Granulomatous Hypophysitis Caused by a Ruptured Intrasellar Rathke's Cleft Cyst: Report of a Case and Review of the Literature

Roncaroli, Federico; Bacci, A.; Frank, Giorgio; Calbucci, Fabio

doi:10.1097/00006123-199807000-00092

Cited by 58 publications

(54 citation statements)

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“…Rupture of RCC led to a chronic inflammatory reaction caused by leakage of cyst contents into the adjacent tissue. 16 15) Granulomatous change found in adamantinomatous craniopharyngioma should be recognized as a secondary reaction similar to that seen with RCC. We think that this is reasonable because craniopharyngioma and RCC have the same pathological origin.…”

Section: Discussionmentioning

confidence: 99%

“…7) Only 13 cases of RCC with granulomatous change have been diagnosed by pathological examination (Table 1). 1,[4][5][6][8][9][10][11][12][13]16,18,20) Four cases showed xanthogranulomatous change (Cases 3, 4, 6, and 8) and 2 cases had ossification of the cyst wall (Cases 6 and 8). Another case of ossifying xanthogranuloma in the dermis was described as being secondary to a metaplastic process.…”

Section: Discussionmentioning

confidence: 99%

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Rathke's Cleft Cyst With Xanthogranulomatous Change -Case Report-

Miyajima

Oka

Utsuki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Fig. 1 Computed tomography scans showing a solid intrasellar lesion appearing isodense with rod-like calcification (arrow). AbstractA 58-year-old man presented with a rare case of Rathke's cleft cyst (RCC) manifesting as headache and visual disturbance. Goldman's perimeter showed he had bitemporal hemianopia. Magnetic resonance imaging revealed a solid intrasellar lesion. He underwent surgery via a right pterional approach. The lesion was red, solid, and fibrous. Histological examination revealed a few columnar epithelial cells with poor cilia in a xanthogranulomatous lesion. Only 13 cases of RCC with granulomatous change have been diagnosed by pathological examination, including 4 xanthogranulomatous cases. Xanthogranuloma of the sellar region is relatively rare. The etiology is still unknown. We speculate that xanthogranulomas of the sellar region may be caused by reaction to the presence of RCC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rathke's Cleft Cyst With Xanthogranulomatous Change -Case Report-

Miyajima

Oka

Utsuki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…They found ciliated columnar cells, foamy cells, and lymphoid cells in the anterior and posterior pituitary, and fibrosis in the adenohypophysis. Meanwhile, Roncaroli et al 24 reported a granulomatous hypophysitis caused by a ruptured RCC. They found that the anterior pituitary gland was entirely altered by noncaseous giant cell granulomas that contained eosinophilic amorphous material, calcium deposits, mature lymphocytes, plasma cells, and neutrophils.…”

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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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“…Histologic analysis revealed discontinuation of the epithelial line in the RCC [15] , abundant inflammatory cells and fibrosis, compatible with granulomatous inflammation in the anterior pituitary gland [15] .…”

Section: Clinical Casementioning

confidence: 95%

“…Chronic inflammatory reaction is caused by extravased fluid cyst content into the adjacent gland [15] . Radiologically, the lesion seemed as an intrasellar mass with a cystic component indistinguishable from a pituitary adenoma with cystic degeneration, have been demonstrated mucins produced by cells lining the cyst wall caused the granulomatous giant cell reaction [6,15] .…”

Section: Clinical Casementioning

confidence: 99%

Xanthogranulomatous hypophysitis due to craniopharyngioma rupture: a case report

Tena-Suck

Palacios-Ortiz

Martinez

et al. 2015

CRCP

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Introduction: Hypophysitis is a rare, inflammatory disorder of the pituitary that mimics neoplastic lesions resulting in anterior and posterior pituitary dysfunction. Presentation of case:We present a 36-year-old woman who presented with chronic headaches and was found to have a pituitary mass on MRI, suggested of craniopharyngioma, and the histological inspection showed a piloide gliosis, one year ago. She continuing with visual disturbance and recurrence was suspected and she was operated to craniopharyngioma. After that, she showed clinical and radiologically symptoms of recurrence and was reopeated which biopsied was reported as xantogranulomatosous hypophysitis.Discussion: This woman illustrates a rare pituitary pathology presented with a literature review of published patients describing xanthomatous hypophysitis. In this case we describe a patients with xanthogranulomatous hypophysitis (XGH) demonstrating post-surgical procedure of craniopharyngioma resection. Conclusion:Xantomagranulomatous reaction was due to rupture of cyst walls of craniopharyngioma or natural immunological and inflammatory mechanism of reduction of tumor growth and progression of disease caused by extravased cyst content into the adjacent gland and favoring the reduction or regression of tumor.

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Granulomatous Hypophysitis Caused by a Ruptured Intrasellar Rathke's Cleft Cyst: Report of a Case and Review of the Literature

Cited by 58 publications

References 14 publications

Rathke's Cleft Cyst With Xanthogranulomatous Change -Case Report-

Rathke's Cleft Cyst With Xanthogranulomatous Change -Case Report-

Parasellar xanthogranulomas

Xanthogranulomatous hypophysitis due to craniopharyngioma rupture: a case report

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