Remarkable Diagnostic Magnetic Resonance Imaging Findings in Sellar Xanthogranuloma: Report of Three First Cases in Latin America

Céspedes, Mario Tapia; Vargas, Jaime Pinto; Yañez, Fernando Andrade; León, Loreto Spencer; Arancibia, Pablo Álvarez; Putz, Thomas Schmidt

doi:10.1055/s-0037-1598203

Cited by 12 publications

(8 citation statements)

References 19 publications

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“…The cystic part shared the same imagistic features with pure cystic XGs, typically hyperintense in T1 and T2 sequences. In predominantly cystic masses, the solid component, represented by fibrosis or chronic hemorrhage, appeared as excentric nodules with low-intensity signal in T2WI, or T1WI and T2WI, and almost no contrast enhancement [ 15 , 41 , 47 ]. Several heterogeneous solid lesions also presented intratumoral cysts [ 21 ].…”

Section: Neuroimaging Of Sellar Xanthogranulomasmentioning

confidence: 99%

“…Our data are concordant with previous results provided by Cespedes et al in a review of 33 sellar and juxta-sellar XGs who underwent MRI of the pituitary gland. Half of the cases showed no contrast enhancement, whereas 30% showed peripheral LR enhancement, and 20% proved heterogeneous enhancement [ 47 ]. By contrast, peripheral rim enhancement was identified in seven (50%), and heterogeneous enhancement was detected in 4 of 14 subjects from a study conducted by Yang et al [ 5 ].…”

Section: Neuroimaging Of Sellar Xanthogranulomasmentioning

confidence: 99%

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Xanthogranuloma of the Sellar Region: A Comprehensive Review of Neuroimaging in a Rare Inflammatory Entity

Lozovanu

Georgescu

Florescu³

et al. 2022

JPM

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Xanthogranuloma of the sellar region is a rare chronic inflammatory lesion resulting from secondary hemorrhage, inflammation, infarction, and necrosis of an existing Rathke’s cleft cyst, craniopharyngioma, or pituitary adenoma. Sellar xanthogranulomas are challenging to differentiate from other cystic lesions preoperatively due to the lack of characteristic imaging features. We performed a literature overview of the clinical and paraclinical features, treatment options, and long-term outcomes of patients with sellar xanthogranuloma, focusing on the preoperative radiological diagnosis. The hyperintense signal in both T1- and T2-weighted sequences, cystic or partially cystic morphology, ovoid shape, sellar epicenter, intra- and suprasellar location, intratumoral calcifications, linear rim contrast enhancement, and the absence of cavernous sinus invasion suggest xanthogranuloma in the preoperative differential diagnosis. An endoscopic endonasal gross total resection without radiotherapy is the preferred first-line treatment. Given the low rate of recurrence rate and low chance of endocrinological recovery, a mass reduction with decompression of the optic apparatus may represent an appropriate surgical goal. Identifying the xanthogranulomas’ mutational profile could complement histopathological diagnosis and give insight into their histo-pathogenesis. A better preoperative neuroimagistic diagnosis of sellar xanthogranulomas and differentiation from lesions with a poorer prognosis, such as craniopharyngioma, would result in an optimal personalized surgical approach.

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Section: Neuroimaging Of Sellar Xanthogranulomasmentioning

confidence: 99%

Section: Neuroimaging Of Sellar Xanthogranulomasmentioning

confidence: 99%

Xanthogranuloma of the Sellar Region: A Comprehensive Review of Neuroimaging in a Rare Inflammatory Entity

Lozovanu

Georgescu

Florescu³

et al. 2022

JPM

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“…Céspedes et al reviewed the MRI findings of 33 cases of sellar xanthogranuloma, and 30 cases performed post-contrast T1WI scans. [9] They found that 15 cases (50%) demonstrated no contrast enhancement; 9 cases (30%) demonstrated peripheral rim enhancement; and 6 cases (20%) demonstrated heterogeneous enhancement on the post-contrast T1WI. In our case, the lesion showed no enhancement on the post-contrast T1WI.…”

Section: Discussionmentioning

confidence: 97%

“…In our case, the lesion showed no enhancement on the post-contrast T1WI. [9] Typically, Rathke cleft cyst is homogeneous on both T1WI and T2WI, and demonstrates no contrast enhancement on the post-contrast T1WI. Craniopharyngioma typically has calcification within the cystic lesion, and shows heterogeneous enhancement on the post-contrast T1WI.…”

Section: Discussionmentioning

confidence: 99%

“…There are no typical radiological characteristics or patterns for sellar xanthogranuloma. [ 8 9 ] It has been speculated that cholesterol clefts within these lesions show T1WI high and T2WI low-signal intensities[ 6 10 ]; fluid components within the cystic lesions can appear high signal on T2WI, and the development of more profound fibrosis (granulation) and hemorrhage can show low-signal on both T1WI and T2WI. [6] These mixed signal intensities reflect the complex histologic components that make up granulomatous inflammatory lesions.…”

Section: Discussionmentioning

confidence: 99%

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Xanthogranuloma of the sellar region

Shao

Wang²,

Min³

2020

Medicine

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Rationale: Xanthogranuloma of the sellar region is exceedingly rare, and described in only a handful of case reports. Herein, we present a case of xanthogranuloma of the sellar region to improve our knowledge for the diagnosis and management of this unusual disease. Patient concerns: A 50-year-old female presented with the symptoms of intermittent vomiting, occasional head discomfort, and diabetes insipidus of 1 month duration. Diagnoses: Magnetic resonance imaging showed a large well-defined, vase-like, heterogeneous mass in the sellar region. The lesion showed mixed signal with hierarchical signal presentation. Fluid-fluid level sign can be found within the lesion. The upper part of the lesion was hyperintense, and the lower part was hypointense on both T1-weighted images and T2-weighted images. The lesion showed no enhancement following the intravenous administration of gadolinium. The normal pituitary tissue was not clearly visible. Optic chiasm was compressed and displaced by the lesion. Initial diagnosis of pituitary macroadenoma with hemorrhage in the sellar region was made before surgery. Final diagnosis of sellar xanthogranuloma was confirmed by histopathological examination after surgical resection. Interventions: Gross total resection of the lesion was achieved using the microscope through endonasal transsphenoidal approach. Outcomes: The patient recovered well with improved binocular vision and no symptom of diabetes insipidus, and was discharged 5 days after operation. Lessons: Sellar xanthogranuloma should receive diagnostic consideration for the lesion that is a heterogeneously mixed mass with a degree of T1-weighted images hyperintense in the sellar region.

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Endoscopic Endonasal Surgery for Uncommon Pathologies of the Sellar and Parasellar Regions

Azab,

Khan,

Alqunaee

et al. 2023

Advances and Technical Standards in Neurosurgery

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Remarkable Diagnostic Magnetic Resonance Imaging Findings in Sellar Xanthogranuloma: Report of Three First Cases in Latin America

Cited by 12 publications

References 19 publications

Xanthogranuloma of the Sellar Region: A Comprehensive Review of Neuroimaging in a Rare Inflammatory Entity

Xanthogranuloma of the Sellar Region: A Comprehensive Review of Neuroimaging in a Rare Inflammatory Entity

Xanthogranuloma of the sellar region

Endoscopic Endonasal Surgery for Uncommon Pathologies of the Sellar and Parasellar Regions

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