrinology, The University of Washington, Seattle, WA, USA
| | - Luis F Gonzalez-Cuyar
- Division of Neuropathology, Department of Pathology, The University of Washington, Seattle, WA, USA
| | - Patrick J Cimino
- Division of Neuropathology, Department of Pathology, The University of Washington, Seattle, WA, USA
| | - Kristen Moe
- Department of Otolaryngology-Head and Neck Surgery, The University of Washington, Seattle, WA, USA
| | - Lorena A Wright
- Division of Endocrinology, The University of Washington, Seattle, WA, USA
| | - Richard Failor
- Division of Endocrinology, The University of Washington, Seattle, WA, USA
| | - Manuel Ferreira
- Department of Neurological Surgery, The University of Washington, 908 Jefferson St, Seattle, WA, 98104, USA
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9
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Chaudhry NS, Ahmad F, Blieden C, Morcos JJ. Suprasellar and sellar paraganglioma presenting as a nonfunctioning pituitary macroadenoma. J Clin Neurosci 2013; 20:1615-8. [PMID: 23876285 DOI: 10.1016/j.jocn.2013.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 02/09/2013] [Indexed: 10/26/2022]
Abstract
It is extremely rare for paragangliomas to be present in the brain. We present a 44-year-old man with a suprasellar-sellar paraganglioma encasing the internal carotid arteries. We review all such tumors reported in the literature and conclude that paraganglioma should be kept in the differential diagnosis of unusual suprasellar-sellar lesions.
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Affiliation(s)
- Nauman S Chaudhry
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace, D4-6, Miami, FL 33136, USA
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10
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Albert A, Ramirez JAR, Codere F, Petrecca K. Sellar paraganglioma: a unique route to a rare destination case report and literature review. Clin Neurol Neurosurg 2011; 113:675-7. [PMID: 21550714 DOI: 10.1016/j.clineuro.2011.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 03/21/2011] [Accepted: 04/03/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Paragangliomas of the sella are rare; 14 cases have been reported in the literature. We describe here the unique case of a sellar paraganglioma that extended into the orbit through the superior orbital fissure. We have also reviewed all reported cases of sellar paragangliomas to better define best management strategies. CLINICAL PRESENTATION A 63-year-old male presented with left eye proptosis and conjunctival vessel dilatation. INTERVENTION Resection of the intraorbital component of the tumor was accomplished using a transcranial-transorbital approach. CONCLUSION This is the first report of a sellar/parasellar paraganglioma extending into the orbit through the superior orbital fissure. While an appropriate treatment paradigm has not been established, a review of all previously reported cases suggests that radiotherapy is an important consideration.
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Prajsnar A, Balak N, Walter GF, Stan AC, Deinsberger W, Tapul L, Bayindir C. Recurrent paraganglioma of Meckel's cave: Case report and a review of anatomic origin of paragangliomas. Surg Neurol Int 2011; 2:45. [PMID: 21660268 PMCID: PMC3108444 DOI: 10.4103/2152-7806.79763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 03/22/2011] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Paragangliomas are rare, usually benign tumors of neural crest origin. They account for only 0.6% of all head and neck tumors. In the craniocervical area, they are more common in the carotid body and tympanico-jugular regions. To the authors' knowledge, a case of paraganglioma in Meckel's cave has not yet been reported in the medical literature. The pathogenesis and natural history of paragangliomas are still not well understood. We present a case of recurrent paraganglioma in Meckel's cave. CASE DESCRIPTION A 53-year-old woman was diagnosed with trigeminal neuralgia, dysesthesia and hypoesthesia on the left side of the face, hearing disturbance and a history of chronic, persistent temporal headaches. Magnetic resonance imaging (MRI) showed a lesion located in Meckel's cave on the left side, extending to the posterior cranial fossa and compressing the left cerebral peduncle. The lesion was first thought to be a recurrence of an atypical meningioma, as the pathologist described it in the tissue specimen resected 3 years earlier, and a decision for re-operation was made. A lateral suboccipital approach to the lesion was used under neuronavigational guidance. The tumor was removed, and histological examination proved the lesion to be a paraganglioma. Five months later, the follow-up MRI showed local regrowth, which required subsequent surgical intervention. CONCLUSIONS A paraganglioma in Meckel's cave is an uncommon tumor in this location. Although ectopic paragangliomas have been described in the literature, a paraganglioma atypically located in Meckel's cave makes a topographic correlation difficult, mainly because paraganglionic cells are usually not found in Meckel's cave. Another peculiarity of the case is the local recurrence of the tumor in a relatively short time despite an attempted, almost gross total resection.
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Affiliation(s)
- Anna Prajsnar
- Department of Neurosurgery, Klinikum Kassel, Kassel, Germany
| | - Naci Balak
- Goztepe Education and Research Hospital, Istanbul, Turkey
| | | | | | | | - Leyla Tapul
- Department of Histology, Istanbul Faculty of Medicine, University of Istanbul, Turkey
| | - Cicek Bayindir
- Department of Neuropathology, Istanbul Faculty of Medicine, University of Istanbul, Turkey
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Haresh KP, Prabhakar R, Anand Rajan KD, Sharma DN, Julka PK, Rath GK. A rare case of paraganglioma of the sella with bone metastases. Pituitary 2009; 12:276-9. [PMID: 18320326 DOI: 10.1007/s11102-008-0099-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sellar paragangliomas are very rare lesions with only 11 previous cases described in the literature. We present a further case of sellar paraganglioma. The patient is a 17-year-old man who developed headache, visual blurring, and diplopia. MRI showed a sellar lesion. Trans-nasal trans-sphenoid biopsy showed features of paraganglioma. He was treated by Stereotactic radiotherapy. Four months after treatment he developed bone metastases which was palliated by radiation, zoledronic acid, and chemotherapy. This is the first case of sellar paraganglioma showing metastases to bone.
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Affiliation(s)
- K P Haresh
- Department of Radiotherapy and Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.
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Abstract
Paragangliomas are neuroendocrine tumors of paraganglionic tissue which are extremely rare in the sellar area. We present a case of sellar paraganglioma with parasellar and suprasellar extension in a 70-year-old man who presented with headache. CT demonstrated sellar mass with suprasellar and right parasellar extension. The lesion was removed subtotally via a trans-sphenoidal approach. Histopathological diagnosis was paraganglioma. Differential diagnosis between paragangliomas and unusual types of pituitary adenomas, especially null-cell adenomas, is made by presence of cell nests (Zellballen) in paraganglioma, lack of immunopositivity for pituitary hormones, cytoplasmic immunopositivity for chromogranin A and neuron-specific enolase, and immunonegativity for cytokeratin 19, cytokeratin 20 and endomysial antibody. In the case of a mass in the sellar region, paraganglioma, although rare, should be included in the differential diagnosis.
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Affiliation(s)
- Unal Ozüm
- Department of Neurosurgery, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
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14
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Powell M. Chapter 10 Disorders of the Sella and Parasellar Region. Neuroophthalmology 2008. [DOI: 10.1016/s1877-184x(09)70040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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15
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Peltier J, Fichten A, Lefranc M, Grunewald P, Thelu F, Toussaint P, Desenclos C, Le Gars D. Paragangliome du sinus caverneux. À propos d'un cas. Neurochirurgie 2007; 53:391-4. [PMID: 17707867 DOI: 10.1016/j.neuchi.2007.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 06/25/2007] [Indexed: 10/28/2022]
Abstract
A case of paraganglioma arising from the cavernous area is presented. A 51-year-old woman presented with a parasellar mass causing decreased visual acuity, oculomotor nerve paresis and retro-orbital headaches without endocrinological dysfunction. Diagnosis was confirmed by histological appearance and electron microscopy. The patient was treated with surgery followed by radiation therapy consisting of 45 Gy. The clinicopathological features and the possible pathogenesis are discussed.
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Affiliation(s)
- J Peltier
- Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens, Place Victor-Pauchet, 80054 Amiens Cedex 01, France.
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16
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Boari N, Losa M, Mortini P, Snider S, Terreni MR, Giovanelli M. Intrasellar paraganglioma: a case report and review of the literature. Acta Neurochir (Wien) 2006; 148:1311-4; discussion 1314. [PMID: 17039304 DOI: 10.1007/s00701-006-0895-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 08/03/2006] [Indexed: 10/24/2022]
Abstract
Intrasellar paragangliomas are very rare lesions with only six previous cases described in the literature. We present a further case of intrasellar paraganglioma. The patient was a 52 yr-old man who developed two transient ischemic attacks. A CT scan showed an intra- and supra-sellar expanding lesion, which was regarded as a possible non-functioning pituitary macro-adenoma. Removal of the lesion was accomplished by transsphenoidal surgery. Histological examination was diagnostic of a paraganglioma. We review the literature and discuss pathological features and possible pathogenesis of sellar and parasellar paragangliomas, underlining the necessity to consider paraganglioma in the differential diagnosis of sellar lesions.
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Affiliation(s)
- N Boari
- Department of Neurosurgery, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy.
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17
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Vajtai I, Sahli R, Kappeler A, Christ ER, Seiler RW. Leiomyomatoid angiomatous neuroendocrine tumor (LANT) of the pituitary: a distinctive biphasic neoplasm with primitive secretory phenotype and smooth muscle-rich stroma. Acta Neuropathol 2006; 111:278-83. [PMID: 16520966 DOI: 10.1007/s00401-006-0051-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 01/24/2006] [Indexed: 10/24/2022]
Abstract
We describe a hitherto undocumented variant of dimorphic pituitary neoplasm composed of an admixture of neurosecretory cells and profuse leiomyomatous stroma around intratumoral vessels. Radiologically perceived as a macroadenoma of 3.8 cm in diameter, this pituitary mass developed in an otherwise healthy 43-year-old female. At the term of a yearlong history of amenorrhea and progressive bitemporal visual loss, subtotal resection was performed via transsphenoidal microsurgery. Discounting mild hyperprolactinemia, there was no evidence of excess hormone production. Histologically, solid sheets, nests and cords of epithelial-looking, yet cytokeratin-negative cells were seen growing in a richly vascularized stroma of spindle cells. While strong immunoreactivity for NCAM, Synaptophysin and Chromogranin-A was detected in the former, the latter showed both morphological and immunophenotypic hallmarks of smooth muscle, being positive for vimentin, muscle actin and smooth muscle actin. Architectural patterns varied from monomorphous stroma-dominant zones through biphasic neuroendocrine-leiomyomatous areas, to pseudopapillary fronds along vascular cores. Only endothelia were labeled with CD34. Staining for S100 protein and GFAP, characteristics of sustentacular cells, as well as bcl-2 and c-kit was absent. Except for alpha-subunit, anterior pituitary hormones tested negative in tumor cells, as did a panel of peripheral endocrine markers, including serotonin, somatostatin, calcitonin, parathormone and vasoactive intestinal polypeptide. Mitotic activity was absent and the MIB-1 labeling index low (1-2%). While assignment of this lesion to any established neoplastic entity is not forthcoming, we propose it is being considered as a low-grade neuroendocrine tumor possibly related to null cell adenoma.
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Affiliation(s)
- Istvan Vajtai
- Institute of Pathology, University of Bern, Murtenstrasse 31, Postfach 62, 3010, Bern, Switzerland.
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18
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Nitsche M, Prinz M, Hermann RM, Christiansen H, Weiss E. Paraganglioma of the cerebellum: case report and review of the literature. Int J Clin Oncol 2005; 10:447-52. [PMID: 16369753 DOI: 10.1007/s10147-005-0529-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 08/18/2005] [Indexed: 10/25/2022]
Abstract
Intracerebral paragangliomas are tumors with a low incidence. Only 13 cases have been reported in the literature to date. This type of tumor shows characteristic histopathological features but unclear histogenesis. Owing to its low incidence, little knowledge exists concerning the best therapeutic strategy. We report on a 55-year-old male patient with the diagnosis of a paraganglioma of the cerebellum. We compare our patient's case to similar cases reported in the literature, describe the typical course of the disease, and discuss therapeutic options. No relapse of disease was observed in our patient within 2 years of diagnosis. Surgery and adjuvant conventionally fractionated external beam radiotherapy seem to be well tolerated and feasible. A review of patients reported in the literature and a comparison to our patient reveals a good prognosis for intracerebral paragangliomas. The optimal therapeutic strategy with regard to the benefit of adjuvant radiotherapy after total or subtotal resection has yet to be defined.
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Affiliation(s)
- Mirko Nitsche
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Georg-August-Universität, Robert-Koch Strasse 40, 37075 Goettingen, Germany.
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19
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Naggara O, Varlet P, Page P, Oppenheim C, Meder JF. Suprasellar paraganglioma: a case report and review of the literature. Neuroradiology 2005; 47:753-7. [PMID: 16047139 DOI: 10.1007/s00234-005-1422-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Accepted: 07/01/2005] [Indexed: 10/25/2022]
Abstract
Paragangliomas arising in the suprasellar region are extremely rare. We report a case of suprasellar paraganglioma in a 47-year-old man who presented with amnesia and impaired visual acuity without any endocrine dysfunction. Magnetic resonance imaging (MRI) showed a large enhancing tumour in the suprasellar area. Following subtotal surgical excision, the diagnosis of paraganglioma was confirmed by pathology. In this case report we describe the MRI pattern of suprasellar paraganglioma and review the literature of this uncommon lesion.
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Affiliation(s)
- O Naggara
- Department of Neuroradiology, Centre Hospitalier Sainte-Anne, 1 rue Cabanis, 75013 Paris, France.
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20
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Dahiya S, Sarkar C, Hedley-Whyte ET, Sharma MC, Zervas NT, Sridhar E, Louis DN. Spindle cell oncocytoma of the adenohypophysis: report of two cases. Acta Neuropathol 2005; 110:97-9. [PMID: 15973544 DOI: 10.1007/s00401-005-1009-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Revised: 03/09/2005] [Accepted: 03/09/2005] [Indexed: 10/25/2022]
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21
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Abstract
We report a very rare case of a paraganglioma arising from sellar and suprasellar region which has been treated with radiotherapy following multiple surgeries.
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Affiliation(s)
- Faruk Zorlu
- Department of Radiation Oncology Faculty of Medicine, Hacettepe University, Ankara, Turkey
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22
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Abstract
Paragangliomas arising as primary neoplasms in the intracranial portion of the central nervous system are relatively uncommon and only have been rarely reported. We report a case of apparent primary paraganglioma arising in the left cerebellar hemisphere in an 11-year-old girl who presented with a 6-month history of headaches. The tumor was marked by a nested architectural pattern (zellballen), delimited by S-100-positive sustentacular cells. Morphologic and immunohistochemical features of the neoplasm are discussed and literature is reviewed regarding involvement of the central nervous system by paraganglioma.
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Affiliation(s)
- Richard A Prayson
- Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44195, USA
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23
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Riopel C, Courville P, Fabre B, Callonnec F, Bolognini B, Marie JP, Laquerrière A. Le paragangliome parasellaire : à propos d’un cas. Ann Pathol 2004; 24:62-7. [PMID: 15192541 DOI: 10.1016/s0242-6498(04)93903-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 66-Year-old man presented with diplopia, headache and dizziness. Magnetic resonance imaging showed a right intrasphenoidal paracavernous mass. A biopsy was performed by endonasal route in the lesion which appeared to be part of the hypophyseal fossa. Histological examination revealed a highly cellular tumoral proliferation, with a variable architecture, of which chief cells were immunoreactive for neuroendocrine markers and spindle-shaped cells positive for PS 100. Morphological features were consistent with the diagnosis of paraganglioma. Our observation is the first case of this rare tumor reported in the French literature.
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Affiliation(s)
- Céline Riopel
- Service d'Anatomie Pathologique, Hôpital Charles Nicolle, CHU de Rouen, 1 rue de Germont, 76031 Rouen.
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24
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Hertel F, Bettag M, Mörsdorf M, Feiden W. Paragangliomas of the parasellar region. Neurosurg Rev 2003; 26:210-4. [PMID: 12690532 DOI: 10.1007/s10143-003-0266-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2003] [Accepted: 02/06/2003] [Indexed: 10/22/2022]
Abstract
Parasellar paragangliomas are rare tumors. As far as we know, only ten cases are described in the literature. Their clinical, pathological, and radiological features and possible origin are discussed in this article and a review of the literature is given. Additionally, we report a new case of a 51-year-old woman with paraganglioma growing in the anterior, middle, and posterior cranial fossa with extended destruction of the skull base. The patient had been suffering from long-standing headaches and facial nerve paresis. Preoperatively, this tumor was suspected to be a meningioma.
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Affiliation(s)
- F Hertel
- Department of Neurosurgery, Krankenhaus der Barmherzigen Brüder, Nordallee 1, 54292 Trier, Germany.
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25
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Salame K, Ouaknine GE, Yossipov J, Rochkind S. Paraganglioma of the pituitary fossa: diagnosis and management. J Neurooncol 2001; 54:49-52. [PMID: 11763422 DOI: 10.1023/a:1012535230135] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Paraganglioma of the sellar area is extremely rare with only six cases having been reported in the literature. Surgical removal of these tumors is difficult, and the transsphenoidal approach usually results in limited resection. Most authors who published reports on this tumor recommended radiation therapy after partial removal of the tumor. However, considering the benign nature of these tumors, the risk of radiation-induced endocrine insufficiency and optic neuropathy and the lack of proven effectiveness of radiotherapy, its value remains controversial. We describe a 48-year-old woman with parasellar paraganglioma who presented with headaches, visual loss and oligomenorrhea. Magnetic resonance imaging (MRI) showed an invasive tumor in the sellar and parasellar areas which extended to both cavernous sinuses and compressed the optic chiasm and the left internal carotid artery. Surgery by the transsphenoidal approach enabled only limited biopsy of the tumor. The patient was reoperated by an extended pterional approach which resulted in a subtotal removal of the tumor and adequate decompression of the adjacent structures. She received no adjuvant treatment during the 8-year postsurgical follow-up and remained in good health. A repeated MRI showed no change in the size of the residual tumor. Contrary to the therapeutic recommendations described in previous reports, we favor postoperative adjuvant therapy only if the symptoms or signs of cranial nerve compression persist following maximal tumor removal, or if there is evidence of subsequent growth of residual tumor.
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Affiliation(s)
- K Salame
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center the Sackler Faculty of Medicine, Tel Aviv University, Israel.
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26
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Sambaziotis D, Kontogeorgos G, Kovacs K, Horvath E, Levedis A. Intrasellar paraganglioma presenting as nonfunctioning pituitary adenoma. Arch Pathol Lab Med 1999; 123:429-32. [PMID: 10235503 DOI: 10.5858/1999-123-0429-ippanp] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Paragangliomas arising in the sellar region are rare. We report a case of intrasellar paraganglioma of a 54-year-old man who presented with gradually decreasing visual acuity. Physical examination revealed bitemporal hemianopsia with no apparent signs of endocrinologic dysfunction. Magnetic resonance imaging revealed a large sellar mass believed to be a nonfunctioning pituitary adenoma. The tumor was removed transsphenoidally and submitted for histologic examination. The morphologic features, based on histologic, immunocytochemical, and electron microscopic analyses, were consistent with the diagnosis of paraganglioma. The diagnostic morphologic features and the immunocytochemical profile of the tumor are reported.
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Affiliation(s)
- D Sambaziotis
- Department of Pathology and Neurosurgery, G. Gennimatas Athens General Hospital, Greece
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27
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Roche PH, Figarella-Branger D, Regis J, Peragut JC. Cauda equina paraganglioma with subsequent intracranial and intraspinal metastases. Acta Neurochir (Wien) 1996; 138:475-9. [PMID: 8738400 DOI: 10.1007/bf01420312] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A case of cauda equina paraganglioma is described; subsequent intracranial and intraspinal metastases occurred after partial resection and adjunctive radiotherapy. Cerebrospinal fluid dissemination is a rare complication of spinal paragangliomas. Factors predictive of this unusual biological behaviour are discussed.
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Affiliation(s)
- P H Roche
- Department of Neurosurgery, Hôpital de la Timone, Marseille, France
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