Inflammatory Hypophysitis - The Spectrum of Disease

Flanagan, Daniel; Ibrahim, A E K; Ellison, David W.; Armitage, Mary; Gawne-Cain, M. L.; Lees, Peter

doi:10.1007/s701-002-8273-5

Cited by 68 publications

(62 citation statements)

References 33 publications

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“…1,12,21 Many authors have described the presentation of endocrine, visual, and neurological manifestations in parasellar xanthogranulomatous reactions, but a unique symptomatology has not yet been elucidated. 1,2,[6][7][8]12,15,16,20,21,23,[25][26][27] Furthermore, there is significant controversy regarding the etiology and development of these unusual lesions. One theory of the etiology of these parasellar lesions is that all xanthogranulomas arise from inflammatory processes occurring in preexisting CPs.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Parasellar xanthogranulomas

Rahmani

Sukumaran

Donaldson

et al. 2015

JNS

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“…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%

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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“…25 Cystic appearance was described in 5% of the patients with LYH. 1,8,11,12,[26][27][28][29][30][31][32][33][34] Homogeneous enhancement can also be observed in pituitary adenomas. 35 On the other hand, parasellar T2 dark sign was a characteristic finding in LYH and can contribute to distinguishing pituitary LYH from adenoma with certainty.…”

Section: Discussionmentioning

confidence: 99%