Intrasellar clear cell meningioma mimicking invasive pituitary adenoma: a case report and review of literature

Abstract

The authors report on a 55-year-old man with complaints of intermittent pulsatile headache for 6 months, vision loss of the right eye and diplopia for 2 months. A magnetic resonance image (MRI) showed a large heterogeneously enhanced intrasellar mass lesion, occupying the entire hypophyseal fossa and extending into the sphenoid sinus. The patient underwent microscopic transsphenoidal surgery for removal of the tumor. Microscopic examination with hematoxylin&eosin and immunohistochemical staining of the tumor specimen was performed and confirmed the diagnosis of clear cell meningioma (CCM). Though postoperative MRI indicated gross total resection of the tumor, rapid recurrence was detected at 4 months after surgery. Gamma knife radiotherapy was administered. To the authors' knowledge, the present case is the first case of transsphenoidal removal of CCM. We reviewed the current literature on this rare histological type of meningioma in the sellar region. KeywOrds: Clear cell meningioma, Pituitary adenoma, Differential diagnosis ÖZYazarlar 6 aydan beri intermitan pulsatil baş ağrısı, 2 aydan beri sağ gözde görme kaybı ve diplopi şikayeti olan 55 yaşında bir erkek hastayı sunuyorlar. Manyetik rezonans görüntüleme (MRG); tüm hipofizeal fossayı dolduran, sfenoid sinüse doğru yayılan, büyük, heterojen olarak kontrast tutan intrasellar kitle lezyonunu ortaya koydu. Hastaya tümör rezeksiyonu amacıyla mikroskopik transsfenoidal cerrahi uygulandı. Tümör dokusunun hematoksilen & eozin ve immünohistokimyasal boyalarla yapılan mikroskopik incelemesi yapıldı ve berrak hücreli menenjiyoma (BHM) tanısı konuldu. Postoperatif MRG tümörün gros total olarak çıkartıldığını gösterdi, ancak cerrahiden 4 ay sonra hızlı nüks gözlendi. Hastaya gamma knife radyocerrahisi uygulandı. Yazarların bilgisine göre bu olgu transsfenoidal rezeksiyon uygulanan ilk BHM olgusudur. Sellar bölgedeki bu nadir menenjiyoma histolojik tipi ile ilgili mevcut literatürü taradık.

Pituitary Adenoma Coexistent with Sellar Clear Cell Meningioma Unattached to the Dura: Case Report and Treatment Considerations

“…Few reports have described the diagnosis of a parasellar clear cell meningioma, all of which occurred as a single tumor. 33 42 43 44 45 46 Although more common in young adults and children, sellar region clear cell meningioma was diagnosed in 11- to 79-year-old patients. 33 42 43 44 45 46 Additionally, in all but one case, a dural attachment was seen, 42 43 44 45 46 while a single case described the occurrence of an intrasellar clear cell meningioma without a dural attachment.…”

“… 33 42 43 44 45 46 Although more common in young adults and children, sellar region clear cell meningioma was diagnosed in 11- to 79-year-old patients. 33 42 43 44 45 46 Additionally, in all but one case, a dural attachment was seen, 42 43 44 45 46 while a single case described the occurrence of an intrasellar clear cell meningioma without a dural attachment. 33 Therefore, given the rarity of clear cell meningioma arising as a single-region tumor, this further emphasizes the diagnostic conundrum seen in our case where a gonadotropic adenoma was simultaneously diagnosed with a suprasellar clear cell meningioma without the classic dural attachment.…”

“…The results of this literature review are shown in Tables 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 and 2 . 31 32 33 34 35 36 37 …”

“…The results of this literature review are shown in ►Tables 1-1-30 and 2. [31][32][33][34][35][36][37]…”

Collision tumors composed of meningioma and growth hormone-secreting pituitary adenoma in the sellar region

“…[ 18 – 21 ] Meanwhile, giant intrasellar meningiomas mimicking pituitary adenomas have been well described in previous studies. [ 22 , 23 ] However, few articles regarding collision tumors composed of pituitary adenoma and meningioma have been published. To date, Karsy et al [ 9 ] reported the only case study of coincident pituitary adenoma and sellar meningioma in which mental changes were the chief complaint and a non-secreting pituitary adenoma was identified by pituitary laboratory tests and postoperative pathology.…”