Comparative Immunohistochemical Assessment of Craniopharyngioma and Related Lesions

Le, Brian; Towfighi, Javad; Kapadia, Silloo B.; Lopes, M. Beatriz S.

doi:10.1007/s12022-007-0011-y

Cited by 50 publications

(52 citation statements)

References 24 publications

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“…2,7,56,63,108 The higher recurrence rates observed in RCCs with squamous metaplasia support the idea that these are likely more aggressive lesions that more closely approach the natural history of CP. 2 The presence of stratified squamous epithelial cells in a minority of RCCs, as well as the higher MIB-1 labeling indexes associated with these lesions, also lends support to the theory that at least a subset of CPs may develop from such transitional intermediaries.…”

mentioning

confidence: 75%

“…Squamous metaplasia of RCCs has been noted in 9-39% of patients and is associated with higher rates of cyst recurrence. 2,56,63 Similarly, stratified squamous epithelium occurs in a minority of RCCs and is thought to pose a higher risk for cyst recurrence. 56 There is a tendency for RCCs to develop attachment to the pituitary stalk, which plays a major in the development of postoperative diabetes insipidus and pituitary insufficiency following complete cyst removal.…”

Section: Typical Histopathological Features Of Rccsmentioning

confidence: 99%

“…82 A major limitation of these reports, however, is that for any given case it cannot been proven with certainty that a CP neoplasm actually arose from a preexisting RCC. The possibilities of coexisting lesions or dif- stratified squamous epithelium, pseudopapillae 28-33% in adults, 2% in children 0-12% adamantinomatous 1,26,109 adamantoid epithelium, wet keratin 66-68% in adults, 96-100% in children 13-22% xanthogranuloma 63,83 xanthogranulomatous component, little epithelium (usually squamous) 34% of suspected CPs unknown epidermoid cyst 20,31,112 squamous epithelium, dry keratin, keratohyaline granules <1% of primary CNS lesions 0-26% * Superscripted numbers indicate studies discussing the respective lesion.…”

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confidence: 99%

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Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships

Zada¹,

Lin²,

Ojerholm³

et al. 2010

FOC

227

176

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Object Cystic epithelial masses of the sellar and parasellar region may be difficult to differentiate on a clinical, imaging, or even histopathological basis. The authors review the developmental relationships and differentiating features of various epithelial lesions of the sellar region. Methods The authors performed a review of the literature to identify previous studies describing the etiological relationships and differentiating features of various cystic sellar lesions, including craniopharyngioma (CP), Rathke cleft cyst, xanthogranuloma, and dermoid and epidermoid cysts. Results There is significant evidence in the literature to support a common ectodermal origin of selected sellar and suprasellar cystic lesions, which may account for the overlap of features and transitional states observed in some cases. Research obtained from animal studies and reports of transitional cystic epithelial masses or lesions crossing over from typical to more aggressive pathological subtypes have collectively provided a solid foundation for this theory. Histological features that signify transitional entities beyond simple benign Rathke cleft cysts include squamous metaplasia, stratified squamous epithelium, and ciliated or mucinous goblet cells in squamous-papillary CPs. Several studies have identified key clinical, imaging, and histopathological features that can be used in the differentiation of these lesions. Conclusions The pattern of embryological formation of the hypothalamic-pituitary axis plays a major role in its propensity for developing cystic epithelial lesions. Subsequent inflammatory, metaplastic, and neoplastic processes may promote further progression along the pathological continuum, ranging from benign epithelial cysts to aggressive neoplastic cystic CPs. Selected clinical, imaging, and histopathological features can be used collectively to help differentiate these lesions and assign a formal diagnosis, thus accurately guiding further treatment.

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confidence: 75%

Section: Typical Histopathological Features Of Rccsmentioning

confidence: 99%

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confidence: 99%

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Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships

Zada¹,

Lin²,

Ojerholm³

et al. 2010

FOC

227

176

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“…1,2,[14][15][16]20,25,26 Hence, the incidence of xanthogranulomas in Western countries is unclear. Likewise, the management of these lesions has been almost universally through craniotomy or microscopic transsphenoidal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…1,14 These lesions have been described to occur on a spectrum of transitional states from benign RCC to neoplastic CPs. 27 We report on the clinical and pathological findings in 4 documented patients with xanthogranulomas in the sellar region and the incidence of such lesions in the western hemisphere.…”

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confidence: 99%

Parasellar xanthogranulomas

Rahmani

Sukumaran

Donaldson

et al. 2015

JNS

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OBJECT Xanthogranulomas are rare inflammatory masses most often found in the skin and eye. The incidence of intracranial xanthogranulomas is 1.6%–7%, with those found in the sellar and parasellar region being exceedingly rare and their etiology controversial. Sellar and parasellar xanthogranulomas are rarely reported in the western hemisphere, and their incidence in Western countries is unknown. METHODS A prospectively acquired database of all endonasal endoscopic transsphenoidal surgeries performed at Weill Cornell Medical College was queried. Patients with histologically confirmed xanthogranulomas who were diagnosed and treated between 2003 and 2013 were included in the study. Patient history, demographic data, histological findings, and surgical approach were also evaluated. RESULTS A total of 643 endonasal endoscopic procedures had been performed at the time of this study. Four patients (0.6%) were identified as having a histologically confirmed xanthogranuloma of the parasellar region, compared with an incidence of 6.7% for craniopharyngioma (CP) and 2% for Rathke cleft cyst (RCC). The most common symptom was visual loss, followed by headache. Preoperative diagnosis was CP in all cases. All patients underwent extended endonasal endoscopic transsphenoidal surgery with gross-total resection. Two patients developed panhypopituitarism after surgery. There were no CSF leaks. The mean follow-up was 61 months, at which time there were no recurrences. The key histological features differentiating xanthogranulomas from CPs were accumulation of foamy macrophages, multinucleated foreign body giant cells, cholesterol clefts, and hemosiderin deposits without stratified squamous epithelium. These histological features appear commonly as part of the spectrum of a secondary inflammatory response in an RCC. CONCLUSIONS Parasellar xanthogranulomas most closely approximate CPs clinically but pathological evidence may suggest an RCC origin. Gross-total resection can be achieved through extended endonasal endoscopic transsphenoidal approaches, and is curative.

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

137

268

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Comparative Immunohistochemical Assessment of Craniopharyngioma and Related Lesions

Cited by 50 publications

References 24 publications

Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships

Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships

Parasellar xanthogranulomas

ICAR: endoscopic skull‐base surgery

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