Rathke's Cleft Cyst With Xanthogranulomatous Change -Case Report-

Miyajima, Yoshiteru; Oka, Hiroyuki; Utsuki, Satoshi; Fujii, Kiyotaka

doi:10.2176/nmc.51.740

Cited by 22 publications

(15 citation statements)

References 16 publications

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“…Although some theories have been proposed, the pathogenesis of XGI remains largely unknown. The content of a ruptured cyst and cyst epithelium in contact with the surrounding tissue have been suggested to cause XGI through various mechanisms including activation of monocytes/macrophages [17][18][19]. Similar to the presented case, patients with ruptured Rathke' cleft cyst also result in reactive xanthogranulomatous hypophysitis.…”

Section: Discussionsupporting

confidence: 71%

Thyroglossal Duct Cyst Associated with Xanthogranulomatous Inflammation

Taşkin

Güçer

Winer

et al. 2015

Head and Neck Pathol

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Xanthogranulomatous inflammation (XGI) is an uncommon destructive chronic inflammatory process mainly occurring in the kidney and gallbladder, characterized by the accumulation of foamy histiocytes, multinucleated giant cells (Touton type), cholesterol clefts and chronic inflammatory cells. The head and neck region is an uncommon site for XGI. This type of inflammatory reaction has been defined in branchial cleft cyst, salivary gland tumors following fine-needle aspiration biopsies, Rathke's cleft cyst in the pituitary gland, and colloid cyst in the 3rd ventricle. We present herein a unique case of ruptured thyroglossal duct cyst leading to XGI, characterized by an infiltrative subcutaneous central neck lesion, clinically mimicking a thyroid carcinoma. In addition, we also summarize current insights into the pathogenesis of XGI in the head and neck region.

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Section: Discussionsupporting

confidence: 71%

Thyroglossal Duct Cyst Associated with Xanthogranulomatous Inflammation

Taşkin

Güçer

Winer

et al. 2015

Head and Neck Pathol

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“…Then in 1999, Paulus et al suggested that sellar xanthogranuloma is clinically and pathologically distinct from the classical adamantinomatous craniopharyngioma (2). 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).…”

Section: Discussionmentioning

confidence: 99%

Xanthogranulomatous pituitary adenoma: A case report and literature review

Zhang

Sun

et al. 2018

mol clin onc

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Abstract. Xanthogranuloma, also referred to as cholesterol granuloma or xanthogranulomatous reaction, is a granulomatous lesion that is infrequently found in the sellar and parasellar regions. Xanthogranulomatous pituitary adenoma is relatively rare and, thus, the etiology, diagnosis, management and prognosis of this condition remain incompletely understood. We herein report the case of a 56-year-old female patient who presented to our institution with intermittent headache, vomiting and distending pain in the bilateral orbital regions. Brain magnetic resonance imaging revealed a sellar mass with a heterogeneous signal. The mass was subtotally resected, and histopathological examination confirmed the diagnosis of xanthogranulomatous pituitary adenoma. Although the patient's symptoms were relieved following surgical treatment, intractable hyponatremia and diabetes insipidus developed and she received hormone replacement therapy. At the last follow-up (November 2016), the patient remained recurrence-free. A total of 14 cases of pituitary adenoma with concomitant xanthogranuloma were identified in the literature, and the clinical and radiological manifestations are discussed. Sellar xanthogranuloma is usually associated with craniopharyngioma or Rathke's cleft cyst; however, it may also occur in isolation. Xanthogranulomatous pituitary adenomas are infrequent, making their diagnosis challenging. Surgical resection is the preferred treatment, and attention should be paid to postoperative hypopituitarism and development of diabetes insipidus. IntroductionSellar xanthogranuloma, also referred to as cholesterol granuloma or xanthogranulomatous reaction, is a rare granulomatous lesion consisting of cholesterol clefts, hemosiderin deposits, macrophages, chronic inflammatory infiltrates and fibrous proliferation (1,2). Sellar xanthogranuloma is most commonly associated with craniopharyngioma or Rathke's cleft cyst, but may also occur in isolation (2). The xanthogranulomatous change was first described in 1988 (3). Xanthogranulomatous pituitary adenomas are extremely rare, with only a few cases reported in the literature to date (1,3,4). Therefore, the etiology, diagnosis, management and prognosis of this condition have yet to be fully elucidated. We herein report a case of pituitary adenoma with concomitant xanthogranuloma in a female patient who developed diabetes insipidus postoperatively. The relevant literature is also reviewed and discussed. Case reportA 56-year-old woman presented to The First Hospital of Jilin University (Changchun, China) on August 30, 2014, with a 20-day history of intermittent headache, vomiting and distending pain in the bilateral orbital regions. Brain computed tomography (CT) scanning revealed a sellar mass exhibiting heterogeneous hyperintensity (Fig. 1A). Subsequently, brain magnetic resonance imaging (MRI) revealed an intra-and suprasellar oval mass sized 30x25x30 mm, involving the hypothalamus and the foramen of Monro. The pituitary gland and the pituitary stalk could not be clearly ident...

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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%

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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Rathke's Cleft Cyst With Xanthogranulomatous Change -Case Report-

Cited by 22 publications

References 16 publications

Thyroglossal Duct Cyst Associated with Xanthogranulomatous Inflammation

Thyroglossal Duct Cyst Associated with Xanthogranulomatous Inflammation

Xanthogranulomatous pituitary adenoma: A case report and literature review

Parasellar xanthogranulomas

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