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Ebrahimzadeh K, Mirahmadi Eraghi M, Ansari M, Dmytriw AA. Sellar hemangiopericytoma masquerading as pituitary adenoma: an overlooked intriguing case study unveiling a rare surgical conundrum. Front Surg 2024; 11:1359787. [PMID: 38840972 PMCID: PMC11150949 DOI: 10.3389/fsurg.2024.1359787] [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] [Received: 12/22/2023] [Accepted: 04/18/2024] [Indexed: 06/07/2024] Open
Abstract
Hemangiopericytoma (HPC) constitutes less than 1% of all primary central nervous system tumors. It is a vascular neoplasm with potential malignancy that, in rare instances, manifests as a primary lesion within the brain. Typically, it originates from the meninges. Here, we describe an exceptionally uncommon sellar region solitary fibrous tumor/hemangiopericytoma (SFT/HPC) that mimicked a nonfunctional pituitary adenoma. Introduction and importance Case presentation A 54-year-old male was referred to our hospital due to progressive blurred vision in the left eye over the past year. A homogeneous iso-dense extra-axial intrasellar round mass with extension into the suprasellar region, mainly on the left side, along with bony erosion and osteolysis around the sellar region, was observed on a brain computed tomography (CT) scan. Brain magnetic resonance imaging (MRI) revealed a well-defined 251,713 mm mass with iso-signal on T1-weighted images and hypersignal on T2-weighted images, originating from the pituitary gland within the sella turcica. The mass avidly enhanced following Gadolinium injection and adhered to both carotid arteries without vascular compression or invasion. It extended to the suprasellar cistern and compressed the optic chiasm. The diagnosis was nonfunctional pituitary macroadenoma, leading to the decision for Endoscopic Trans-Sphenoidal Surgery (ETSS). A non-sustainable, soft, grayish mass was grossly and totally resected during the operation. Subsequently, there was a significant improvement in visual acuity during the early postoperative period. Histopathologic examination confirmed hemangiopericytoma (WHO grade II). Conclusion Due to its malignant nature, hemangiopericytoma should be included in the differential diagnosis of a sellar mass, both from a clinical and morphological perspective.
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Affiliation(s)
- Kaveh Ebrahimzadeh
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mirahmadi Eraghi
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Medicine, Islamic Azad University, Qeshm International Branch, Qeshm, Iran
| | - Mohammad Ansari
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Adam A. Dmytriw
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Wu J, Deng P, Qian J, Lu Y, Ding Z, Hu X, Gong Y, Tang X, Ma M. Endoscopic endonasal transsphenoidal surgery for unusual sellar lesions: eight cases and review of the literature. Front Neurol 2024; 15:1309691. [PMID: 38414554 PMCID: PMC10896968 DOI: 10.3389/fneur.2024.1309691] [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: 10/08/2023] [Accepted: 01/26/2024] [Indexed: 02/29/2024] Open
Abstract
Background Preoperative imaging for some unusual lesions in the sellar region can pose challenges in establishing a definitive diagnosis, impacting treatment strategies. Methods This study is a retrospective analysis of eight cases involving unusual sellar region lesions, all treated with endoscopic endonasal transsphenoidal surgery (EETS). We present the clinical, endocrine, and radiological characteristics, along with the outcomes of these cases. Results Among the eight cases, the lesions were identified as follows: Solitary fibrous tumor (SFT) in one case, Lymphocytic hypophysitis (LYH) in one case, Cavernous sinus hemangiomas (CSH) in one case, Ossifying fibroma (OF) in two cases; Sphenoid sinus mucocele (SSM) in one case, Pituitary abscess (PA) in two cases. All patients underwent successful EETS, and their diagnoses were confirmed through pathological examination. Postoperatively, all patients had uneventful recoveries without occurrences of diabetes insipidus or visual impairment. Conclusion Our study retrospectively analyzed eight unusual lesions of the sellar region. Some lesions exhibit specific imaging characteristics and clinical details that can aid in preoperative diagnosis and inform treatment strategies for these unusual sellar diseases.
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Affiliation(s)
- Jiandong Wu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Peng Deng
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jinhong Qian
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yanli Lu
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhiliang Ding
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiaolong Hu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yuhui Gong
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiaoyu Tang
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Mian Ma
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
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Ma M, Gong Y, Tang X, Deng P, Qian J, Hu X, Wu J, Ding Z. Solitary fibrous tumor in the saddle area treated with neuroendoscopic surgery and proton therapy: A case report and literature review. Oncol Lett 2023; 26:505. [PMID: 37920432 PMCID: PMC10618926 DOI: 10.3892/ol.2023.14092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/15/2023] [Indexed: 11/04/2023] Open
Abstract
Solitary fibrous tumor (SFT) of the central nervous system is a rare fibroblastic tumor of mesenchymal origin. SFTs in the saddle area are much less common. In January 2022, a 43-year-old female patient was admitted with SFT 3 months following partial resection of a microscopic transsphenoidal saddle area tumor at a different hospital. Magnetic resonance imaging indicated that the unresected part of the tumor was significantly enhanced on T1 enhancement, which strongly indicated a recurrence. Subsequently, the patient underwent transnasal endoscopic saddle area tumor resection at our hospital and the tumor was successfully removed. By using postoperative pathology examination, immunohistochemical analysis of Bcl-2, cluster of differentiation 99, STAT6 and vimentin, and a fusion gene test performed by high-throughput sequencing technology, the SFT was definitively diagnosed. Following 3 months of follow-up, the patient was found to have tumor recurrence in the cavernous sinus and absence of tumor growth in the pituitary fossa. Therefore, the patient received proton therapy and tumor growth was controlled effectively.
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Affiliation(s)
- Mian Ma
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215002, P.R. China
| | - Yuhui Gong
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215002, P.R. China
| | - Xiaoyu Tang
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215002, P.R. China
| | - Peng Deng
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215002, P.R. China
| | - Jinhong Qian
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215002, P.R. China
| | - Xiaolong Hu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215002, P.R. China
| | - Jiandong Wu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215002, P.R. China
| | - Zhiliang Ding
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215002, P.R. China
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Allen AJ, Labella DA, Richardson KM, Sheehan JP, Kersh CR. Recurrent Solitary Fibrous Tumor (Intracranial Hemangiopericytoma) Treated With a Novel Combined-Modality Radiosurgery Technique: A Case Report and Review of the Literature. Front Oncol 2022; 12:907324. [PMID: 35720016 PMCID: PMC9204631 DOI: 10.3389/fonc.2022.907324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Solitary Fibrous Tumor (SFT) is a rare and aggressive mesenchymal malignancy of the dura with a predilection for recurrence after treatment. We report a case of a SFT initially treated with subtotal surgical resection followed by a combination of Gamma Knife (GK) and linear accelerator-based radiosurgery. Forty-four days post-resection, the tumor had demonstrated radiographic evidence of recurrent disease within the post-operative bed. GK radiosurgery treatment was delivered in a "four-matrix" fashion targeting the entire surgical cavity as well as three nodular areas within this wide field. This treatment was delivered in one fraction with a stereotactic head frame for immobilization. A consolidation radiosurgery treatment course was then delivered over three additional fractions to the resection bed using a linear accelerator and mesh mask for immobilization. The total biologically effective dose (BED) was calculated as 32.50 Gy to the surgical bed and approximately 76.50 Gy to each nodular area. Almost three years post-operatively, the patient is alive and without radiographic or clinical evidence of disease recurrence. To our knowledge, no prior experiences have documented treatment of SFT using a mixed-modality, multi-fraction radiosurgery technique like the method detailed in this report. Our experience describes a combined modality, multi-fraction radiosurgery approach to treating recurrent SFT that maximizes radiation dose to the targets while minimizing complication risk. We believe this novel radiosurgery method should be considered in cases of grade II SFT post-resection.
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Affiliation(s)
- Alexander J Allen
- Chesapeake Regional, Riverside & University of Virginia Radiosurgery Center, Riverside Regional Medical Center, Newport News, VA, United States
| | - Dominic Angelo Labella
- Chesapeake Regional, Riverside & University of Virginia Radiosurgery Center, Riverside Regional Medical Center, Newport News, VA, United States
| | - K Martin Richardson
- Chesapeake Regional, Riverside & University of Virginia Radiosurgery Center, Riverside Regional Medical Center, Newport News, VA, United States
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Charles R Kersh
- Chesapeake Regional, Riverside & University of Virginia Radiosurgery Center, Riverside Regional Medical Center, Newport News, VA, United States
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Ramanathan P, Mantziaris G, Pikis S, Young L, Dumot C, Sheehan J. Stereotactic radiosurgery for sellar solitary fibrous tumors: Case report and literature review. JOURNAL OF RADIOSURGERY AND SBRT 2022; 8:159-163. [PMID: 36275131 PMCID: PMC9489078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/24/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Purushotham Ramanathan
- Department of Neurological Surgery, University of Virginia Health System, 1300 Jefferson Park Ave, Charlottesville, VA 22908, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia Health System, 1300 Jefferson Park Ave, Charlottesville, VA 22908, USA
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia Health System, 1300 Jefferson Park Ave, Charlottesville, VA 22908, USA
| | - Lena Young
- Department of Neurological Neuropathology, University of Virginia Health System, 1300 Jefferson Park Ave, Charlottesville, VA 22908, USA
| | - Chloe Dumot
- Department of Neurological Surgery, University of Virginia Health System, 1300 Jefferson Park Ave, Charlottesville, VA 22908, USA
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia Health System, 1300 Jefferson Park Ave, Charlottesville, VA 22908, USA
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