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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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Albadr FB, Alhatlani AH, Alhelal NS, Albakri AA, Alhumidi AA, Alshwieer MA. Calcified Pituitary Adenoma Mimicking Craniopharyngioma: A Case Report. Cureus 2024; 16:e54352. [PMID: 38500912 PMCID: PMC10946292 DOI: 10.7759/cureus.54352] [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: 02/17/2024] [Indexed: 03/20/2024] Open
Abstract
A 60-year-old woman presented with a history of a previously diagnosed sellar mass and a recent onset of severe headache, vision loss, and dizziness. The patient was found to have a large mass with curvilinear calcification on imaging. Histopathology confirmed the presence of a pituitary adenoma with abnormal acini, consistent with adenoma, and moderate amounts of granular eosinophilic cytoplasm. A detailed analysis of the patterns of calcification and the radiological morphology is crucial to distinguishing between pituitary adenoma and craniopharyngioma. Recognition of these patterns can aid in distinguishing between these conditions, providing a more accurate diagnosis and an effective treatment plan.
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Affiliation(s)
- Fahad B Albadr
- Radiology and Medical Imaging/Neuroradiology, King Saud University Medical City, Riyadh, SAU
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Ayasa LA, Rahhal S, Najjar AK, Aldarawish A, Bakri IA. Sellar Xanthogranulomatosis in a Two-Year-Old Girl: A Case Report. Cureus 2023; 15:e49405. [PMID: 38149166 PMCID: PMC10749890 DOI: 10.7759/cureus.49405] [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: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
Sellar xanthogranulomas are extremely rare intracranial lesions, particularly in pediatric patients, and their diagnostic and therapeutic challenges prompt thorough investigation. We describe a case of a two-year-old toddler diagnosed with sellar xanthogranuloma, highlighting the challenges encountered in its diagnosis and management. The child presented with symptoms, including headache, ptosis of the left eye, and neurological deficits. Brain computed tomography (CT) and magnetic resonance imaging (MRI) revealed a hypodense sellar lesion. The patient underwent a left pterional craniotomy for resection of the mass. Histopathological examination suggested the diagnosis of sellar xanthogranuloma, characterized by foamy macrophages, giant cells, lymphocytic infiltrates, fibrous proliferation, necrotic detritus, and hemosiderin deposits. Further diagnostic precision was achieved through immunohistochemical staining, including CD1a and langerin, which successfully ruled out the possibility of Langerhans cell histiocytosis (LCH), reinforcing the diagnosis of sellar xanthogranuloma. The successful surgical resection of the lesion led to a favorable outcome, evidenced by the significant alleviation of symptoms as well as the restoration of normal neurological function. Post-operative assessments demonstrated a marked improvement in the patient's quality of life, and there were no observed complications or recurrence of the lesion during the follow-up period. In summary, our case report not only highlights the rarity and diagnostic challenges of sellar xanthogranulomas but also emphasizes the importance of collaborative medical expertise in achieving accurate diagnosis and successful therapeutic outcomes in pediatric patients. The successful management of this case offers valuable insights into the clinical presentation, diagnostic complexities, and treatment strategy of sellar xanthogranulomas, further enriching our understanding of this uncommon intracranial pathology.
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Affiliation(s)
- Laith A Ayasa
- Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Sara Rahhal
- School of Medicine, The University of Jordan, Amman, JOR
| | - Ala'a K Najjar
- Department of Neurosurgery, Al-Makassed Islamic Charitable Hospital, Jerusalem, PSE
| | - Asad Aldarawish
- Department of Neurosurgery, Al-Makassed Islamic Charitable Hospital, Jerusalem, PSE
| | - Izzeddin A Bakri
- Department of Pathology, Al-Makassed Islamic Charitable Hospital, Jerusalem, PSE
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Fernández SC, Bernhardt MC, Grondona E, Venier AC, Bertolino ML, Pautasso MJ, Mezzano E, Damilano RA, Sala CS, Herrera EJ, Pesaola FN, Maldonado CA, Quintar AA, De Paul AL. Sellar xanthogranuloma as a diagnostic challenge: a report on five cases. Front Neurosci 2023; 17:1227144. [PMID: 37811322 PMCID: PMC10556246 DOI: 10.3389/fnins.2023.1227144] [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: 05/22/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Xanthogranulomas are considered rare tumors, with their sellar and non-sellar frequency ranging from 1.6 to 7% among intracranial lesions, and described as a separate entity by the World Health Organization in 2000. The diagnosis of sellar xanthogranulomas is challenging, given their uncertain origin and clinical course. In addition, the limited reporting of sellar xanthogranuloma cases and the absence of characteristic images make these entities difficult to distinguish from other cystic lesions of the sellar region, such as adamantinomatous craniopharyngiomas, Rathke's cleft cysts, pituitary tumors, arachnoid cysts, epidermoid cysts, and dermoid cysts. Here, we describe the clinical presentation, radiological findings, immunohistochemical/histopathological analysis, and the ultrastructural examination by transmission electron microscopy of five sellar xanthogranulomas cases reported in two care centers in Cordoba, Argentina. Two males and three females between 37 and 73 years of age (average 51.8 years) presented with persistent headaches, generalized endocrine defects, and visual problems. MRI revealed cystic formations in the sellar region, which usually projected into adjacent tissues such as the suprasellar region or cavernous sinuses, and compressed other structures such as the optic chiasm, pituitary gland, and cranial nerves. All patients underwent surgical intervention to remove the tumor tissue. The histopathological analysis of the samples showed cellular tissue with a xanthogranulomatous appearance, inflammatory cellular infiltrate (mainly lymphocytes and macrophages), fibroblasts, abundant collagen fibers, and hemorrhages. An ultrastructural analysis helped to identify cellular infiltrates and granules resulting from tumor cell activity. The data support the hypothesis that sellar xanthogranulomas could occur as an inflammatory reaction secondary to the rupture and hemorrhage of a previous cystic process, thereby generating an expansion of the tumor body toward adjacent tissues. The information obtained from these cases contributes to the current knowledge about this disease's origin and clinical and histological evolution. However, the scarcity of patients and the observed phenotypic heterogeneity make its diagnosis still challenging. Undoubtedly, more investigations are needed to provide additional information in order to be able to achieve a more accurate diagnosis and effective treatment of this rare disease.
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Affiliation(s)
- Silvia Carolina Fernández
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | - Ezequiel Grondona
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Instituto de Investigación en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Ana Clara Venier
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Instituto de Investigación en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | | | - Mauro José Pautasso
- Servicio de Neurocirugía, Clínica Universitaria Reina Fabiola, Córdoba, Argentina
| | - Emilio Mezzano
- Servicio de Endocrinología, Clínica Universitaria Reina Fabiola, Córdoba, Argentina
| | | | | | | | - Favio Nicolás Pesaola
- Department of Pediatrics, School of Medicine, Genetics and Genomic Medicine, Washington University in St. Louis, Saint Louis, MO, United States
| | - Cristina Alicia Maldonado
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Instituto de Investigación en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Amado Alfredo Quintar
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Instituto de Investigación en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Ana Lucía De Paul
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Instituto de Investigación en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
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Mei L, Bai M, Gong Y, Lyu J. A suprasellar Xanthogranuloma shows unique radiological features of annular calcification and typical cystic lesion. Asian J Surg 2023; 46:3827-3828. [PMID: 37059677 DOI: 10.1016/j.asjsur.2023.03.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 04/16/2023] Open
Affiliation(s)
- Lingjun Mei
- Department of Radiology, the Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, PR China
| | - Miaomiao Bai
- Department of Radiology, the Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, PR China
| | - Yanling Gong
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, 116001, PR China.
| | - Jianbo Lyu
- Department of Radiology, the Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, PR China.
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Armao D, Bouldin TW, Hartman TS, Thorp BD, Jewells V. Pituitary adenoma associated with xanthogranuloma. Radiol Case Rep 2023; 18:2078-2080. [PMID: 37064081 PMCID: PMC10102808 DOI: 10.1016/j.radcr.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/07/2023] [Accepted: 03/05/2023] [Indexed: 04/08/2023] Open
Abstract
Xanthogranuloma (XG) of the sellar region is a non-neoplastic inflammatory lesion characterized histologically by recent and remote hemorrhage, necrotic debris, fibrosis, chronic inflammation, and cholesterol clefts with associated foreign-body giant cells. The inflammatory lesion was recognized by the World Health Organization in 2000. XG of the sellar region is rare. Cases of pituitary adenoma (PA) with an associated XG (PA/XG) are extremely rare, with a total of 16 cases in the literature. PA/XG lacks specific clinical and radiologic signs, making pre-operative diagnosis challenging. Herein, we report a case of PA/XG, describe the radiologic and pathologic findings, and discuss the role of so-called silent or "subclinical pituitary apoplexy" in the possible histogenesis of PA/XGs.
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