Abstract:Background It is difficult to distinguish between invasive pituitary adenomas (IPAs) and skull base chordomas based on tumor location and clinical manifestations. Purpose To investigate the value of the apparent diffusion coefficient (ADC), T2-weighted (T2W) imaging, and dynamic contrast enhancement (DCE) in differentiating skull base chordomas and IPAs. Material and Methods Data for 21 patients with skull base chordomas and 27 patients with IPAs involving the paranasal sinus were retrospectively reviewed, and… Show more
“…e Diffusion-weighted imaging (DWI) shows isointensity compared to white matter in the mass (mean apparent diffusion coefficient = 1.4 × 10 -3 mm 2 /s) (arrow) T2WI compared to chordomas [43]. Invasive PitNET/pituitary adenoma shows lower mean ADC and hypointensity on T2WI compared to chordomas [45]. And the enhancement peak and maximum contrast-enhancement ratio on dynamic MRI are higher for invasive PitNETs/pituitary adenomas than these values for chordomas [45].…”
Many types of tumors can develop in the pituitary gland. In the recently revised 5th editions of the World Health Organization (WHO) classifications (2021 WHO Classification of Central Nervous System Tumors and the 2022 WHO Classification of Endocrine and Neuroendocrine Tumors), various changes have been made to the tumors other than pituitary neuroendocrine tumor (PitNET)/pituitary adenoma, as well as PitNET. Adamantinomatous craniopharyngioma and papillary craniopharyngioma are now considered separate tumors in the 5th edition of the WHO classification. Tumors positive for thyroid transcription factor 1, a marker of posterior pituitary cells, are now grouped together in the pituicyte tumor family in the 5th edition of the WHO classification of Endocrine and Neuroendocrine Tumors. Poorly differentiated chordoma is newly listed in the 5th edition of the WHO Classification of Endocrine and Neuroendocrine Tumors. In this paper, we present the latest WHO classification of pituitary tumors (adamantinomatous craniopharyngioma, papillary craniopharyngioma, pituitary blastoma, pituicyte tumor family, tumors of pituitary origin other than those of the pituicyte tumor family, germinoma, meningioma, chordoma, metastatic tumors, lymphoma, and pituitary incidentaloma), review diseases requiring differentiation from tumors (pituitary abscess, hypophysitis, pituitary hyperplasia, Rathke’s cleft cyst, arachnoid cyst, and aneurysm), and discuss diagnoses based on imaging findings.
“…e Diffusion-weighted imaging (DWI) shows isointensity compared to white matter in the mass (mean apparent diffusion coefficient = 1.4 × 10 -3 mm 2 /s) (arrow) T2WI compared to chordomas [43]. Invasive PitNET/pituitary adenoma shows lower mean ADC and hypointensity on T2WI compared to chordomas [45]. And the enhancement peak and maximum contrast-enhancement ratio on dynamic MRI are higher for invasive PitNETs/pituitary adenomas than these values for chordomas [45].…”
Many types of tumors can develop in the pituitary gland. In the recently revised 5th editions of the World Health Organization (WHO) classifications (2021 WHO Classification of Central Nervous System Tumors and the 2022 WHO Classification of Endocrine and Neuroendocrine Tumors), various changes have been made to the tumors other than pituitary neuroendocrine tumor (PitNET)/pituitary adenoma, as well as PitNET. Adamantinomatous craniopharyngioma and papillary craniopharyngioma are now considered separate tumors in the 5th edition of the WHO classification. Tumors positive for thyroid transcription factor 1, a marker of posterior pituitary cells, are now grouped together in the pituicyte tumor family in the 5th edition of the WHO classification of Endocrine and Neuroendocrine Tumors. Poorly differentiated chordoma is newly listed in the 5th edition of the WHO Classification of Endocrine and Neuroendocrine Tumors. In this paper, we present the latest WHO classification of pituitary tumors (adamantinomatous craniopharyngioma, papillary craniopharyngioma, pituitary blastoma, pituicyte tumor family, tumors of pituitary origin other than those of the pituicyte tumor family, germinoma, meningioma, chordoma, metastatic tumors, lymphoma, and pituitary incidentaloma), review diseases requiring differentiation from tumors (pituitary abscess, hypophysitis, pituitary hyperplasia, Rathke’s cleft cyst, arachnoid cyst, and aneurysm), and discuss diagnoses based on imaging findings.
“…Marked T2 hyperintensity, which is believed to be due to the high fluid content of the chordoma, is a hallmark of skull base chordomas. [ 8 , 27 ] Displacement patterns of the pituitary gland were described in nine patients; 8 (89%) of the nine patients showed anterior or superior displacement, and only 1 (11%) showed posterior displacement. Displacement of the pituitary gland theoretically reflects the tumor’s epicenter and direction of growth.…”
Background:
Chordomas are rare, locally aggressive neoplasms recognized as derivatives of the notochord vestiges. These tumors typically involve the midline axial skeleton, and intracranial chordomas exhibit proclivity for the spheno-occipital region. However, purely intrasellar occurrences are extremely rare. We report a case of intrasellar chordoma, which masqueraded as a pituitary neuroendocrine tumor.
Case Description:
An 87-year-old female presented with an acutely altered mental state after a few-week course of headaches and decreased left vision. Adrenal insufficiency was evident, and magnetic resonance imaging revealed an intrasellar lesion with heterogeneous contrast enhancement and marked T2 hyperintensity. Central adrenal insufficiency due to an intrasellar lesion was suspected. Cortisol replacement was initiated, and transsphenoidal surgery was performed. Anterosuperior displacement of the normal pituitary gland and the absence of the bony dorsum sellae were notable during the procedure. Histological examination led to a diagnosis of conventional chordoma, and upfront adjuvant stereotactic radiosurgery was executed. She has been free from tumor progression for 12 months.
Conclusion:
This case and literature review suggested that the pathognomonic features of intrasellar chordoma were heterogeneous contrast enhancement, marked T2 hyperintensity, osteolytic destruction of the dorsum sellae, and anterosuperior displacement of the pituitary gland. Clinical outcomes seemed slightly worse than those of all skull base chordomas, which were the rationale for upfront radiosurgery in our case. Neurosurgeons should include intrasellar chordomas in the differential diagnosis of intrasellar lesions, carefully dissect them from the adjacent critical anatomical structures, and consider upfront radiosurgery to achieve optimal patient outcomes.
“…On MRI, macroadenoma presents medium–low SI on T1W images, medium-slightly high SI on T2W images, variable SI on DWI trace, and highly variable ADC values. CE is usually homogeneous [ 67 ]. Fig.…”
Section: Benign Tumours (Table
2
)mentioning
confidence: 99%
“…Differential diagnoses : chordoma shows a higher T2 and DWI b1000 SI and higher ADC values than invasive macroadenoma, due to difference in histopathologic features (chordoma has an abundant myxoid stroma containing physaliferous cells with large cytoplasm, invasive macroadenoma shows highly crammed cells with large nuclei) [ 67 ]. Pituitary fossa meningioma could resemble a pituitary macroadenoma; nevertheless, two main aspects allow to distinguish these different conditions since meningioma reveals a more avid and homogeneous CE than adenoma [ 66 ], and in case of meningioma, the normal pituitary gland can still be recognised [ 65 ].…”
The sphenoid bone is an unpaired bone that contributes to the formation of the skull base. Despite the enormous progress in transnasal endoscopic visualisation, imaging techniques remain the cornerstones to characterise any pathological condition arising in this area. In the present review, we offer a bird’s-eye view of the developmental, inflammatory, and neoplastic alterations affecting the sphenoid body and clivus, with the aim to propose a practical diagnostic aid for radiologists based on clinico-epidemiological, computed tomography, and magnetic resonance imaging features.
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