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Collision tumors of the sella: coexistence of pituitary adenoma and craniopharyngioma in the sellar region.

Jin G, Hao S, Xie J, Mi R, Liu F - World J Surg Oncol (2013)

Bottom Line: Histopathological and immunohistochemical examinations of the excised tissue revealed a pituitary adenoma in the first operation and a craniopharyngioma in the second operation.Retrospective analysis found the coexistence of a pituitary adenoma and a craniopharyngioma, known as a collision tumor.Instead of the transsphenoidal approach, a craniotomy should be performed, to explore the suprasellar region.

View Article: PubMed Central - HTML - PubMed

Affiliation: Brain Tumor Research Center, Beijing Neurosurgical Institute & Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China.

ABSTRACT
Collision tumors of the sellar region are relatively uncommon and consist mainly of more than one type of pituitary adenoma or a cyst or cystic tumor. The association of a pituitary adenoma and a craniopharyngioma is particularly rare. This study describes a rare occurrence in which a pituitary adenoma and a craniopharyngioma coexisted in the sellar region. The case involves a 47-year-old woman who underwent transsphenoidal surgery with subtotal tumor resection and reoperation using an interhemispheric transcallosal approach for total microsurgical resection of the tumor because the visual acuity in her left eye had re-deteriorated. Histopathological and immunohistochemical examinations of the excised tissue revealed a pituitary adenoma in the first operation and a craniopharyngioma in the second operation. Retrospective analysis found the coexistence of a pituitary adenoma and a craniopharyngioma, known as a collision tumor. Instead of the transsphenoidal approach, a craniotomy should be performed, to explore the suprasellar region.

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Preoperative images of computed tomography (CT) and magnetic resonance imaging (MRI) scans. (A) Sagittal CT showing isodensity or slightly higher density in the sellar and suprasellar areas (arrow indicates the cystic mass in the suprasellar areas). (B,C) Transverse MRI showing a short T1-weighted signal in the sellar area and prepontine cistern and a short T2-weighted signal (arrows indicate the mass). (D-F) Contrast MRI showing an enhanced mass in the sellar and suprasellar areas with a cystic mass in the prepontine cistern (D,F; arrows indicate the mass. E; arrow indicates the cystic mass in the prepontine cistern).
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Figure 1: Preoperative images of computed tomography (CT) and magnetic resonance imaging (MRI) scans. (A) Sagittal CT showing isodensity or slightly higher density in the sellar and suprasellar areas (arrow indicates the cystic mass in the suprasellar areas). (B,C) Transverse MRI showing a short T1-weighted signal in the sellar area and prepontine cistern and a short T2-weighted signal (arrows indicate the mass). (D-F) Contrast MRI showing an enhanced mass in the sellar and suprasellar areas with a cystic mass in the prepontine cistern (D,F; arrows indicate the mass. E; arrow indicates the cystic mass in the prepontine cistern).

Mentions: A 47-year-old right-handed woman presented with intermittent blurred vision of the left eye and headaches, which she had had for 5 months. She had also suffered from sore roughening or splitting of the palms and arches for 6 months. The patient had been pregnant twice with normal deliveries, and she had not reached menopause at admission. Neurological examination revealed no obvious clinical signs. The patient complained of decreased vision in her left eye. An examination of her visual acuity revealed that her left eye had almost no distant vision. Visual field testing showed that her left eye’s mean sensitivity and mean defect were significantly decreased compared with the normal value. Ophthalmic fundus examination of both eyes did not show any obvious abnormality. The vision of the patient’s right eye was 5/4, and the mean sensitivity and mean defect were decreased but higher than in the left eye. An endocrine evaluation revealed increased levels of prolactin (111.9 ng/ml, reference value: 2 ng/ml to 25 ng/ml) and adrenocorticotropic hormone (ACTH) (116.7 pg/ml, reference value: 11.6 pg/ml to 70.8 pg/ml). Levels of other hormones, including luteinizing hormone, growth hormone, and follicle-stimulating hormone were normal. Other physical examinations revealed that the patient had no other clinical symptoms, neurologic deficits, or other hormonal dysfunction. Biochemical evaluations, including analysis of blood chemistry, electrolyte levels, and urine did not show any obvious abnormality. Computed tomography (CT) and magnetic resonance imaging (MRI) of the patient’s brain revealed an abnormal signal in the sellar and suprasellar areas, owing to the presence of a partial contrasting mass with clear edges (Figure 1). The patient was diagnosed with pituitary adenoma.


Collision tumors of the sella: coexistence of pituitary adenoma and craniopharyngioma in the sellar region.

Jin G, Hao S, Xie J, Mi R, Liu F - World J Surg Oncol (2013)

Preoperative images of computed tomography (CT) and magnetic resonance imaging (MRI) scans. (A) Sagittal CT showing isodensity or slightly higher density in the sellar and suprasellar areas (arrow indicates the cystic mass in the suprasellar areas). (B,C) Transverse MRI showing a short T1-weighted signal in the sellar area and prepontine cistern and a short T2-weighted signal (arrows indicate the mass). (D-F) Contrast MRI showing an enhanced mass in the sellar and suprasellar areas with a cystic mass in the prepontine cistern (D,F; arrows indicate the mass. E; arrow indicates the cystic mass in the prepontine cistern).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750462&req=5

Figure 1: Preoperative images of computed tomography (CT) and magnetic resonance imaging (MRI) scans. (A) Sagittal CT showing isodensity or slightly higher density in the sellar and suprasellar areas (arrow indicates the cystic mass in the suprasellar areas). (B,C) Transverse MRI showing a short T1-weighted signal in the sellar area and prepontine cistern and a short T2-weighted signal (arrows indicate the mass). (D-F) Contrast MRI showing an enhanced mass in the sellar and suprasellar areas with a cystic mass in the prepontine cistern (D,F; arrows indicate the mass. E; arrow indicates the cystic mass in the prepontine cistern).
Mentions: A 47-year-old right-handed woman presented with intermittent blurred vision of the left eye and headaches, which she had had for 5 months. She had also suffered from sore roughening or splitting of the palms and arches for 6 months. The patient had been pregnant twice with normal deliveries, and she had not reached menopause at admission. Neurological examination revealed no obvious clinical signs. The patient complained of decreased vision in her left eye. An examination of her visual acuity revealed that her left eye had almost no distant vision. Visual field testing showed that her left eye’s mean sensitivity and mean defect were significantly decreased compared with the normal value. Ophthalmic fundus examination of both eyes did not show any obvious abnormality. The vision of the patient’s right eye was 5/4, and the mean sensitivity and mean defect were decreased but higher than in the left eye. An endocrine evaluation revealed increased levels of prolactin (111.9 ng/ml, reference value: 2 ng/ml to 25 ng/ml) and adrenocorticotropic hormone (ACTH) (116.7 pg/ml, reference value: 11.6 pg/ml to 70.8 pg/ml). Levels of other hormones, including luteinizing hormone, growth hormone, and follicle-stimulating hormone were normal. Other physical examinations revealed that the patient had no other clinical symptoms, neurologic deficits, or other hormonal dysfunction. Biochemical evaluations, including analysis of blood chemistry, electrolyte levels, and urine did not show any obvious abnormality. Computed tomography (CT) and magnetic resonance imaging (MRI) of the patient’s brain revealed an abnormal signal in the sellar and suprasellar areas, owing to the presence of a partial contrasting mass with clear edges (Figure 1). The patient was diagnosed with pituitary adenoma.

Bottom Line: Histopathological and immunohistochemical examinations of the excised tissue revealed a pituitary adenoma in the first operation and a craniopharyngioma in the second operation.Retrospective analysis found the coexistence of a pituitary adenoma and a craniopharyngioma, known as a collision tumor.Instead of the transsphenoidal approach, a craniotomy should be performed, to explore the suprasellar region.

View Article: PubMed Central - HTML - PubMed

Affiliation: Brain Tumor Research Center, Beijing Neurosurgical Institute & Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China.

ABSTRACT
Collision tumors of the sellar region are relatively uncommon and consist mainly of more than one type of pituitary adenoma or a cyst or cystic tumor. The association of a pituitary adenoma and a craniopharyngioma is particularly rare. This study describes a rare occurrence in which a pituitary adenoma and a craniopharyngioma coexisted in the sellar region. The case involves a 47-year-old woman who underwent transsphenoidal surgery with subtotal tumor resection and reoperation using an interhemispheric transcallosal approach for total microsurgical resection of the tumor because the visual acuity in her left eye had re-deteriorated. Histopathological and immunohistochemical examinations of the excised tissue revealed a pituitary adenoma in the first operation and a craniopharyngioma in the second operation. Retrospective analysis found the coexistence of a pituitary adenoma and a craniopharyngioma, known as a collision tumor. Instead of the transsphenoidal approach, a craniotomy should be performed, to explore the suprasellar region.

Show MeSH
Related in: MedlinePlus