1
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Apps JR, Gonzalez-Meljem JM, Guiho R, Pickles JC, Prince E, Schwalbe E, Joshi N, Stone TJ, Ogunbiyi O, Chalker J, Bassey A, Otto G, Davies R, Hughes D, Brandner S, Tan E, Lee V, Hayhurst C, Kline C, Castellano S, Hankinson T, Deutschbein T, Jacques TS, Martinez-Barbera JP. Recurrent adamantinomatous craniopharyngiomas show MAPK pathway activation, clonal evolution and rare TP53-loss-mediated malignant progression. Acta Neuropathol Commun 2024; 12:127. [PMID: 39127699 PMCID: PMC11316312 DOI: 10.1186/s40478-024-01838-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024] Open
Abstract
The two types of craniopharyngioma, adamantinomatous (ACP) and papillary (PCP), are clinically relevant tumours in children and adults. Although the biology of primary craniopharyngioma is starting to be unravelled, little is known about the biology of recurrence. To fill this gap in knowledge, we have analysed through methylation array, RNA sequencing and pERK1/2 immunohistochemistry a cohort of paired primary and recurrent samples (32 samples from 14 cases of ACP and 4 cases of PCP). We show the presence of copy number alterations and clonal evolution across recurrence in 6 cases of ACP, and analysis of additional whole genome sequencing data from the Children's Brain Tumour Network confirms chromosomal arm copy number changes in at least 7/67 ACP cases. The activation of the MAPK/ERK pathway, a feature previously shown in primary ACP, is observed in all but one recurrent cases of ACP. The only ACP without MAPK activation is an aggressive case of recurrent malignant human craniopharyngioma harbouring a CTNNB1 mutation and loss of TP53. Providing support for a functional role of this TP53 mutation, we show that Trp53 loss in a murine model of ACP results in aggressive tumours and reduced mouse survival. Finally, we characterise the tumour immune infiltrate showing differences in the cellular composition and spatial distribution between ACP and PCP. Together, these analyses have revealed novel insights into recurrent craniopharyngioma and provided preclinical evidence supporting the evaluation of MAPK pathway inhibitors and immunomodulatory approaches in clinical trials in against recurrent ACP.
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Affiliation(s)
- John R Apps
- Institute of Cancer and Genomic Sciences, Edgbaston Campus, University of Birmingham, Birmingham, B15 2TT, UK.
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
| | - Jose Mario Gonzalez-Meljem
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Tecnologico de Monterrey, School of Engineering and Sciences, Mexico City, Mexico
| | - Romain Guiho
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Oniris, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, Nantes Université, 44000, Nantes, France
| | - Jessica C Pickles
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Eric Prince
- Departments of Neurosurgery and Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, USA
| | - Edward Schwalbe
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Nikhil Joshi
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Thomas J Stone
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Olumide Ogunbiyi
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Jane Chalker
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Akang Bassey
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Georg Otto
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rosalind Davies
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Sebastian Brandner
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Enrica Tan
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Victoria Lee
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | | | - Cassie Kline
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sergi Castellano
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Todd Hankinson
- Departments of Neurosurgery and Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, USA
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
- Medicover Oldenburg MVZ, Oldenburg, Germany
| | - Thomas S Jacques
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Juan Pedro Martinez-Barbera
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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2
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Das S, Sharma MC, Suri V, Sahu S, Garg A, Laythalling RK. Malignancy arising in adamantinomatous craniopharyngioma: Report of a rare case with unusual morphologic features. Neuropathology 2024; 44:292-297. [PMID: 38410881 DOI: 10.1111/neup.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/28/2024]
Abstract
Adamantinomatous craniopharyngioma is a grade 1 tumor that arises in a sellar/suprasellar location. Despite being a grade 1 tumor, there is high recurrence and endocrinal insufficiency. Malignancy arising in craniopharyngioma is extremely rare, has a dismal prognosis, and is currently not included as a separate entity in the World Health Organization Classification of Central Nervous System 5th edition. Here we describe a case of adamantinomatous craniopharyngioma and its malignant counterpart. The malignant part had unique histomorphology and basaloid cells with pseudoglandular architecture and a myxoid background. It bore a striking resemblance to adenoid cystic carcinoma. Both the benign and malignant counterparts were beta-catenin and SOX-2 positive, providing proof of the malignant part arising from the benign part. Tumors like squamous cell carcinoma and odontogenic ghost cell carcinoma have been described in cranipharyngioma. This case study is the first to describe this unique morphology of adenoid cystic carcinoma-like features. The possibility of adenoid cystic carcinoma was excluded by immunohistochemistry.
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Affiliation(s)
- Sumanta Das
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Saumya Sahu
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
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3
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Elarjani T, Alhuthayl MR, Alhindi H, Kanaan IN. The effect of radiation therapy and chemotherapy on malignant craniopharyngioma: A review. Surg Neurol Int 2021; 12:539. [PMID: 34754589 PMCID: PMC8571389 DOI: 10.25259/sni_664_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/01/2021] [Indexed: 11/04/2022] Open
Abstract
Background Malignant craniopharyngioma is a rare tumor with few published case reports. It can form de novo or transform from a benign variant and is associated with a dismal survival rate. We reviewed the literature for all published cases and studied the effect of radiation on the rate of malignant transformation. We analyzed the effect of chemotherapy on survival. Methods We used various search engines to locate literature from 1980 onward and identified 31 case reports, one of which was excluded. Statistical analysis using the SAS software was conducted, and a significant value was identified if P < 0.05. Results There was equal distribution among male and female patients. The average age at malignant diagnosis is 31.11 years (±15.16) and 12.19 years (±8.41) for the average interval of benign tumor progression to malignancy. The most common clinical presentation was visual loss and/or field deficits in 26/30 patients (86%). Almost 11/30 patients (37%) had endocrinological deficits, with panhypopituitarism as the most common in 8/11 patients (73%). Fifteen patients received radiation before malignant transformation (47%) and demonstrated no effect on malignant transformation (P = 0.379). Gross total resection was achieved in 2/30 patients. The average time to mortality postoperatively is 5.3 months ± 4.3. Ten patients received chemotherapy, and five were alive at last follow-up (P = 0.115). Conclusion Malignant craniopharyngioma carries a dismal prognosis with no apparent benefits of radiation therapy and chemotherapy on survival.
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Affiliation(s)
- Turki Elarjani
- Department of Neurological Surgery, University of Miami MILLER School of Medicine Jacson Memorial Hospital, Miami, Florida, United States
| | | | - Hindi Alhindi
- Department of Pathology and Laboratory Medicine, King Faisal specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Imad N Kanaan
- Neurosciences Center, King Faisal Specialist Hospital and Research Center
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4
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E J, PJ V, Vleeschouwer S D, Calenbergh F V, E H, C P, M B. Craniopharyngioma with malignant transformation: A case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bteich F, El Khoury L, Nohra G, Trak V, Yazbek S, Akiki M. Pituitary Adenoma and Papillary Craniopharyngioma: A Rare Case of Collision Tumor and Review of the Literature. World Neurosurg 2020; 139:63-69. [PMID: 32298831 DOI: 10.1016/j.wneu.2020.03.088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pituitary adenomas are the most common lesion of the sellar region. Very few cases in the literature have described their association with craniopharyngiomas in the same anatomic compartment, an entity defined as collision tumors of the sella. CASE DESCRIPTION A 35-year-old man presented with headaches and progressive visual disturbances. Radiographic imaging initially highlighted the presence of a pituitary craniopharyngioma. An endoscopic transsphenoidal pituitary approach was performed, during which the tumor was partially resected. The pathology report was positive for 2 entities: a nonfunctioning pituitary adenoma and a papillary craniopharyngioma. This was an unexpected diagnosis based on the surgical and initial radiologic findings. CONCLUSIONS To our knowledge, this is the first documented case of a collision tumor of the sella comprising a pituitary adenoma and a craniopharyngioma of the papillary type.
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Affiliation(s)
- Fred Bteich
- Neurosurgery Department, Hotel-Dieu de France Hospital, Achrafieh, Lebanon; Faculty of Medicine, Saint Joseph University, Achrafieh, Lebanon.
| | - Lea El Khoury
- Pathology Departments, Hotel-Dieu de France Hospital, Achrafieh, Lebanon; Faculty of Medicine, Saint Joseph University, Achrafieh, Lebanon
| | - Georges Nohra
- Neurosurgery Department, Hotel-Dieu de France Hospital, Achrafieh, Lebanon; Faculty of Medicine, Saint Joseph University, Achrafieh, Lebanon
| | - Viviane Trak
- Pathology Departments, Hotel-Dieu de France Hospital, Achrafieh, Lebanon; Faculty of Medicine, Saint Joseph University, Achrafieh, Lebanon
| | - Sandrine Yazbek
- Neurosurgery Department, Hotel-Dieu de France Hospital, Achrafieh, Lebanon; Faculty of Medicine, Saint Joseph University, Achrafieh, Lebanon
| | - Mira Akiki
- Pathology Departments, Hotel-Dieu de France Hospital, Achrafieh, Lebanon
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6
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A Rare Case of Malignant Craniopharyngioma Reactive to Adjunctive Stereotactic Radiotherapy and Chemotherapy: Case Report and Literature Review. World Neurosurg 2018; 117:332-338. [DOI: 10.1016/j.wneu.2018.05.244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 11/18/2022]
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7
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Nagata T, Nakayama H, Uchida K, Uetsuka K, Yasoshima A, Yasunaga S, Masuda K, Tsujimoto H, Kuwajima E, Nishimura R, Sasaki N, Doi K. Two Cases of Feline Malignant Craniopharyngioma. Vet Pathol 2016; 42:663-5. [PMID: 16145213 DOI: 10.1354/vp.42-5-663] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Tumors at the cranial base in 2 cats (a 9 1/2-year-old, castrated male Chinchilla and a 7-year-old, castrated male American shorthair) were diagnosed as malignant craniopharyngioma. The tumor lesion was histopathologically divided into four parts: 1) a small acinus part, in which relatively large cells with a pale cytoplasm composed small acini; 2) a duct part, in which small cuboidal cells composed ducts; 3) a cyst part, in which there were large cysts lined with flat cells; and 4) a pavement part, in which large multiangular-shaped cells proliferated in a pavement pattern. The epithelial cells of some parts were positive for keratin by immunohistochemistry. Histopathologic findings of the present feline cases were identical to those of malignant craniopharyngioma in other animal species.
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Affiliation(s)
- T Nagata
- Department of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, 1-1-1 Yayoi, Bunkyoku, Tokyo 113-8657, Japan
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8
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Negoto T, Sakata K, Aoki T, Orito K, Nakashima S, Hirohata M, Sugita Y, Morioka M. Sequential pathological changes during malignant transformation of a craniopharyngioma: A case report and review of the literature. Surg Neurol Int 2015; 6:50. [PMID: 25883842 PMCID: PMC4392567 DOI: 10.4103/2152-7806.154274] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/03/2014] [Indexed: 11/21/2022] Open
Abstract
Background: Malignant transformation of craniopharyngiomas is quite rare, and the etiology of transformation remains unclear. The prognosis of malignantly transformed craniopharyngiomas is very poor. Case Description: A 36-year-old male had five craniotomies, five transsphenoidal surgeries, and two radiation treatments until 31 years of age after diagnosis of craniopharyngioma at 12 years of age. All serial pathological findings indicated adamantinomatous craniopharyngioma including those of a surgery performed for tumor regrowth at 31 years of age. However, when the tumor recurred approximately 5 years later, the pathological findings showed squamous metaplasia. The patient received CyberKnife surgery, but the tumor rapidly regrew within 4 months. The tumor was resected with the cavernous sinus via a dual approach: Transcranial and transsphenoidal surgery with an extracranial-intracranial bypass using the radial artery. Pathologic examination of a surgical specimen showed that it consisted primarily of squamous cells; the lamina propria was collapsed, and the tumor cells had enlarged nuclei and clarification of the nucleolus. The tumor was ultimately diagnosed as malignant transformation of craniopharyngioma. After surgery, he received combination chemotherapy (docetaxel, cisplatin, and fluorouracil). The tumor has been well controlled for more than 12 months. Conclusion: Serial pathological changes of the craniopharyngioma and a review of the 20 cases reported in the literature suggest that radiation of the squamous epithelial cell component of the craniopharyngioma led to malignant transformation via squamous metaplasia. We recommend aggressive surgical removal of craniopharyngiomas and avoidance of radiotherapy if possible.
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Affiliation(s)
- Tetsuya Negoto
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Kiyohiko Sakata
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Takachika Aoki
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Kimihiko Orito
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Shinji Nakashima
- Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan
| | - Masaru Hirohata
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Yasuo Sugita
- Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
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9
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Wang W, Chen XD, Bai HM, Liao QL, Dai XJ, Peng DY, Cao HX. Malignant transformation of craniopharyngioma with detailed follow-up. Neuropathology 2014; 35:50-5. [PMID: 25112406 DOI: 10.1111/neup.12142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/05/2014] [Accepted: 06/08/2014] [Indexed: 11/29/2022]
Abstract
A 29-year-old male patient was admitted into hospital with the main complaint of progressive visual disturbance. Both CT SCAN and MRI demonstrated a cystic-solid contrast-enhancing sellar-suprasellar mass with obvious calcification. Histopathological examination of the first resected specimen showed a typical appearance of adamantinomatous craniopharyngioma. The patient received gamma knife therapy after his first operation because of partial tumor removal. He experienced two relapses in the subsequent 2 years, for which only surgical resection was performed. The later histopathology presented malignant appearance with tumor cells moderate to severe pleomorphism, hyperchromasia, increased nuclear cytoplastic ratio, high mitotic activity (30/10 high power fields) and focal coagulative necrosis. The patient died 9 months after identification of histologic malignancy. Clinical and histopathological features, biological behavior of one case of malignant craniopharyngioma were discussed, with a brief review of the relevant literature.
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Affiliation(s)
- Wei Wang
- Department of Pathology, Guangzhou Liuhuaqiao Hospital, Guangzhou, China
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10
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Sofela AA, Hettige S, Curran O, Bassi S. Malignant Transformation in Craniopharyngiomas. Neurosurgery 2014; 75:306-14; discussion 314. [DOI: 10.1227/neu.0000000000000380] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Craniopharyngiomas are successfully managed with surgery and/or adjuvant chemoradiotherapy but have been documented to undergo malignant transformation (MT), albeit very rarely, with only 23 reported cases. The exact cause and pathogenesis of this MT are unknown, although the literature has suggested a possible correlation with radiotherapy.
OBJECTIVE:
To review the reported cases of malignancy, in particular looking at the incidence, tumor characteristics, previous treatment modalities, and median survival.
METHODS:
We conducted a PUBMED, SCOPUS, OVID SP, and INFORMA search with a combination of key words: craniopharyngioma, malignancy, transformation, neoplasm, radiation therapy, and anaplastic. We identified 23 cases relevant to our study.
RESULTS:
Median age at the time of diagnosis of malignant craniopharyngiomas was 31 years (range, 10-66 years); 52.6% of the patients were female. Histologically, the most common tumor types were squamous cell carcinoma (80.96%), with adamantinomatous cell type being the most common morphology (89.47%). We found that 21.7% of the cases were diagnosed as malignant craniopharyngioma at first biopsy. Of the rest, the median time from initial benign diagnosis to MT was 8.5 years (range, 3-55 years). Median overall survival after MT was 6 months (range, 2 weeks-5 years). Using the Spearman rank correlation, we found no correlation between the use of radiation therapy (correlation coefficient, −0.25; P < .05) or its dosage (correlation coefficient, −0.26; P < .05) and MT.
CONCLUSION:
Malignant craniopharyngiomas are rare and are associated with a poor prognosis. MTs occur years after the initial benign craniopharyngioma diagnosis and are associated with multiple benign craniopharyngioma recurrence. Results also show that, contrary to widespread belief, there is a poor correlation between radiotherapy and MT.
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Affiliation(s)
| | - Samantha Hettige
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Olimpia Curran
- Department of Clinical Neuropathology, Academic Neuroscience Centre, King's College Hospital, London, United Kingdom
| | - Sanj Bassi
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
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11
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Uncommon presentation of a benign nasopharyngeal mass in an adolescent: comprehensive review of pediatric nasopharyngeal masses. Case Rep Pediatr 2013; 2013:816409. [PMID: 23936713 PMCID: PMC3727118 DOI: 10.1155/2013/816409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 06/21/2013] [Indexed: 11/17/2022] Open
Abstract
Nasopharyngeal masses in the pediatric population are quite rare, and the majority of these are benign. In adolescent boys, there should be a high index of suspicion for juvenile nasopharyngeal angiofibromas. When malignant, the most common lesions encountered are rhabdomyosarcomas, carcinomas, and lymphomas. We report a single case from a tertiary care institution of an adolescent male with an unusual presentation of a benign nasopharyngeal mass and provide a comprehensive review of pediatric nasopharyngeal masses. Whenever possible, radiographic imaging should be obtained, in addition to biopsy, to assist in the diagnosis of pediatric nasopharyngeal masses.
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12
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Abstract
Primary intracranial squamous cell carcinoma is extremely rare, with most cases arising from malignant transformation of dysembryogenetic lesions such as epidermoid and dermoid cysts. Intracranial squamous cell neoplasm arising de novo is even rarer and has been reported in only four patients to date. We herein describe a case of primary intracranial squamous cell carcinoma arising de novo in the right frontal lobe in a 35-year-old woman treated with a combination of surgery and postoperative conformal radiation. We have also shed light on the biology and the therapeutic options of this enigmatic tumour.
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13
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Fernandez-Miranda JC, Gardner PA, Snyderman CH, Devaney KO, Strojan P, Suárez C, Genden EM, Rinaldo A, Ferlito A. Craniopharyngioma: a pathologic, clinical, and surgical review. Head Neck 2011; 34:1036-44. [PMID: 21584897 DOI: 10.1002/hed.21771] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Craniopharyngioma is a rare and mostly benign epithelial tumor of the sellar and suprasellar region. Two principal patterns of craniopharyngioma are recognized: papillary and adamantinomatous. Papillary craniopharyngiomas are encountered in adults and may lack the cystic spaces filled with "motor oil" as well as the palisading peripheral rows of epithelial cells, keratinization, or calcification typical of pediatric adamantinomatous craniopharyngioma. Secondary to their anatomic location, craniopharyngiomas may present with endocrinologic dysfunction and visual disturbances. Differential diagnosis includes Rathke's cleft cyst, pituitary adenoma, dermoid/epidermoid cysts, and other rare sellar/suprasellar lesions as pituicytomas. Many controversies exist concerning the preferred surgical approach for these tumors. Endoscopic endonasal surgery is no longer reserved only for sellar or small cystic suprasellar lesions. Prechiasmatic/preinfundibular lesions are effectively removed using an endonasal transtuberculum/transplanum approach; subchiasmatic/transinfundibular tumors require the addition of a transellar approach with inferior pituitary transposition; and retrochiasmatic/retroinfundibular lesions are better accessed performing an endonasal superior pituitary transposition. Compared with well-established trancranial approaches (pterional, subfrontal, presigmoid), endoscopic endonasal surgery combines the virtues of the caudocranial and midline approaches, allowing for appropriate infrachiasmatic exposure without the need for manipulation of surrounding neurovascular structures to access the tumor. This anatomic advantage, combined with high-definition wide-angle visualization, exquisite endonasal microsurgical techniques, and devoted instrumentation facilitates a high rate of endocrine function preservation and visual improvement, while concurrently achieving comparable resections. Endoscopic skull base reconstruction with the vascularized nasoseptal flap has dramatically reduced the incidence of cerebrospinal fluid leak, consolidating endoscopic endonasal surgery as an effective and safe alternative for the treatment of these challenging tumors.
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Affiliation(s)
- Juan C Fernandez-Miranda
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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14
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Sughrue ME, Yang I, Kane AJ, Fang S, Clark AJ, Aranda D, Barani IJ, Parsa AT. Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma. J Neurooncol 2011; 101:463-76. [PMID: 20535527 PMCID: PMC3024496 DOI: 10.1007/s11060-010-0265-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 05/30/2010] [Indexed: 11/24/2022]
Abstract
Craniopharyngiomas are locally aggressive tumors which typically are focused in the sellar and suprasellar region near a number of critical neural and vascular structures mediating endocrinologic, behavioral, and visual functions. The present study aims to summarize and compare the published literature regarding morbidity resulting from treatment of craniopharyngioma. We performed a comprehensive search of the published English language literature to identify studies publishing outcome data of patients undergoing surgery for craniopharyngioma. Comparisons of the rates of endocrine, vascular, neurological, and visual complications were performed using Pearson's chi-squared test, and covariates of interest were fitted into a multivariate logistic regression model. In our data set, 540 patients underwent surgical resection of their tumor. 138 patients received biopsy alone followed by some form of radiotherapy. Mean overall follow-up for all patients in these studies was 54 ± 1.8 months. The overall rate of new endocrinopathy for all patients undergoing surgical resection of their mass was 37% (95% CI = 33-41). Patients receiving GTR had over 2.5 times the rate of developing at least one endocrinopathy compared to patients receiving STR alone or STR + XRT (52 vs. 19 vs. 20%, χ(2) P < 0.00001). On multivariate analysis, GTR conferred a significant increase in the risk of endocrinopathy compared to STR + XRT (OR = 3.45, 95% CI = 2.05-5.81, P < 0.00001), after controlling for study size and the presence of significant hypothalamic involvement. There was a statistical trend towards worse visual outcomes in patients receiving XRT after STR compared to GTR or STR alone (GTR = 3.5% vs. STR 2.1% vs. STR + XRT 6.4%, P = 0.11). Given the difficulty in obtaining class 1 data regarding the treatment of this tumor, this study can serve as an estimate of expected outcomes for these patients, and guide decision making until these data are available.
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Affiliation(s)
- Michael E. Sughrue
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Isaac Yang
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Ari J. Kane
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Shanna Fang
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Aaron J. Clark
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Derrick Aranda
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Igor J. Barani
- Department of Radiation Oncology, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Andrew T. Parsa
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
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Pekmezci M, Louie J, Gupta N, Bloomer MM, Tihan T. Clinicopathological Characteristics of Adamantinomatous and Papillary Craniopharyngiomas: University of California, San Francisco Experience 1985–2005. Neurosurgery 2010; 67:1341-9; discussion 1349. [DOI: 10.1227/neu.0b013e3181f2b583] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Melike Pekmezci
- Departments of Pathology and Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Jonathan Louie
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Nalin Gupta
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Michele M Bloomer
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Tarik Tihan
- Department of Pathology, University of California, San Francisco, San Francisco, California
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16
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Malignant transformation of craniopharyngioma: case report and review of the literature. J Neurooncol 2010; 103:719-25. [DOI: 10.1007/s11060-010-0407-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 09/06/2010] [Indexed: 11/30/2022]
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17
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De novo malignant craniopharyngioma: case report and literature review. J Neurooncol 2010; 103:381-6. [DOI: 10.1007/s11060-010-0382-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 08/20/2010] [Indexed: 11/27/2022]
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18
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Yang I, Sughrue ME, Rutkowski MJ, Kaur R, Ivan ME, Aranda D, Barani IJ, Parsa AT. Craniopharyngioma: a comparison of tumor control with various treatment strategies. Neurosurg Focus 2010; 28:E5. [PMID: 20367362 DOI: 10.3171/2010.1.focus09307] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Craniopharyngiomas have a propensity to recur after resection, potentially causing death through their aggressive local behavior in their critical site of origin. Recent data suggest that subtotal resection (STR) followed by adjuvant radiotherapy (XRT) may be an appealing substitute for gross-total resection (GTR), providing similar rates of tumor control without the morbidity associated with aggressive resection. Here, the authors summarize the published literature regarding rates of tumor control with various treatment modalities for craniopharyngiomas. METHODS The authors performed a comprehensive search of the English language literature to identify studies publishing outcome data on patients undergoing surgery for craniopharyngioma. Rates of progression-free survival (PFS) and overall survival (OS) were determined through Kaplan-Meier analysis. RESULTS There were 442 patients who underwent tumor resection. Among these patients, GTR was achieved in 256 cases (58%), STR in 101 cases (23%), and STR+XRT in 85 cases (19%). The 2- and 5-year PFS rates for the GTR group versus the STR+XRT group were 88 versus 91%, and 67 versus 69%, respectively. The 5- and 10-year OS rates for the GTR group versus the STR+XRT group were 98 versus 99%, and 98 versus 95%, respectively. There was no significant difference in PFS (log-rank test) or OS with GTR (log-rank test). CONCLUSIONS Given the relative rarity of craniopharyngioma, this study provides estimates of outcome for a variety of treatment combinations, as not all treatments are an option for all patients with these tumors.
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Affiliation(s)
- Isaac Yang
- Department of Neurological Surgery, University of California, San Francisco, California, USA
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19
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Aquilina K, Merchant TE, Rodriguez-Galindo C, Ellison DW, Sanford RA, Boop FA. Malignant transformation of irradiated craniopharyngioma in children: report of 2 cases. J Neurosurg Pediatr 2010; 5:155-61. [PMID: 20121363 DOI: 10.3171/2009.9.peds09257] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malignant transformation of craniopharyngioma is a rare event; only 3 cases have been reported in children, all in the Japanese literature. The authors describe 2 additional pediatric cases. Treatment in both of these cases consisted of multiple resections and external beam radiation therapy (EBRT). Malignant transformation occurred 7 and 8 years after EBRT. The authors also review another 6 cases in adults. A possible causative association with radiation therapy is discussed. As radiation is currently an important option in the management of craniopharyngiomas, this association requires further study.
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Affiliation(s)
- Kristian Aquilina
- Department of Neurosurgery, Frenchay Hospital, Bristol, United Kingdom
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21
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UJIFUKU K, MATSUO T, TAKESHITA T, HAYASHI Y, HAYASHI K, KITAGAWA N, HAYASHI T, SUYAMA K, NAGATA I. Malignant Transformation of Craniopharyngioma Associated With Moyamoya Syndrome -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:599-603. [DOI: 10.2176/nmc.50.599] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kenta UJIFUKU
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Takayuki MATSUO
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Tomonori TAKESHITA
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Yukishige HAYASHI
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kentaro HAYASHI
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Naoki KITAGAWA
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Kazuhiko SUYAMA
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Izumi NAGATA
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
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22
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Nishioka H, Shibuya M, Izawa H, Ikeda Y. Primary suprasellar malignant tumor with odontogenic features: case report. Neurosurgery 2009; 65:E380-2; discussion E382. [PMID: 19625894 DOI: 10.1227/01.neu.0000349923.24247.d1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Primary malignant odontogenic tumors in the suprasellar region have rarely been reported. CLINICAL PRESENTATION A partially cystic tumor that originated from the stalk and showed rapid enlargement was observed in a 56-year-old woman. INTERVENTION Gross total removal of the tumor was performed with sacrifice of the stalk. The tumor was a malignant epithelial type with odontogenic features, whereas findings consistent with craniopharyngioma were absent. The tumor recurred 14 months after surgery. CONCLUSION The present unusual tumor may represent a novel member of malignant tumors of the suprasellar region. Given the common embryological origin of craniopharyngiomas to odontogenic lesions, a possible correlation with craniopharyngioma was suggested.
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Affiliation(s)
- Hiroshi Nishioka
- Department of Neurosurgery, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan.
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23
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Boongird A, Laothamatas J, Larbcharoensub N, Phudhichareonrat S. Malignant craniopharyngioma; case report and review of the literature. Neuropathology 2009; 29:591-6. [DOI: 10.1111/j.1440-1789.2008.00986.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Abstract
Apart from pituitary adenomas, a number of tumours may arise from within the sella presenting a diagnostic and therapeutic challenge at a multidisciplinary specialist level. This article focus on the most commonly diagnosed non-adenomatous pituitary tumours (craniopharyngiomas, Rathke's cleft cysts and meningiomas) and provides data on their pathogenesis, diagnosis and treatment.
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Affiliation(s)
- Niki Karavitaki
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Old Rd, Headington, Oxford OX3 7LE, UK
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25
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Elliott RE, Moshel YA, Wisoff JH. Surgical treatment of ectopic recurrence of craniopharyngioma. Report of 4 cases. J Neurosurg Pediatr 2009; 4:105-12. [PMID: 19645541 DOI: 10.3171/2009.3.peds0948] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Local recurrence following radical resection is one of the most common complications of pediatric craniopharyngioma. Only 28 cases of ectopic recurrence of craniopharyngioma have been reported in the literature, and only 13 cases occurred in patients originally treated as children. In this consecutive series of 86 children who underwent radical resection of primary and recurrent craniopharyngiomas, 4 patients (4.7%) experienced ectopic tumor recurrence, accounting for 27% of all recurrences after gross-total resection. The authors report on the successful surgical treatment of these 4 patients and the impact of ectopic craniopharyngioma recurrence on survival.
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Affiliation(s)
- Robert E Elliott
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
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26
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Tena-Suck ML, Ortiz-Plata A, Galán F, Sánchez A. Expression of epithelial cell adhesion molecule and pituitary tumor transforming gene in adamantinomatous craniopharyngioma and its correlation with recurrence of the tumor. Ann Diagn Pathol 2009; 13:82-8. [DOI: 10.1016/j.anndiagpath.2008.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Chang CV, Nunes VDS, Felicio AC, Zanini MA, Cunha-Neto MBC, Castro AVBD. Mixed germ cell tumor of the pituitary-hypothalamic region presenting as craniopharyngioma: case report and review of the literature. ACTA ACUST UNITED AC 2008; 52:1501-4. [DOI: 10.1590/s0004-27302008000900015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Accepted: 09/05/2008] [Indexed: 11/22/2022]
Abstract
Craniopharyngiomas and germ cell tumors (GCT) may affect the pituitary-hypothalamic region during childhood. Although different in origin, their clinical and radiological features may be similar. In this article we present a 5-year-old girl with clinical and radiological findings (computer tomography calcification) that were initially considered as craniopharyngioma. However clinical outcome, blood and cerebral spinal fluid tumoral markers, and results from anatomopathology and immunohistochemistry disclosed a mixed GCT. This case report highlights that some clinical features and radiological findings of pituitary-hypothalamic tumors may be misdiagnosed as craniopharyngioma mainly when there is a mature teratoma with cartilaginous tissue differentiation.
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Affiliation(s)
- Claudia Veiga Chang
- Faculdade de Medicina de Botucatu, Brasil; Universidade Federal de São Paulo
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28
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Peralta Watt M, Peñalver Talavera D. Panhypopituitarism due to craniopharyngioma associated with hyperthyroidism caused by graves' disease. ACTA ACUST UNITED AC 2008; 55:297-300. [PMID: 22975522 DOI: 10.1016/s1575-0922(08)72184-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 04/21/2008] [Indexed: 11/28/2022]
Abstract
Craniopharyngiomas are unusual tumors that are mainly located in the sella turcica or parasellar structures. These tumors can produce multiple neurological and visual symptoms or manifestations due to involvement of the hypothalamic-pituitary axis. Pituitary manifestations can be produced by involvement of the anterior or posterior pituitary and contribute to the substantial morbidity and mortality associated with these tumors, despite their benign histology. We present the case of a woman with a craniopharyngioma that produced panhypopituitarism and diabetes insipidus, in whom diagnosis was hampered by the development of primary hyperthyroidism due to Graves' disease during the diagnostic process.
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Affiliation(s)
- María Peralta Watt
- Unidad de Endocrinología y Nutrición. Hospital Virgen del Puerto. Plasencia. Cáceres. España.
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29
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Abstract
Craniopharyngiomas are epithelial tumors arising along the path of the craniopharyngeal duct and presenting with a variety of manifestations. Their optimal management remains a subject of debate. Currently, surgical excision followed by external beam irradiation is the main treatment option. Craniopharyngiomas are associated with significant long-term morbidity and mortality rates.
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Affiliation(s)
- Niki Karavitaki
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology, and Metabolism, Old Road, Headington, Oxford, OX3 7LJ, United Kingdom
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30
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Rodriguez FJ, Scheithauer BW, Tsunoda S, Kovacs K, Vidal S, Piepgras DG. The Spectrum of Malignancy in Craniopharyngioma. Am J Surg Pathol 2007; 31:1020-8. [PMID: 17592268 DOI: 10.1097/pas.0b013e31802d8a96] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Craniopharyngiomas are low-grade epithelial neoplasms occurring almost exclusively in the sellar/suprasellar region. Histologic malignancy is extremely rare; the literature consists mostly of isolated case reports. Herein, we report 3 patients with craniopharyngiomas exhibiting histologic malignancy, 2 of which received radiation therapy before its appearance. Hematoxylin and eosin-stained slides and selected immunohistochemical stains were reviewed in all cases. Microvessel density analysis was performed in case 2. The patients included 2 men and 1 woman, age 14, 31, and 58 years at presentation, respectively. All patients expired 3 months to 9 years after first resection and 3 to 9 months after identification of histologic malignancy. The latter developed after multiple recurrences and radiation therapy in 2 cases, but seemed to arise de novo in 1 case resembling odontogenic ghost cell carcinoma and lacking any definite low-grade craniopharyngioma precursor. The malignant component of the other 2 cases resembled squamous cell carcinoma and low-grade myoepithelial carcinoma, respectively. The MIB-1 labeling index was markedly increased in the malignant component in comparison with the low-grade precursor. Malignant transformation in craniopharyngiomas, although rare, does exist. It assumes varied histologic appearances, usually after multiple recurrences and radiation therapy, and has a near uniformly fatal outcome. De novo malignancy in odontogenic tumors of the sella is even more unusual, but also has an ominous prognosis.
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Affiliation(s)
- Fausto J Rodriguez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
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31
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Tena-Suck ML, Salinas-Lara C, Arce-Arellano RI, Rembao-Bojórquez D, Morales-Espinosa D, Sotelo J, Arrieta O. Clinico-pathological and immunohistochemical characteristics associated to recurrence/regrowth of craniopharyngiomas. Clin Neurol Neurosurg 2006; 108:661-9. [PMID: 16500745 DOI: 10.1016/j.clineuro.2006.01.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Revised: 01/04/2006] [Accepted: 01/16/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Craniopharyngioma is a rare, benign epithelial brain tumor of the suprasellar region with a high rate of recurrence. Clinical and histopathological features that might be predictors of recurrence/regrowth have not been clearly delineated. METHODS We compared recurrence/regrowth of the tumors with the clinico-pathological characteristics, vascular density, cell proliferation index, and immunohistochemical profile (cytokeratins, epithelial membrane antigen [EMA], carcinoembrionary antigen [CEA], and laminin) of 47 patients with craniopharyngioma followed for more than 5 years. RESULTS Tumors were adamantinomatous in 42 cases (89%) and papillary squamous in 5 cases (11%). Immunoreactivity for cytokeratin 8/18/19 was positive in 64%; cytokeratin 5 in 42%; laminin 8 in 62%; and CEA in 21%. The cell proliferation index and vascular density were greater in adamantinomatous than in papillary tumors (22+/-6 versus 17+/-3, p=0.05; and 21+/-3 versus 17+/-3, p=0.037, respectively); they were neither related to recurrence nor to regrowth. No significant differences were found between adamantinomatous and papillary tumors regarding the presence of cytokeratin, laminin, CEA or glial fibrillary acidic protein (GFAP). Recurrence rate at 5 years was 59%. No relation was found between recurrence and adjuvant radiotherapy (AR). Residual tumor after surgery, whorl-like arrays (p=0.04) and immunoreactivity for p53 (p=0.022) were significantly related to recurrence/regrowth. CONCLUSIONS Residual tumor after surgery, immunoreactivity to p53 and presence of whorl-like arrays are associated to recurrence/regrowth of craniopharyngioma.
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Abstract
Craniopharyngiomas are rare, mainly sellar/parasellar, epithelial tumors diagnosed during childhood or adult life. Histologically, two primary subtypes have been recognized (adamantinomatous and papillary) with an as yet, unclarified pathogenesis. They may present with a variety of manifestations (neurological, visual, and hypothalamo-pituitary). Despite their benign histological appearance, they often show an unpredictable growth pattern, which, combined with the lack of randomized studies, poses significant difficulties in the establishment of an optimal therapeutic protocol. This should focus on the prevention of recurrence(s), improvement of survival, reduction of the significant disease and treatment-related morbidity (endocrine, visual, hypothalamic, neurobehavioral, and cognitive), and preservation of the quality of life. Currently, surgical excision followed by external beam irradiation, in cases of residual tumor, is the main treatment option. Intracystic irradiation or bleomycin, stereotactic radiosurgery, or radiotherapy and systemic chemotherapy are alternative approaches; their place in the management plan remains to be assessed in adequately powered long-term trials. Apart from the type of treatment, the identification of clinical and imaging parameters that will predict patients with a better prognosis is difficult. The central registration of patients with these challenging tumors may provide correlates between treatments and outcomes and establish prognostic factors at the pathological or molecular level that may further guide us in the future.
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Affiliation(s)
- Niki Karavitaki
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, United Kingdom
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33
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Hamlat A, Hua ZF, Saikali S, Laurent JF, Gedouin D, Ben-Hassel M, Guegan Y. Malignant transformation of intra-cranial epithelial cysts: systematic article review. J Neurooncol 2005; 74:187-94. [PMID: 16193391 DOI: 10.1007/s11060-004-5175-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Epidermoid and dermoid cysts are among the most benign intra cranial tumors. Their malignant transformation into squamous cell carcinoma is rare. The authors reviewed the literature. MATERIALS AND METHODS MEDLINE and SCIENCE DIRECT searches, and examination of the references in the selected articles yielded 74 patients, 52 of whom fulfilled Garcia's criteria and were selected for the study. Survival analyses were performed to determine whether survival differences were of statistical significance, and P < 0.05 was considered as significant. RESULTS Malignant transformation is characterized by a rapid onset of symptoms, recurrence, leptomeningeal carcinomatosis (LC), and tumor enhancement at Computed Tomography Scan or Magnetic Resonance Imaging (87.8 showed this radiological feature). In this review, the SCCs were classified in five groups: (1) Initial malignant transformation of a benign cyst; (2) malignant transformation from a remnant cyst; (3) malignant transformation of a dermoid and epithelial cyst; (4) malignant transformation with leptomeningeal carcinomatosis; (5) other malignancies arising from benign cysts. The median survival was 9 months. Statistics show that LC was of poor prognosis and radiotherapy, although not statistically significant, seems effective against such lesions, with a median survival of 26 months as opposed to 3 months (P=0.077). CONCLUSION Although rare, malignant transformation of intracranial epithelial cysts has a poor prognosis and surgery followed by radiotherapy seems to be the best therapeutic modality.
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Affiliation(s)
- Abderrahmane Hamlat
- Department of Neurosurgery, Service de Neurochirurgie, CHRU Pontchaillou, Rue Henry Le Guilloux, 35000 Rennes Cedex 2, France.
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Rakheja D, Meehan JJ, Gomez AM. Pathologic quiz case: sphenoid sinus mass in a 12-year-old girl. Infrasellar adamantinomatous craniopharyngioma. Arch Pathol Lab Med 2005; 129:e73-4. [PMID: 15737054 DOI: 10.5858/2005-129-e73-pqcssm] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dinesh Rakheja
- Department of Pathology, Children's Medical Center of Dallas, Dallas, USA.
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35
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Tomita T, Bowman RM. Craniopharyngiomas in children: surgical experience at Children's Memorial Hospital. Childs Nerv Syst 2005; 21:729-46. [PMID: 16044343 DOI: 10.1007/s00381-005-1202-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Craniopharyngioma during childhood poses difficulty in management because of the high incidence of surgical complications and treatment failure. In order to identify less detrimental and more effective treatment, a personal series of craniopharyngioma was reviewed in regard to various clinical factors, patient factors (age and sex), tumor factors (location and extension, relationship with chiasm, and hydrocephalus), and therapeutic modes [extent of resection and radiation therapy (RT)]. MATERIALS AND METHODS Fifty-four childhood craniopharyngiomas treated from 1984 to 2003 were reviewed. Preoperative neuroimaging studies were classified depending upon tumor location and extension. In this series of 54 patients, 43 had total tumor resection and 11 had subtotal resection. Of the total resection group, ten showed evidence of residual tumor on postoperative neuroimaging studies. Following the initial resection, 46 did not have RT whereas 8 with subtotal resection received RT. RESULTS There were no surgical deaths. Postoperative complications included pseudoaneurysm in 1, hemiparesis in 3, severe obesity in 5, panhypopituitarism in 50, and worsening of visual function in 7. During follow-up ranging from 12 months to 21 years, 24 patients had recurrence. Of the 33 patients with radiographic total resection, 9 (27.3%) had recurrence. Among the patients with total resection but radiographic residual and those with subtotal resection, the craniopharyngioma recurred in 90% and 100%, respectively. Three (37.5%) of eight patients with subtotal resection with RT had recurrence. Overall recurrence-free survival was 62% at 5 years and 49% at 10 years. The sex and age, location and extension of the tumor, nature of the optic chiasm, and hydrocephalus did not influence survival with statistical significance. However, the extent of surgical resection and use of RT showed significant differences for survival. Patients with total resection had a recurrence-free survival rate of 83% and 70% at 5 and 10 years, respectively. Patients with subtotal resection with RT had 71% at 5 years and 36% at 10 years. Patients who had subtotal resection or radiographically residual tumor without RT had a recurrence-free survival rate of only 9%. Among 22 patients whose recurrent tumor was treated with RT, a second recurrence-free survival rate was 90% at 5 years. CONCLUSION Total resection provided the best outcome. However, recurrence rates and surgical complications remained high following radical tumor resection. RT was effective for recurrent tumors and should be considered being the primary treatment for recurrences or difficult tumors, which are not amenable to total resections.
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Affiliation(s)
- Tadanori Tomita
- Division of Pediatric Neurosurgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Plowman PN, Besser GM, Shipley J, Summersgill B, Geddes J, Afshar F. Dramatic response of malignant craniopharyngioma to cis-platin-based chemotherapy. Should craniopharyngioma be considered as a suprasellar 'germ cell' tumour? Br J Neurosurg 2005; 18:500-5. [PMID: 15799153 DOI: 10.1080/02688690400012400] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The case is described of a 21-year-old woman, who developed a malignant tumour arising from a craniopharyngioma 14 years after the original diagnosis. The remarkable response of this malignant tumour ex-craniopharyngioma to cis-platin based chemotherapy, together with other midline tumour characteristics of craniopharyngioma, raise the question as to whether craniopharyngioma should any longer be separately considered from suprasellar germ cell tumour. This subject is discussed.
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Affiliation(s)
- P N Plowman
- Department of Clinical Oncology, St Bartholomew's Hospital, London, UK
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Larijani B, Bastanhagh MH, Pajouhi M, Kargar Shadab F, Vasigh A, Aghakhani S. Presentation and outcome of 93 cases of craniopharyngioma. Eur J Cancer Care (Engl) 2004; 13:11-5. [PMID: 14961770 DOI: 10.1111/j.1365-2354.2003.00433.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We studied a series of 93 patients diagnosed with craniopharyngioma during a 15-year period with respect to presenting symptom, clinical course and management. The majority (62%) of patients were men, and had presented with neurological symptoms (75%), with headaches (82%) being the most common presenting symptom. The incidence of certain endocrine and ophthalmic symptoms varied little from that in the literature, on the other hand, the incidence of certain other symptoms did differ markedly from the literature. For example, loss of libido and amenorrhoea were seen at a much lower frequency than that stated in the literature. Hypertension, sensorimotor symptoms and urinary incontinence were not seen at all in our patients. In most cases diagnosis was made by a cranial CT scan, which is more sensitive than plain radiography for detection of enlarged sella turcica (69% vs. 24%; P < 0.001). In over 90% of cases, therapy consisted of removal of a variable portion of the tumour, with or without radiotherapy. Post-operative mortality was substantially reduced in cases treated by radiotherapy (P < 0.05). The most common post-operative complications in all cases were recurrence of disease, panhypopituitarism and diabetes insipidus.
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Affiliation(s)
- B Larijani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Lubansu A, Ruchoux MM, Brotchi J, Salmon I, Kiss R, Lefranc F. Cathepsin B, D and K expression in adamantinomatous craniopharyngiomas relates to their levels of differentiation as determined by the patterns of retinoic acid receptor expression. Histopathology 2003; 43:563-72. [PMID: 14636257 DOI: 10.1111/j.1365-2559.2003.01751.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the potential predictive value of cathepsins B, D and K in a series of 51 adamantinomatous craniopharyngiomas. While almost always benign, craniopharyngiomas exhibit a high propensity to recur postsurgically and biological markers are therefore needed to predict their recurrence. We have previously demonstrated the potential predictive value of retinoic acid receptors (RARs) (Lefranc et al., J. Neurosurg. 2003; 98; 145-153). METHODS AND RESULTS Computer-assisted microscopy was used to determine quantitatively the immunohistochemical levels of expression of the alpha, beta and gamma RAR subtypes and cathepsins B, D and K. The levels of expression of cathepsin D and of cathepsin B correlated significantly with the levels of expression of RARbeta. The levels of expression of cathepsin K correlated significantly with the levels of expression of RARgamma. CONCLUSIONS Recurrent adamantinomatous craniopharyngiomas are characterized by low levels of RARbeta and high levels of RARgamma. The tendency to recurrence seems, at least partly, to relate to the fact that (i) craniopharyngiomas with low levels of RARbeta express low levels of cathepsin D, and (ii) craniopharyngiomas with high levels of RARgamma express high levels of cathepsin K.
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Affiliation(s)
- A Lubansu
- Department of Neurosurgery, Erasmus University Hospital, Brussels, Belgium
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Zee CS, Go JL, Kim PE, Mitchell D, Ahmadi J. Imaging of the pituitary and parasellar region. Neurosurg Clin N Am 2003; 14:55-80, vi. [PMID: 12690979 DOI: 10.1016/s1042-3680(02)00034-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The pituitary is part of a chain of enormous biologic amplification, which is regulated by a small amount of releasing factors in the portal blood from the hypothalamus. The pituitary is a master gland that regulates a number of hormones. A subtle abnormality in the pituitary can cause significant changes in body metabolism. Because the pituitary glands are small structures, high-resolution imaging techniques are required to satisfactorily evaluate the gland. It is imperative for the radiologist to be familiar with the anatomy, physiology, and pathology of the pituitary gland, which provides a solid foundation for accurate interpretation of the imaging studies of the pituitary gland.
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Affiliation(s)
- Chi S Zee
- Department of Imaging, University of Southern California University Hospital, 1500 San Pablo Street, Los Angeles, CA 90033, USA.
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Plzák J, Haninec P, Smetana K, Holíková Z, André S, Kuwabara I, Liu FT, Gabius HJ. Craniopharyngioma: a case report and comparative galectin histochemical analysis. THE HISTOCHEMICAL JOURNAL 2002; 34:117-22. [PMID: 12495217 DOI: 10.1023/a:1020934329211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Craniopharyngioma is a rare benign tumour originating from Rathke's pouch. This paper reports a tumour case studied with a set of markers defining protein-carbohydrate recognition. Expression of endogenous lectins and their reactive glycoligands is under differentiation-dependent control in many cell types. These parameters can be related to the degree of cell differentiation in tumours. Therefore, the expression patterns of endogenous lectins, namely galectins-1, -3, and -7, in the craniopharyngioma case were determined. Galectins-1 and -3 were also used to reveal glycoconjugates in cells and extracellular matrices, an approach that has heretofore relied largely on plant lectins. The staining pattern of craniopharyngioma is compared with that of two other types of ectodermally derived tumours, namely basal and squamous cell carcinomas. Clusters of polygonal and flattened cells with morphological characteristics of differentiated cells in the craniopharyngioma and the majority of poorly differentiated cells in squamous cell carcinomas were reactive with galectin-3. No binding of this probe was observed in cells of basal cell carcinomas and the majority of craniopharyngioma cells. In view of the lack of accessible binding in the basal layer of normal squamous epithelia where proliferative cells (including stem cells) are located, galectin-3 binding could be used to distinguish basal from suprabasal cells of squamous epithelial cells.
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Affiliation(s)
- Jan Plzák
- 1st Faculty of Medicine, Institute of Anatomy, Charles University, Prague, Czech Republic
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Vidal S, Kovacs K, Lloyd RV, Meyer FB, Scheithauer BW. Angiogenesis in patients with craniopharyngiomas: correlation with treatment and outcome. Cancer 2002; 94:738-45. [PMID: 11857307 DOI: 10.1002/cncr.10281] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Craniopharyngiomas are histologically benign epithelial neoplasms of the sellar region that often exhibit aggressive and invasive growth. The authors hypothesized that tumor proliferation, spread, and recurrence are angiogenesis dependent and investigated the significance of vascularization relative to biologic behavior. To the authors' knowledge, angiogenesis for patients with craniopharyngiomas has not been examined to date. METHODS The authors measured microvessel densities in resected, histologically proven craniopharyngiomas using immunostains for CD-34, a monoclonal antibody that selectively recognizes endothelial cells. Both histologic types of craniopharyngiomas, adamantinomatous and papillary, were included in the study. In addition, the cellular distribution of vascular endothelial growth factor (VEGF), a strong stimulator of new vessel formation, was assessed by both immunohistochemistry and in situ hybridization for VEGF receptor 2 (VEGFR-2) mRNA expression. RESULTS Histologically, small numbers of capillaries were identified in temporal stroma but not in their epithelial components. Immunohistochemistry revealed strong, conclusive cytoplasmic immunoreactivity for VEGF in the epithelial cells of both adamantinomatous craniopharyngiomas and papillary craniopharyngiomas. In situ hybridization showed that VEGFR-2 mRNA was expressed widely, not only in neoplastic epithelium but also in capillary endothelium. CONCLUSIONS Tumors with greater microvessel density regrow more frequently compared with tumors that have lower microvessel density, suggesting that the extent of angiogenesis is of prognostic value in patients with craniopharyngioma. VEGFR-2 may act as a key modulator of VEGF activity in endothelial cells and nonendothelial cells, indicating that VEGF plays an important role in the behavior of craniopharyngiomas.
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Affiliation(s)
- Sergio Vidal
- Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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