The sellar and suprasellar region: A “hideaway” of rare lesions. Clinical aspects, imaging findings, surgical outcome and comparative analysis

Petrakakis, Ioannis; Pirayesh, Ariyan; Krauss, Joachim K.; Raab, Peter; Hartmann, Christian; Nakamura, Makoto

doi:10.1016/j.clineuro.2016.08.011

Cited by 43 publications

(46 citation statements)

References 68 publications

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“…With ten such lesions out of 1138 SSR lesions managed at our centre in last decade, the prevalence of such lesions is 0.1 % in our series, signifying the rarity of these lesions. There are only two similar series previously described in literature, both reporting spectrum of etiologies remarkably different from that found in our centre (5,6). In a German neurosurgical series, Petrakakis et al described 20 patients with rare SSR lesions of eight different etiologies (5).…”

Section: Discussionmentioning

confidence: 47%

“…There are only two similar series previously described in literature, both reporting spectrum of etiologies remarkably different from that found in our centre (5,6). In a German neurosurgical series, Petrakakis et al described 20 patients with rare SSR lesions of eight different etiologies (5). While xanthogranulomas (n = 6) were the commonest tumors in their series, other etiologies included metastases, colloid/ epidermal cysts, pilocytic astrocytomas, gangliocytoma, lymphocytic hypophysitis, and concomitant germ cell tumor/rhabdomyosarcoma.…”

Section: Discussionmentioning

confidence: 53%

“…These lesions often have characteristic radiological appearance suggesting pre-operative diagnosis. However, besides these common lesions, certain 'rare SSR lesions' are sometimes encountered, whose diagnosis may be missed pre-operatively (5,6). Herein we present clinical, biochemical, and radiological characteristics as well as management outcomes of rare SSR lesions other than pituitary adenomas, CR, RCC, LyH, and meningioma.…”

Section: Introductionmentioning

confidence: 97%

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Sellar surprises: a single-centre experience of unusual sellar masses

Thakkar¹,

Ramteke-Jadhav²,

Kasaliwal

et al. 2020

Endocrine Connections

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Background Most common incidentally detected sellar-suprasellar region (SSR) masses are pituitary adenomas, followed by craniopharyngioma, rathke’s cleft cyst, hypophysitis, and meningioma. Besides these, certain unusual SSR lesions can sometimes present as diagnostic challenges, where diagnosis is often made post-operatively on histopathology, the pre-operative suspicion of which might have influenced the management strategies. Series describing such masses are few. Objective To present clinical, biochemical, and radiological characteristics and management outcomes of rare SSR lesions other than pituitary adenomas, craniopharyngioma, rathke’s cleft cyst, hypophysitis, and meningioma. Design, setting, patients Retrospective case record analysis of patients with uncommon SSR masses (from January 2006 to December 2016). Results Our series consisted of ten patients, five with neoplastic and five with non-neoplastic lesions. Neoplastic masses included granular cell tumor (n = 2), astrocytoma (n = 1), malignant peripheral nerve sheath tumor (MPNST, n = 1), and metastasis from occult papillary carcinoma of thyroid (n = 1), while non-neoplastic masses were aspergillus abscess (n = 1), sterile abscess (n = 1), and tubercular abscess (n = 1), aneurysm of left internal carotid artery (n = 1), and ruptured dermoid cyst (n = 1). All patients (except one) presented with headache and/or visual disturbance. Only one patient had acromegaly while most others had hypopituitarism. We describe detailed MRI characteristics of each of the lesion. Seven patients underwent trans-sphenoidal surgery. Post-operatively, five patients had permanent diabetes insipidus, while two patients died in early post-operative period. Conclusion Our series expand the differential diagnostic considerations of SSR lesions. Most of the rare SSR masses present with symptoms of mass effects and hypopituitarism. Except for some non-neoplastic lesions like sellar abscesses, aneurysms, and dermoid cysts which can have some specific imaging characteristics that can provide clue to pre-operative diagnosis, most of the other neoplastic masses have overlapping radiological features, and pre-operative suspicion remains difficult.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Sellar surprises: a single-centre experience of unusual sellar masses

Thakkar¹,

Ramteke-Jadhav²,

Kasaliwal

et al. 2020

Endocrine Connections

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“…Descriptions of sellar CC are extremely rare in the medical literature, with only a few published works describing clinical presentation. [4][5][6][7] The exact pathogenesis of this entity lacks clarity. Possible theories include degenerative processes and/or vascular insults.…”

Section: Discussionmentioning

confidence: 99%

Sellar Colloid Cyst—An Anatomically Aberrant and Diagnostically Challenging Entity: Report of a Rare Case with Literature Review

Ali

Gaur

Srivastava

et al. 2019

IJNS

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The sellar colloid cyst is a rare entity anatomically occurring at the intermediate lobe of the pituitary gland. Clinically a cystic sellar lesion with pressure effects usually evokes the suspicion of a pituitary adenoma. We present the case of a middle-aged woman presenting with visual diminution and bilateral optic atrophy, caused by a large sellar lesion, variably intense on magnetic resonance imaging (MRI). The subsequent histologic diagnosis of a colloid cyst was unexpected. This report highlights the subtle intraoperative and diagnostic features key to diagnosing this rarity. We also discuss a practical differential diagnostic approach relevant to the practicing surgeon and review the existing literature.

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“…These includes gangliocytoma, chondrosarcoma, suprasellar germinoma, hemangioma, fibroma, hamartoma, and lymphocytic hypophysitis only naming a few (9). Petrakakis et al in their studies of rare lesions in this region, out of 223 cases only 20 diagnosed with histopathology other than pituitary adenoma, craniopharyngioma, meningioma, and rathke cleft cyst (13). entry, operative note, MRI report, histopathology report, and perimetry report.…”

Section: Introductionmentioning

confidence: 99%