Differential Diagnosis of Suprasellar Tumors in Children

Warmuth‐Metz, Monika; Gnekow, Astrid; Müller, Hermann L.; Solymosi, L.

doi:10.1055/s-2004-832358

Cited by 84 publications

(63 citation statements)

References 25 publications

(32 reference statements)

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“…These results are in accordance with the previous observation that the occurrence of fluid-fluid levels within hemorrhagic pituitary tumors ranges from 48.1-55.8% (10,14). Additionally, hemorrhage within pituitary adenomas is common in patients with non-functioning adenomas and prolactinomas (9,(16)(17)(18)(19)(20)(21); although an earlier study suggests that GH-and ACTH-secreting pituitary adenomas are more likely to present apoplexy than others (22). This immunological variation may be due to the lack of specific clinical markers for non-functioning and FSH/LH tumors, which may remain undetected for many years until they become large enough to induce tumor ischemia (13,21).…”

Section: Discussionsupporting

confidence: 82%

Fluid-fluid level on magnetic resonance images may predict the occurrence of pituitary adenomas in cystic sellar-suprasellar masses

Xiao

Wang

Zhang

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to evaluate the value of identifying fluid-fluid level via preoperative magnetic resonance (MR) images in differentiating pituitary adenomas from craniopharyngioma, Rathke's cleft cyst (RCC), and other cystic sellar-suprasellar lesions. The data of 293 consecutive patients who underwent surgery for sellar-suprasellar lesions between July 2010 and December 2012 was retrospectively reviewed, and a total of 133 cystic cases were included in the present study. MR images and pathological features of all subjects were examined. Among the 133 cystic sellar-suprasellar masses, there were 78 cases of pituitary adenomas, 31 cases of craniopharyngioma, 21 cases of RCC, one case of epidermoid cyst and two cases of abscess. Fluid-fluid levels were identified n 43 cases (55.13%) of cystic pituitary adenomas, with a single fluid level in 23 cases, two fluid levels in 8 cases, and three levels or more in 12 cases. Two cases (6.45%) of craniopharyngioma, and one case (4.76%) of RCC presented single fluid level. No instances of fluid-fluid levels were observed in epidermoid cyst or abscess. Fluid-fluid levels were typically exhibited on axial T2-weighted images. The identification of fluid-fluid level in cysts provides useful diagnostic value in distinguishing pituitary adenoma from other sellar-suprasellar lesions. The findings of the present study suggest that a sellar-suprasellar mass with a fluid-fluid level inside the tumor is most likely a pituitary adenoma, particularly if multiple fluid levels are observed in the same tumor. The fluid-fluid level is typically clearly depicted on axial or sagittal MR images, suggesting subacute or chronic hemorrhage in pituitary adenomas.

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Section: Discussionsupporting

confidence: 82%

Fluid-fluid level on magnetic resonance images may predict the occurrence of pituitary adenomas in cystic sellar-suprasellar masses

Xiao

Wang

Zhang

et al. 2017

Experimental and Therapeutic Medicine

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“…Cranial magnetic resonance imaging (MRI) was prospectively performed according to the recommendations as part of the trial protocol KRANIOPHARYNGEOM 2000 (19,22) at diagnosis and at 3-month intervals during follow-up. The assessment of progression or recurrence was based on MRI and prospectively confirmed by reference panel in all cases.…”

Section: Neuroimagingmentioning

confidence: 99%

Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up

Müller

Gebhardt²,

Teske³

et al. 2011

European Journal of Endocrinology

238

246

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Background: Hypothalamic obesity has major impact on prognosis and quality of life (QoL) in childhood craniopharyngioma. Patients and methods: For this study, 120 patients were prospectively recruited during 2001 and 2007 and evaluated after 3 years of follow-up (KRANIOPHARYNGEOM 2000). Body mass index (BMI) and QoL at diagnosis and 36 months after diagnosis were analysed based on the reference assessment of tumour localisation and post-surgical hypothalamic lesions. Treatment was analysed based on the neurosurgical strategy of 50 participating neurosurgical centres, the centre size based on the patient load. Results: BMI SDS at diagnosis was similar in patients with or without hypothalamic involvement. Surgical lesions of anterior and posterior hypothalamic areas were associated with higher increase in BMI SDS during 36 months post-diagnosis compared with patients without or only anterior lesion (C1.8 BMISD, PZ0.033, C2.1 BMISD; PZ0.011), negative impact on QoL in patients with posterior hypothalamic lesions. Surgical strategies varied among the 50 neurosurgical centres (three largesized, 24 middle-sized and 23 small-sized centres). Patients treated in small-sized centres presented with a higher rate of hypothalamic involvement compared with those treated in the middle-and largesized centres. Treatment in large-sized centres was less radical, and the rates of complete resection and hypothalamic surgical lesions were lower in large-sized centres than those of the middle-and smallsized centres. However, a multivariable analysis showed that pre-operative hypothalamic involvement was the only independent risk factor for severe obesity (PZ0.002). Conclusions: Radical neurosurgical strategies leading to posterior hypothalamic lesions are not recommended due to the potential to exacerbate hypothalamic obesity and impaired QoL. Treatment should be confined to experienced multidisciplinary teams.

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“…If this occurs while the tumor contracts, it can be unclear whether the tumor involves the optic nerve or is a new mass formation in front of the neurohypophseal germinoma without infiltrating the pituitary stalk. There is no difference in treatment according to the region of occurrence of the germinoma, but differentiation with craniophalyngioma, chiasmatic/hypothalamic low-grade gliomas, Langerhans cell histiocytosis and lymphocytic hypophysitis is needed when a tumor is large [13]. Also, it is necessary to differentiate optic nerve germinoma as well as optic sheath meningioma, infectious or granulomatous neuritis, orbital pseudotumor, lymphoma, medulloepithetlioma of the optic nerve and metastasis even if the mass is limited to the optic nerve [10].…”

Section: Discussionmentioning

confidence: 99%

Outcome of Vision Impairment and Diabetes Insipidus in Suprasellar Region Germinoma

Utsuki¹,

Oka²,

Miyajima³

et al. 2011

IJCM

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Differential Diagnosis of Suprasellar Tumors in Children

Cited by 84 publications

References 25 publications

Fluid-fluid level on magnetic resonance images may predict the occurrence of pituitary adenomas in cystic sellar-suprasellar masses

Fluid-fluid level on magnetic resonance images may predict the occurrence of pituitary adenomas in cystic sellar-suprasellar masses

Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up

Outcome of Vision Impairment and Diabetes Insipidus in Suprasellar Region Germinoma

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