Lesions within and around the Pituitary

Doerfler, Arnd; Richter, Gregor

doi:10.1007/s00062-008-8001-0

Cited by 8 publications

(23 citation statements)

References 106 publications

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“…Owing to their slow growth, radiological studies show an expansive soft tissue mass coupled with the preservation of most bony margins (thinning and / or swelling of the bony sinus walls) [11,12]. This finding can be helpful in differentiating schwannomas from other malignant tumours, such as chondrosarcoma, plasmacytoma, carcinoma, lymphomas, melanomas, etc., which tend to destroy the bone aggressively.…”

Section: Discussionmentioning

confidence: 99%

“…The isoatenuated compared with that of the brain stem and relatively homogeneous mild (masseter muscle) or marked enhancements on CT [1,4] may provide the differential diagnosis in case of the most common causes namely expansive soft-tissue lesions on paranasal sinuses and mucocele, which will not enhance at all [10,11]. …”

Section: Discussionmentioning

confidence: 99%

“…Both, the MR imaging and CT scans show an intense heterogeneous contrast enhancement [9,11]. The MRI may be useful in obtaining information about the nature of the lesion and in detecting any skull-base or intracranial issues [10].…”

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confidence: 99%

“…Malignant transformation may occur in exceptional cases. Clival chordomas are slow growing tumours heterogeneously hyperintense or bright on T2-W images, and also show foci of haemorrhages as bright spots and dark areas on T1-W sequences, with marked contrast enhancement which may be heterogeneous [11,12]. Preoperative correct judgement can aid to perform appropriate surgical approach [5].…”

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Unusual Association of Sphenoidal Schwannoma with Nasosinusal Polyposis

Álvarez-Montero¹,

Mancheño-Losa²,

Rodríguez-Castejón³

et al. 2017

JOENTR

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Schwannomas or neurilemmomas are tumors of benign nerve sheath, and between 25 and 45% of all arise in the head and neck region. Less than 4 % are found in the sinonasal tract and their diagnosis may have difficulty due to non-specific symptoms and image characteristics. In several cases, complete surgical removal by endoscopic approach is the treatment of choice in these tumors. We report the management of an unusual case of sphenoid sinus schwannoma in a 70-years-old male along with massive bilateral nasal polyposis and severe symptoms. The association with severe sinonasal polyposis has not been previously described.Keywords: Schwannoma; Neurilemmoma; Sinonasal polyposis the III, IV and VI cranial nerves, in the autonomic nervous system, in the carotid plexus or sphenopalatine ganglion [1]. Whether sinonasal schwannomas can be derived from the olfactory nerve components is still a controversial issue [2], but recent studies point more likely to its origin in the meningeal or ethmoidal branches of the trigeminal nerve [3]. The most frequent locations in the sinonasal tract are: the ethmoidal sinus, maxillary sinus, nasal cavity and nasal septum. The sphenoid and frontal sinuses are rarely affected [1].The non-specific signs and symptoms of sinonasal schwannomas are the same of those of any mass of the anterior or posterior nasal tract [1], and their imaging findings are rather unspecific [4,5]. Differential diagnosis should be made with other more common skull base tumours or space-occupying mass lesions such as sphenoid mucocele, angiofibroma, inverted papilloma, clival chordoma, chondrosarcoma, meningioma, pituitary adenomas, craniopharyngiomas and plasmacytoma [4,5].Complete surgical excision is considered the preferred treatment and most lesions may be removed by standard endoscopic techniques [1,6,7], although different approaches must be done if intracranial extension is present [1,7].Here in we report an unusual case of sphenoidal schwannoma coupled with sinonasal massive polyposis, and we focus the role of computed tomography (CT) and magnetic resonance image (MRI) on the differential diagnosis and the surgical endoscopic approach. Case ReportA 70-year-old male was attended at the Emergency Department of our hospital, with nasal obstruction, hyposmia, severe headache, ocular pain and diplopia. He had medical history of arterial hypertension, deep venous thrombosis and nasal polyposis in treatment with hydrochlorothizide, acenocumarol and topical intranasal corticosteroids. There was no personal or family history of neurofibromatosis disease. The physical examination showed a VI left cranial nerve palsy. Noncontrast emergency CT revealed a complete sinonasal polyposis opacification with a 5 x 3.5 cm sphenoid sinus expansive lesion. There was no calcification or bone destruction (Figure 1).The initial suspicion was sphenoidal mucocele, and MRI was performed. The MRI showed an expansive mass of the 4.1 x 4.4 x 4.2 cm sphenoid sinus expansive mass, heterogeneous on T2 weighted images and isointense...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Unusual Association of Sphenoidal Schwannoma with Nasosinusal Polyposis

Álvarez-Montero¹,

Mancheño-Losa²,

Rodríguez-Castejón³

et al. 2017

JOENTR

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“…Некоторые авторы считают, что «немые» кортикотропиномы обладают более агрессивным ростом и худшим прогнозом в отношении рецидива заболевания после оператив-ного лечения [48,49]. Однако в других исследовани-ях подобных результатов получено не было [50,51].…”

Section: диагностикаunclassified

Pituitary incidentalomas: the clinical picture, diagnostics, differential diagnostics, and methods of treatment

Дедов¹,

Мельниченко²,

Рожинская³

et al. 2015

Probl Endokrinol (Mosk)

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Incidentalomas are the most common neoplasms in the hypothalamic-pituitary region. Diagnostics, treatment strategy, and indications for the surgical intervention on the patients with these tumours pose a serious challenge for a wide circle of specialists. The diagnostic problems arise from the absence of the specific clinical signs and symptoms as well as the reliable biochemical markers of the disease. The modern laboratory methods do not allow to reveal the pathological hormonal secretion during the diagnostic study, predisposition of the neoplasm to the invasive and infiltrative growth, and signs of its «aggressiveness». This considerably complicates the choice of the optimal surgical strategy and the evaluation of the long-term results of the treatment. Bearing in mind the importance of the problem under consideration, the working group was set up for the development of federal recommendations on the treatment of pituitary incidentalomas based on the principles of evidence-based medicine. The experience accumulated by the domestic and international experts was summarized in the federal clinical guidelines on pituitary incidentalomas containing the available information about these neoplasms.

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Pituitary incidentaloma

Orija¹,

Weil²,

Hamrahian³

2012

Best Practice & Research Clinical Endocrinology & Metab

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Pituitary incidentalomas (PIs) are commonly encountered in clinical practice. While most are microincidentalomas (<1 cm) and not functional, in some cases their identification may lead to discovery of unrecognized abnormalities such as pituitary hormonal deficiencies, excess hormone secretion or visual field defects. Although the majority are pituitary adenomas, the potential list of differential diagnosis is extensive. A limited biochemical work up for asymptomatic patients with microincidentalomas, to include measurement of prolactin and IGF-1, is reasonable, with further studies to be tailored based on the clinical picture. All patients with macroincidentalomas (≥1 cm) should be evaluated for hypopituitarism and undergo visual field testing if the sellar mass abuts or compresses the optic chiasm. Most PIs can be followed, closely without surgery over time, but some may require surgical removal, especially if they are found to be macroincidentalomas at presentation, encroaching on or abutting the optic chiasm, or are found to be functional, excluding prolactinomas. Recovery of pituitary function may be seen in some patients with mass effect following resection of a sellar mass. The association of headache and pituitary incidentalomas remains a diagnostic challenge. There are no randomized controlled studies to guide the follow up approach when surgery is not indicated; most of the follow up algorithms in the literature are based on personal experience. Most retrospective series on natural history indicate that microincidentalomas tend not to grow; without a need for long-term follow up unless the patient becomes symptomatic. Macroincidentalomas, on the other hand, have a propensity to grow and need a more aggressive follow up approach to minimize morbidity.

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Lesions within and around the Pituitary

Cited by 8 publications

References 106 publications

Unusual Association of Sphenoidal Schwannoma with Nasosinusal Polyposis

Unusual Association of Sphenoidal Schwannoma with Nasosinusal Polyposis

Pituitary incidentalomas: the clinical picture, diagnostics, differential diagnostics, and methods of treatment

Pituitary incidentaloma

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