Cholesterol granulomas presenting as sellar masses: a similar, but clinically distinct entity from craniopharyngioma and Rathke’s cleft cyst

Hernández-Estrada, Raúl A.; Kshettry, Varun R.; Vogel, Ashley; Curtis, Mark; Evans, James J.

doi:10.1007/s11102-016-0775-5

Cited by 21 publications

(56 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All patients underwent surgery, either transsphenoidal hypophysectomy, (5/6) or craniotomy (1/6) via techniques described previously [ 4 ]. The pituitary stalk was preserved in all but one case, wherein adherence of the tumour to the stalk necessitated sacrifice of the structure to obtain adequate tumour clearance as the pre-operative radiological diagnosis was thought to be craniopharyngioma.…”

Section: Resultsmentioning

confidence: 99%

“…Four patients in the studied cohort were female (67%). Larger case series have also identified a slight female preponderance, with one recent study identifying 16 (59%) females and 11 (41%) males within their 27-patient cohort [ 4 ]. The mean age of patients in this study was 29, in keeping with the largest case series of xanthogranulomatous pituitary lesions to date, which stated a mean age 27 [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pituitary xanthogranulomas: clinical features, radiological appearances and post-operative outcomes

et al. 2018

View full text Add to dashboard Cite

BackgroundXanthogranulomas are inflammatory masses most commonly found at peripheral sites such as the skin. Sellar and parasellar xanthogranulomas are rare and present a diagnostic challenge as they are difficult to differentiate from other sellar lesions such as craniopharyngiomas and Rathke’s cleft cysts pre-operatively. Their radiological imaging features are yet to be clearly defined, and clinical outcomes after surgery are also uncertain. This study reviews clinical presentation, radiological appearances, and clinical outcomes in a cohort of patients with pituitary xanthogranulomas.MethodsA prospectively maintained pituitary surgery database was screened for histologically confirmed pituitary xanthogranulomas between May 2011–December 2016. Retrospective case note assessments were then performed by three independent reviewers. Patient demographics, clinical presentations, imaging, and clinical outcomes were analysed.ResultsDuring the study period 295 endoscopic endonasal pituitary surgeries were performed. Six patients had confirmed pituitary xanthogranulomas (2%). Patients most commonly presented with visual field deficits and/or endocrine dysfunction. Common imaging features included: a cystic consistency, hyperintensity on T1-weighted MR images, and contrast enhancement either peripherally (n = 3) or homogenously (n = 3). The most common pre-operative endocrine deficits were hyperprolactinaemia and hypoadrenalism (at least one of which was identified in 4/6 patients; 66%). Thirty-three percent (2/6) of patients presented with diabetes insipidus. The most common post-operative endocrinological deficits were adrenocortical dysfunction (66%) and gonadotropin deficiency (66%). Visual assessments normalised in all six patients post-operatively. Gross total resection was achieved in all patients, and at median follow up of 33.5 months there were no cases of tumour recurrence.ConclusionsThe prevalence of pituitary xanthogranulomas in our series is higher than that suggested in the literature. Surgery restored normal vision to all cases, however four patients (67%) required long-term hormonal replacement post-operatively. Imaging features such peripheral rim enhancement, a suprasellar tumour epicentre, and the absence of both calcification or cavernous sinus invasion were identified as potential indicators that together should alert clinicians to the possibility of pituitary xanthogranuloma when assessing patients with cystic sellar and parasellar tumours.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pituitary xanthogranulomas: clinical features, radiological appearances and post-operative outcomes

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Since that time, numerous additional case reports of XG have suggested that, when an etiology can be identified at all, it is a hemorrhagic RCC that is implicated. In addition, since the report of Paulus et al , numerous examples of hemorrhagic and non‐hemorrhagic RCCs mimicking pituitary apoplexy have been published, underscoring the fact that bleeding into RCC may be both subclinical and clinically relevant .…”

Section: Introductionmentioning

confidence: 99%

Review of xanthomatous lesions of the sella

Kleinschmidt‐DeMasters

Lillehei

Hankinson

2017

Brain Pathology

View full text Add to dashboard Cite

Xanthomatous lesions of the sellar region have traditionally been divided into two separate categories, xanthomatous hypophysitis (XH) and xanthogranuloma (XG) of the sellar region. The seminal article on XH, a condition typified by foamy histiocytes and lymphoplasmacytic infiltrates in the pituitary gland/sellar region, but usually little or no hemosiderin pigment, detailed three patients. However, most reports since that time have been single cases, making understanding of the entity difficult. In contrast, the seminal report on XG, characterized by sellar region cholesterol clefts, lymphoplasmacytic infiltrates, marked hemosiderin deposits, fibrosis, multinucleated giant cells around cholesterol clefts, eosinophilic granular necrotic debris, and accumulation of macrophages, included 37 patients, allowing more insights into etiology. Few examples could be linked to adamantinomatous craniopharyngioma, and although ciliated epithelium similar to that of Rathke cleft cyst (RCC) was identified up to 35% of the 37 cases, it could not be proven that XG was related to hemorrhage into RCC. Case reports since that time, however, occasionally linked XG to RCC when an etiology could be identified at all, and a few recognized that a spectrum exists in xanthomatous lesions of the sella. They review literature, adding 23 cases from our own experience, to confirm that overlap occurs between XH and XG, and that the majority-but not all-can be linked to RCC leakage/rupture/hemorrhage. It was suggested that progressive accumulation of hemosiderin pigment in the lesion, possibly caused by the multiple episodes of bleeding, could account for the transition of at least some cases of XH to XG.

show abstract

“…We consulted Medline PubMed databases to investigate articles related to sellar XG over the past 10 years. Including our patient, we analyzed the clinical features of 29 patients from the papers published in English from 2008 to 2017 [ 1 2 3 4 5 6 7 ]. The patients included 15 males and 14 females, with a mean age of 28.3 years (range, 5–60 years).…”

Section: Discussionmentioning

confidence: 99%

Giant Sellar Xanthogranuloma after Surgical Treatment of Symptomatic Rathke's Cleft Cyst

Cho

Park

et al. 2018

Brain Tumor Res Treat

View full text Add to dashboard Cite

Extremely massive sellar xanthogranuloma (XG) are rare, and the surgical outcome and prognosis are not well known. XG remain unknown whether they are derived from Rathke's cleft cysts (RCCs) or craniopharyngiomas (CPs) following extensive inflammation and metaplasia, to the point that no epithelium is readily identifiable. These lesions usually tend to occur in younger patients (mean 28.3 years), have a smaller diameter, and remain primarily intrasellar region with infrequent calcification. This 36-year-old man presented our hospital with visual deterioration. At the time of visit, there were no neurological problems other than visual field defect and hormonal disorder. He visited our hospital in 2007 due to headache and decreased vision, and underwent transphenoid surgery for pituitary RCC. Since then, he has received treatment at our hospital for postoperative hormonal disorders. Through preoperative imaging study, the author suspected CP and underwent surgery. During the operation, the adhesion of the tumor to the surrounding major neurovascular structures was severe in the naked eyes, but the tumor could be removed more easily than expected. The postoperative histological findings were confirmed as XG. The postoperative course was uneventful. Compared to the previous literature, this case is a case where the size of XG is very large in a sellar region and it can be proved that it originated from the RCC. And regular follow-up is necessary to confirm the prognosis after surgery.

show abstract

Cholesterol granulomas presenting as sellar masses: a similar, but clinically distinct entity from craniopharyngioma and Rathke’s cleft cyst

Cited by 21 publications

References 20 publications

Pituitary xanthogranulomas: clinical features, radiological appearances and post-operative outcomes

Pituitary xanthogranulomas: clinical features, radiological appearances and post-operative outcomes

Review of xanthomatous lesions of the sella

Giant Sellar Xanthogranuloma after Surgical Treatment of Symptomatic Rathke's Cleft Cyst

Contact Info

Product

Resources

About