Cavernous Sinus Cavernous Hemangioma Largely Extending Into the Sella Turcica and Mimicking Pituitary Adenoma  -Case Report-

Hori, Satoshi; Hayashi, Nakamasa; Nomoto, Kazuhiro; Sato, Hikari; Hayashi, Tomohide; Nagai, Shoichi; Nishikata, Manabu; Endo, Shunro

doi:10.2176/nmc.50.330

Cited by 20 publications

(18 citation statements)

References 23 publications

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“…According to some published reports, the lesions are quite radiosensitive; radiosurgery and conventional radiotherapy should therefore be important in overall management [21][22][23][24][25]. Several reports in the literature have demonstrated that radiosurgery can be used with high lesion control [7][8][9][10][11][12][13][14][15][16]. Meta-analysis of the published literature suggests that stereotactic radiosurgery seems to provide satisfactory tumor control with little risk, at least over the published follow-up periods reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Remarkable tumor shrinkage was demonstrated in 39 (70.9%) of 55 patients and the mean radiation dose received was 14 Gy (range [10][11][12][13][14][15][16][17][18][19]. The mean radiation dose received by 16 patients with partial or no change tumor shrinkage was 13.5 Gy (range [10][11][12][13][14][15][16]. Patients with remarkable tumor shrinkage (volume reduction rates of C50% relative to those before stereotactic radiosurgery) received higher doses than those with partial tumor shrinkage or no change (P = 0.031).…”

Section: Dose and Treatment Responsementioning

confidence: 99%

“…Radiosurgery was performed as adjuvant therapy, and dramatically decreased tumor size. Since then, more reports have been published, all showing good response [7][8][9][10][11][12][13][14][15][16]. In most reports, radiosurgery is used as adjuvant therapy after partial tumor removal.…”

Section: Introductionmentioning

confidence: 99%

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The role of stereotactic radiosurgery in cavernous sinus hemangiomas: a systematic review and meta-analysis

et al. 2011

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Cavernous sinus hemangioma is a rare and complex vascular tumor. A direct microsurgical approach usually results in massive hemorrhage. Stereotactic radiosurgery has emerged as a treatment alternative to microsurgery. To conduct a meta-analysis assessing the effect and complications of stereotactic radiosurgery in cavernous sinus hemangioma, a systematic review and meta-analysis of all cases of cavernous hemangioma in the cavernous sinus treated with stereotactic radiosurgery was performed. The search revealed ten papers with a total enrollment of 59 patients. Tumor size ranged from 1.5-51.4 cm(3) (mean 9.6 cm(3)). The mean follow-up period was 49.2 months (range 6-156 months). The most recent MR images demonstrated remarkable tumor shrinkage in 40 patients (67.8%), partial shrinkage in 15 patients (25.4%), and no change in four patients (6.8%). There was no significant correlation between lesion volume and tumor shrinkage. Patients with remarkable tumor shrinkage received higher doses than those with partial or no change tumor shrinkage (P = 0.031). Thirteen patients (22.0%) had no cranial nerve impairments before stereotactic radiosurgery. Among those 46 patients with cranial nerve impairments before stereotactic radiosurgery, complete resolution was achieved in seven patients and improvement in 28, and these impairments remained essentially unchanged in 11 patients. Only one patient had additional trigeminal nerve disturbance. There is no statistical significance in tumor control between patients treated with or without surgery (P = 0.091). The meta-analysis suggests stereotactic radiosurgery avoids the complications associated with attempted microsurgical resection. Stereotactic radiosurgery is an alternative for cavernous sinus hemangiomas confirmed by typical imaging.

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Section: Discussionmentioning

confidence: 99%

Section: Dose and Treatment Responsementioning

confidence: 99%

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The role of stereotactic radiosurgery in cavernous sinus hemangiomas: a systematic review and meta-analysis

et al. 2011

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“…The frequency of cavernous hemangioma is low, but due to the possibility of hemorrhage or neurological abnormalities, the risk cannot be underestimated. Intrasellar cavernous hemangioma is a particularly rare disease; there were only seven previous cases reported overseas and only one prior case reported in Korea; each of these cases is presented in Table 3 [12,13,14,15,16,17,18,19]. Intrasellar or cranial cavernous hemangioma was introduced by Lombardi et al [12] in 1994, and was classified into three types: hemangioma of the cavernous venous sinus growing lateral or medial to the lumen of the venous sinus, or growing outside of the cavernous venous sinus.…”

Section: Discussionmentioning

confidence: 99%

Genetic Analysis of Multiple Endocrine Neoplasia Type 1 (MEN1) Leads to Misdiagnosis of an Extremely Rare Presentation of Intrasellar Cavernous Hemangioma as MEN1

Lee

Yoon

et al. 2014

Endocrinol Metab

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BackgroundMultiple endocrine neoplasia type 1 (MEN1) is a rare inherited disorder characterized by the simultaneous occurrence of endocrine tumors in target tissues (mainly the pituitary, endocrine pancreas, and parathyroid glands). MEN1 is caused by mutations in the MEN1 gene, which functions as a tumor suppressor and consists of one untranslated exon and nine exons encoding the menin protein. This condition is usually suspected when we encounter patients diagnosed with tumors in multiple endocrine organs, as mentioned above.MethodsA 65-year-old woman who underwent surgery for a pancreatic tumor (serous cystadenoma) 5 years previously was referred to our hospital due to neurologic symptoms of diplopia and left ptosis. Brain magnetic resonance imaging revealed a 3.4-cm lesion originating from the cavernous sinus wall and extending into the sellar region. It was thought to be a nonfunctioning tumor from the results of the combined pituitary function test. Incidentally, we found that she also had a pancreatic tumor, indicating the necessity of genetic analysis for MEN1.ResultsGenomic analysis using peripheral leukocytes revealed a heterozygous c.1621G>A mutation in the MEN1 gene that was previously reported to be either a pathogenic mutation or a simple polymorphism. We pursued a stereotactic approach to the pituitary lesion, and microscopic findings of the tumor revealed it to be an intrasellar cavernous hemangioma, a rare finding in the sellar region and even rarer in relation to oculomotor palsy. The patient recovered well from surgery, but refused further evaluation for the pancreatic lesion.ConclusionThere is great emphasis placed on genetic testing in the diagnosis of MEN1, but herein we report a case where it did not assist in diagnosis, hence, further discussion on the role of genetic testing in this disease is needed. Also, in cases of pituitary tumor with cranial nerve palsy, despite its low prevalence, intrasellar cavernous hemangioma could be suspected.

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“…Intracranial extracerebral (i.e. extra-axial) cavernous malformations (ECCMs) are rare and comprise 0.4 to 2% of all intracranial cavernous malformations 1,3 . ECCMs usually arise in relation to the dura mater.…”

Section: Introductionmentioning

confidence: 99%

Imaging Characteristics of Cavernous Sinus Cavernous Hemangiomas

et al. 2012

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Cavernous hemangiomas occur rarely in the cavernous sinus and are difficult to diagnose preoperatively. The imaging of these lesions resembles other benign paracavernous lesions such as schwannomas and meningiomas. Profuse intraoperative bleeding may be encountered during surgical resection of these lesions. A preoperative diagnosis is therefore important to alert the surgeon. We report on the imaging characteristics of two different histopathological types of cavernous sinus cavernous hemangiomas and the use of contrast-enhanced MRI, diffusion-weighted MRI and magnetic resonance spectroscopy in the differential diagnosis of these lesions.

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Cavernous Sinus Cavernous Hemangioma Largely Extending Into the Sella Turcica and Mimicking Pituitary Adenoma -Case Report-

Cited by 20 publications

References 23 publications

The role of stereotactic radiosurgery in cavernous sinus hemangiomas: a systematic review and meta-analysis

The role of stereotactic radiosurgery in cavernous sinus hemangiomas: a systematic review and meta-analysis

Genetic Analysis of Multiple Endocrine Neoplasia Type 1 (MEN1) Leads to Misdiagnosis of an Extremely Rare Presentation of Intrasellar Cavernous Hemangioma as MEN1

Imaging Characteristics of Cavernous Sinus Cavernous Hemangiomas

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