Panhypopituitarism Induced by Cholesterol Granuloma in the Sellar Region-Case Report-

Yonezawa, Koichiro; Shirataki, Kunio; Sakagami, Yoshio; Kohmura, Eiji

doi:10.2176/nmc.43.259

Cited by 30 publications

(36 citation statements)

References 4 publications

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“…1,2,[14][15][16]20,25,26 Hence, the incidence of xanthogranulomas in Western countries is unclear. Likewise, the management of these lesions has been almost universally through craniotomy or microscopic transsphenoidal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…1,12,21 Many authors have described the presentation of endocrine, visual, and neurological manifestations in parasellar xanthogranulomatous reactions, but a unique symptomatology has not yet been elucidated. 1,2,[6][7][8]12,15,16,20,21,23,[25][26][27] Furthermore, there is significant controversy regarding the etiology and development of these unusual lesions. One theory of the etiology of these parasellar lesions is that all xanthogranulomas arise from inflammatory processes occurring in preexisting CPs.…”

Section: Discussionmentioning

confidence: 99%

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Parasellar xanthogranulomas

Rahmani

Sukumaran

Donaldson

et al. 2015

JNS

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OBJECT Xanthogranulomas are rare inflammatory masses most often found in the skin and eye. The incidence of intracranial xanthogranulomas is 1.6%–7%, with those found in the sellar and parasellar region being exceedingly rare and their etiology controversial. Sellar and parasellar xanthogranulomas are rarely reported in the western hemisphere, and their incidence in Western countries is unknown. METHODS A prospectively acquired database of all endonasal endoscopic transsphenoidal surgeries performed at Weill Cornell Medical College was queried. Patients with histologically confirmed xanthogranulomas who were diagnosed and treated between 2003 and 2013 were included in the study. Patient history, demographic data, histological findings, and surgical approach were also evaluated. RESULTS A total of 643 endonasal endoscopic procedures had been performed at the time of this study. Four patients (0.6%) were identified as having a histologically confirmed xanthogranuloma of the parasellar region, compared with an incidence of 6.7% for craniopharyngioma (CP) and 2% for Rathke cleft cyst (RCC). The most common symptom was visual loss, followed by headache. Preoperative diagnosis was CP in all cases. All patients underwent extended endonasal endoscopic transsphenoidal surgery with gross-total resection. Two patients developed panhypopituitarism after surgery. There were no CSF leaks. The mean follow-up was 61 months, at which time there were no recurrences. The key histological features differentiating xanthogranulomas from CPs were accumulation of foamy macrophages, multinucleated foreign body giant cells, cholesterol clefts, and hemosiderin deposits without stratified squamous epithelium. These histological features appear commonly as part of the spectrum of a secondary inflammatory response in an RCC. CONCLUSIONS Parasellar xanthogranulomas most closely approximate CPs clinically but pathological evidence may suggest an RCC origin. Gross-total resection can be achieved through extended endonasal endoscopic transsphenoidal approaches, and is curative.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Parasellar xanthogranulomas

Rahmani

Sukumaran

Donaldson

et al. 2015

JNS

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“…1,[3][4][5]10) We postulate that the preferred intrasellar location of xanthogranulomas reflects earlier pathologies of intrasellar origin such as Rathke's cleft cysts, pituitary adenoma, or hypophysitis. However, the tumor in our case was found at a classical location for craniopharyngiomas, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5]7,10) Cholesterol granulomas in the head region are found in the middle ear, petrous apex, paranasal sinuses, and choroid plexus. 2,5,6) Xanthogranulomas of the sellar region are very rare and mainly located in the sella turcica.…”

Section: Introductionmentioning

confidence: 99%

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Xanthogranuloma in the Suprasellar Region -Case Report-

Sugata

Hirano

Yatsushiro

et al. 2009

Neurol. Med. Chir.(Tokyo)

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A 26-year-old man presented with a xanthogranuloma located exclusively in the suprasellar region manifesting as general fatigue, bitemporal hemianopsia, and polyuria. Endocrinological examination disclosed severe hypopituitarism. Magnetic resonance imaging demonstrated a clearly defined suprasellar mass that was heterogeneously enhanced after gadolinium administration and was markedly hypointense on T 2 -weighted images. The tumor was subtotally removed under a preoperative diagnosis of craniopharyngioma. Histological examination found fibrous tissue with abundant cholesterol clefts, multinucleated giant cells, and hemosiderin deposits, but no epithelial cells. Xanthogranulomas of the sellar region are reported to be predominantly located in the sella turcica, but should be included in the differential diagnosis even in cases of suprasellar mass lesions.

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

160

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Panhypopituitarism Induced by Cholesterol Granuloma in the Sellar Region-Case Report-

Cited by 30 publications

References 4 publications

Parasellar xanthogranulomas

Parasellar xanthogranulomas

Xanthogranuloma in the Suprasellar Region -Case Report-

ICAR: endoscopic skull‐base surgery

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