Parasellar xanthogranulomas

Abstract

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.

Xanthogranulomatous pituitary adenoma: A case report and literature review

“…According to previous reports, surgical resection via the transsphenoidal approach is the preferred treatment, and gross total resection has been achieved in 73.3% of the cases (1,6). In the present case, the tumor was resected via the right pterional approach; however, only the posterior portion of the tumor could be removed due to poor exposure.…”

“…According to a study published in 2011, the incidence of intracranial xanthogranuloma is 1.6-7%, and lesions are only rarely found in the sellar and parasellar regions (5). Of the 643 patients with sellar or parasellar tumors retrospectively reviewed by Rahmani et al only 4 patients (0.6%) had histologically confirmed xanthogranulomas (6). Additionally, in our review of the literature regarding sellar or parasellar xanthogranulomas, 160 cases were identified.…”

ICAR: endoscopic skull‐base surgery

“…In a systematic review, Durgam and Batra found that only 14% and 11% of patients with CGs of the paranasal sinuses had a history of craniofacial trauma and prior surgery, respectively. Sellar and parasellar CGs are thought to have a distinct pathogenesis, wherein inflammation develops around RCCs or craniopharyngiomas (46% and 20% have xanthomatous change on pathologic examination, respectively) and leads to formation of CG . As a result of being associated with these conditions, sellar and parasellar CGs are often misdiagnosed as neoplasms as opposed to inflammatory lesions …”

Review of xanthomatous lesions of the sella

“…Since that time, numerous additional case reports of XG have suggested that, when an etiology can be identified at all, it is a hemorrhagic RCC that is implicated. In addition, since the report of Paulus et al , numerous examples of hemorrhagic and non‐hemorrhagic RCCs mimicking pituitary apoplexy have been published, underscoring the fact that bleeding into RCC may be both subclinical and clinically relevant .…”