Metastatic papillary craniopharyngioma: Case study and study of tumorangiogenesis

Abstract

2Abbreviations used are as follows: ER, estrogen receptor; MVD, microvascular density; PR, progesterone receptor; VEGF, vascular endothelial growth factor.We report a case of suprasellar papillary craniopharyngioma metastatic to the temporoparietal region 2 years after its initial resection. The literature documents examples of craniopharyngioma recurrences along the surgical tract, as well as remote ipsi-and contralateral metastases via cerebrospinal uid seeding. Ours is the second report of a craniopharyngioma of papillary type to exhibit metastatic behavior. The tumor spread opposite the side of craniotomy. Although a rare occurrence, it con rms the limited capacity of histologically benign craniopharyngiomas to undergo meningeal seeding, likely the result of surgical manipulation. Immunohistochemical demonstration of increased microvascular density and vascular endothelial growth factor expression, as well as a high vascular endothelial growth receptor (VEGFR2) signal by in situ hybridization, suggests that tumor vascularity facilitated angiogenesis and may have been involved in the establishment and growth of the metastatic deposit. Neuro-Oncology 4, 123-128, 2002 (Posted to Neuro-Oncology [serial online], Doc. 01-046, February 18, 2002 C raniopharyngiomas are assumed to arise from epithelial rests of the normally involuted craniopharyngeal duct (Burger and Scheithauer, 1994).Histologically, they occur in 2 easily recognized forms. Most are adamantinomatous tumors, occurring more often in children than in adults and radiographically characterized by calci cation. Histologically, they resemble adamantinoma of the jaw. Occurring less frequently is the papillary variant, which lacks calci cation and consists of sheets and crude fronds of simple, nonkeratinizing squamous epithelium. Either tumor may be cystic, solid, or both (Burger et al., 1994). Despite their benign histology, craniopharyngiomas may rarely recur as a result of implantation along the operative tract or as remote deposits or metastases due to cerebrospinal uid spread (Barloon et al., 1988;Gupta et al., 1999;Israel and Pomeranz, 1995;Ito et al., 2001;Lee et al., 1999;Malik et al., 1992;Ragoowansi and Piepgras, 1991). Our case is an example of the latter-a leptomeningeal metastasis opposite the side of the craniotomy that presented 2 years after removal of the primary tumor. It represents the second papillary craniopharyngioma to behave in this manner. No doubt surgical manipulation may be implicated in its spread. However, the possibility that angiogenesis played a role in facilitating the establishment and growth of the deposit is explored by a study of MVD 2 and of the expression of VEGF and its receptor VEGFR2. Case Study and PathologyA 62-year-old woman complained of headaches, dizziness, and visual disturbance. Both the general physical and neurologic examinations were normal. CT and MRI of the sellar region revealed a cystic and noncalcified suprasellar mass (3.8 ´3.5 ´2.5 cm) with rim enhancement (Fig. 1, left). The preoperative diagnos...

Impact of neutrophil–lymphocyte ratio on long-term outcome in patients with craniopharyngioma

“…[ 12 , 13 ] Tumor and tumor-related neutrophils produce cytokines like vascular endothelial growth factor (VEGF), which promote angiogenesis, provoke tumor cells to proliferate, therefore, to further promote invasive growth, metastasis, and recurrence. [ 11 , 44 – 47 ] All the above mentioned are associated with worse QOL after surgical treatment and lower PFS rate. [ 3 , 33 , 36 , 48 – 51 ]…”