Sellar xanthogranuloma manifesting as obstructive hydrocephalus

Liu, Zhuo-Hao; Tzaan, Wen-Ching; Wu, Yao‐Kuang; Chen, Hsien-Chih

doi:10.1016/j.jocn.2007.05.028

Cited by 31 publications

(37 citation statements)

References 8 publications

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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%

“…1,12,21 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%

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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%

Section: Discussionmentioning

confidence: 99%

Parasellar xanthogranulomas

Rahmani

Sukumaran

Donaldson

et al. 2015

JNS

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“…Though these lesions are considered clinically separate entities, they can share similar and sometimes overlapping pathogeneses. 1,9,15,17,19,20,26 Xanthogranuloma of the sellar region 10,12,17 or suprasellar region 21 is a rare disease entity recently described in the human medical literature. Grossly, the lesion is a cystic, red to brown mass 10 that contains yellow-brown fluid.…”

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confidence: 99%

“…Grossly, the lesion is a cystic, red to brown mass 10 that contains yellow-brown fluid. 12 Histologically, sellar xanthogranulomas are composed of macrophages, multinucleated giant cells, cholesterol clefts, hemosiderin, and variable epithelial cell clusters 10,17,21 that can be squamous or ciliated. 10,17 Reports in the human literature do not describe Rosenthal fiber formation in conjunction with this entity.…”

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confidence: 99%

Sellar Xanthogranuloma in a Dog

et al. 2011

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Abstract. A 7-year-old, intact male standard Poodle dog with hypothyroidism and atypical hyperadrenocorticism developed acute signs of lethargy, weakness, inappetence, vomiting, and diarrhea. Clinical signs progressed to hind limb proprioceptive deficits, aggressive behavior with obtundation, and an equivocal seizure. Necropsy revealed a mass in the sellar region that histologically consisted of multinucleated giant cells, macrophages, and hemosiderin-laden macrophages with fewer lymphocytes and plasma cells admixed with large regions of cholesterol cleft deposition, fibrin, and prominent Rosenthal fibers. Pituitary tissue was not identified on gross or histologic examination, but the mass was partially bordered by epithelial cells. The histologic characteristics are similar to changes described in the human medical literature as xanthogranuloma of the sellar region and xanthogranulomatous hypophysitis.Key words: Atypical hyperadrenocorticism; canine; craniopharyngioma; Rathke cleft cyst; xanthogranuloma of the sellar region; xanthogranulomatous hypophysitis. and polydipsia. 6 Neurologic deficits might include proprioceptive deficits, 6 circling, 6,24 and cranial nerve deficits, particularly related to compression of the optic chiasm. 16,18,22,24 Last, endocrine disease might manifest as hypothyroidism or diabetes insipidus. 16A 7-year-old, intact male standard Poodle dog presented to the Oklahoma State University Boren Veterinary Medical Teaching Hospital (Stillwater, Oklahoma) with a 1-year history of polyuria and polydipsia and a 1-week history of inappetence. The week before, the dog had been diagnosed with hypothyroidism on the basis of decreased total thyroxine (T4), and treatment with levothyroxine (0.01 mg/kg every 12 hr) had been instituted.Other than mild lumbosacral pain, physical examination findings were within normal limits. Because inappetence had coincided with initiation of thyroid supplementation, and euthyroid-sick syndrome was a differential diagnosis, treatment was discontinued to allow for future reassess- At the 1-month recheck appointment, the dog exhibited hair loss and lethargy consistent with previously diagnosed hypothyroidism. Repeat thyroid testing revealed a low free T4 (4.8, ref. interval: 8-40 pmol/l) with normal thyroidstimulating hormone and T4. Hypercholesterolemia had increased (435 mg/dl). Thyroid supplementation was reinstituted (levothyroxine, 0.02 mg/kg every 12 hr).Concurrently, to address the abnormal ACTH stimulation results seen on initial presentation, low-dose dexamethasone suppression testing was performed. Results were within normal limits, making typical hyperadrenocorticism less likely. Because of the persistent polyuria and polydipsia, additional tests were performed to assess other adrenocortical hormone levels. After exogenous ACTH stimulation, there were elevations in cortisol (191.8, ref. interval: 70.6-161.2 ng/ml), progesterone (6.57, ref. interval: 0.22-1.45 ng/ml), 17-OH progesterone (5.31, ref.interval: 0.25-2.63 ng/ml), and aldosterone (458.7, ref. ...

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“…3) MR imaging was performed in all 10 reviewed cases (Table 1). 2,[4][5][6]8,10,15,16) For nine of the 11 cases including our case, the lesions appeared homogeneously or mainly hyperintense with or without contrast enhancement. The cholesterol clefts of xanthogranuloma characteristically appear as hyperintense on T 1 -weighted imaging.…”

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confidence: 99%

Xanthogranuloma of the Sellar Region -Case Report-

Arai

Nishihara

Sasayama

et al. 2010

Neurol. Med. Chir.(Tokyo)

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A 55-year-old woman presented with a rare xanthogranuloma of the sellar region after complaining of severe headache and visual disturbance 3 months previously. Clinical examination showed she was alert with early signs of bitemporal hemianopsia. Endocrinological examination revealed hypopituitarism. Magnetic resonance imaging showed an intrasellar mass extending into the suprasellar region and compressing the optic chiasma, which appeared homogeneously hyperintense on T 1 -weighted images. Endonasal transsphenoidal resection of the tumor was performed. Histological examination disclosed granulomatous tissue with cholesterol clefts, hemosiderin deposits, fibrous tissues, and macrophages containing rich fat. The histological diagnosis was xanthogranuloma of the sellar region. Her visual symptoms recovered postoperatively although the hypopituitarism remained. Xanthogranuloma of the sellar region is rare, but must be considered in the differential diagnosis of tumors of the sellar region.

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Sellar xanthogranuloma manifesting as obstructive hydrocephalus

Cited by 31 publications

References 8 publications

Parasellar xanthogranulomas

Parasellar xanthogranulomas

Sellar Xanthogranuloma in a Dog

Xanthogranuloma of the Sellar Region -Case Report-

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