A Case Report of Inflammatory Pseudotumor Involving the Clivus: CT and MR Findings

Lee, Jae Hee; Kim, Ki Jun; Chung, Sung Woo; Choi, Yong Chul; Lee, Ahnhi

doi:10.3348/kjr.2001.2.4.231

Cited by 12 publications

(8 citation statements)

References 4 publications

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“…Clinically, an IPT involving the nasopharynx and skull base causes symptoms, including CN neuropathies, pain and hypopituitarism, as the mass grows and compresses the surrounding tissues [17,19,21,22]. The disease may also present with features suggestive of malignancy, such as disease recurrence, bony erosion/destruction or infiltration of surrounding tissues [19,[23][24][25]. It can be difficult to distinguish between IPT and aggressive malignancy in most cases, because they may have similar clinical or radiographical appearances.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is no large series examining the precise effects of systemic steroid therapy on IPT involving the skull base, it has been observed that systemic steroid therapy may help to stabilise or alleviate pain and CN dysfunction [18,21,24]. In a review of literature on orbitsparing IPT of the skull base, Mangiardi and Har-El [20] observed that IPT in this region may be quite responsive to steroid treatment.…”

Section: Nasopharyngeal Inflammatory Pseudotumoursmentioning

confidence: 99%

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Imaging of nasopharyngeal inflammatory pseudotumours: differential from nasopharyngeal carcinoma

Cy²,

Yang³

et al. 2010

BJR

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The purpose of this study was to describe the MRI findings of inflammatory pseudotumours (IPTs) involving the nasopharynx and to differentiate IPTs from nasopharyngeal carcinoma (NPC). The medical records and imaging studies of 7 patients (6 men, 1 woman; age range, 32-71 years; mean age, 52.4+/-18 years) with IPT involving the nasopharynx were reviewed retrospectively. The MRI findings were compared with those of seven patients with advanced NPC with skull base invasion. All patients with IPT involving the nasopharynx presented with single or multiple cranial neuropathies; six reported pain; and four patients had a recent history of otitis media. Three were initially misdiagnosed as having NPC according to MRI findings, and all underwent nasopharyngeal biopsy to exclude malignancy. 7/7 (100%) patients received systemic corticosteroid treatment; 7/7 (100%) showed initial rapid resolution of clinical symptoms or radiographical findings; 3/7 (42.9%) had resolution of all signs and symptoms; 3/7 (42.9%) still have limited residual symptoms; and 1/7 (14.3%) suffered recurrence 3 years after remission. The characteristic MR findings of IPT include an infiltrative growth pattern, minimal to mild mass effect, hypointensity on T(2) weighted images, and moderate homogeneous enhancement after contrast administration. Intact nasopharyngeal mucosa, internal carotid artery encasement and narrowing, extensive pachymeningeal thickening and a relative paucity of associated neck lymphadenopathy are additional MR findings that favour the diagnosis of IPT rather than NPC. In conclusion, IPT involving the nasopharynx has characteristic MR findings which, together with clinical and laboratory presentations, are helpful in differentiating IPT from malignant tumours, especially NPC.

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Section: Discussionmentioning

confidence: 99%

Section: Nasopharyngeal Inflammatory Pseudotumoursmentioning

confidence: 99%

Imaging of nasopharyngeal inflammatory pseudotumours: differential from nasopharyngeal carcinoma

Cy²,

Yang³

et al. 2010

BJR

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“…Inflammatory pseudotumors of the head and neck most commonly occur in the orbits, or more rarely in the skull base (1). Inflammatory pseudotumors of the pituitary gland are a very rare non-neoplastic lesion (2).…”

Section: Discussionmentioning

confidence: 99%

Inflammatory Pseudotumor of the Pituitary Gland Mimicking a Pituitary Adenoma: A Case Report

Kim

et al. 2011

J Korean Soc Radiol

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An inflammatory pseudotumor of the pituitary gland, which is usually preoperatively diagnosed as a pituitary adenoma, is a very rare non-neoplastic lesion. We report a case of a fibrosing inflammatory pseudotumor located in the pituitary gland, that presented with abducens nerve palsy and was confirmed by histopathological analysis. Knowledge of the imaging features of inflammatory pseudotumors can help avoid unnecessary radical surgery prior to histopathological proof of malignancy. Case ReportA 38-year-old man presented with an eight month history of anorexia, sexual dysfunction, a visit to a private clinic; however, his symptoms were not improving despite conservative treatment. Abrupt-onset ophthalmoplegia and diplopia developed for 7 days prior at admission to the neurosurgery ward of our hospital. A neurologic exam revealed limitation of the extraocular muscle during left lateral gaze with aggravated diplopia, suggesting left 6th cranial nerve palsy. Biochemical studies revealed the hormonal profile of panhypopituitarysm.CT images revealed a homogeneously high attenuated box-shaped mass, involving the sellar, parasellar (including cavernous sinuses), and retrosellar regions with homogeneous enhancement and some bony erosion of the dorsum sella, which extended to the sphenoid sinus (Fig. 1). T2-weighted MR images showed localized relatively homogeneous low signal intensity mass at the sellar, parasellar, and retrosellar regions. T1-weighted MR images showed iso-signal intensity of the lesion. On gadolinium enhanced T1-weighted images, homogeneously weak enhancement of the mass with involvement of the bilateral cavernous sinuses was observed A 38-year-old man was admitted to our hospital with diplopia. The patient had a relatively well-defined pituitary mass with high cellularity as well as weaker enhancement on imaging modalities including computed tomography (CT) and magnetic resonance imaging (MRI), than a typical pituitary adenoma. The distinction between a pseudotumor and an invasive neoplasm is very difficult before biopsy. In this case report, we discuss the characteristic imaging features of a fibrosing inflammatory pseudotumor of the pituitary gland.

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“…4 All five patients had homogeneous en-hancement following contrast, with thickening and enhancement of adjacent intracranial dural structures. 1,4,5 The T2 hypointensity is thought to be due to the fibrotic nature of inflammatory pseudotumors, with the relative lack of free water. 4 The hypointensity of the T2 images can help differentiate these tumors from other primary malignant tumors of the skull base such as chordoma, chondrosarcoma, and invasion from nasopharyngeal carcinoma, which are hyperintense on T2.…”

Section: Discussionmentioning

confidence: 99%

“…In the head and neck they have been described in the larynx, trachea, nasopharynx, oropharynx, orbits, meninges, sinuses, salivary glands, thyroid, infratemporal fossa, skull base, and temporal bone. [1][2][3][4][5] We present two patients with very rare inflammatory pseudotumors involving the temporal bone. We present the clinical, histologic, and radiographic features and compare them with previously reported cases.…”

mentioning

confidence: 99%

Inflammatory Pseudotumor of the Temporal Bone: A Case Series

Strasnick

Vaughan

2008

Skull Base

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Inflammatory pseudotumor is a non-neoplastic inflammatory process. Histologically these lesions appear as an inflammatory infiltrate with a fibrotic background. Clinical presentations vary from slow growth with minimal mass effect, to bony destruction that can mimic malignancy. Although they occur most commonly in the orbit, there are a growing number of case reports of tumors of the temporal bone and skull base. Inflammatory pseudotumors of the temporal bone are best treated by excision, with radiation and steroid therapy reserved for inoperable tumors. The clinical, histologic, and radiographic features of two patients with inflammatory pseudotumor of the temporal bone are presented.

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A Case Report of Inflammatory Pseudotumor Involving the Clivus: CT and MR Findings

Cited by 12 publications

References 4 publications

Imaging of nasopharyngeal inflammatory pseudotumours: differential from nasopharyngeal carcinoma

Imaging of nasopharyngeal inflammatory pseudotumours: differential from nasopharyngeal carcinoma

Inflammatory Pseudotumor of the Pituitary Gland Mimicking a Pituitary Adenoma: A Case Report

Inflammatory Pseudotumor of the Temporal Bone: A Case Series

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