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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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CT and MRI scans 11 months after the first operation. (A) Sagittal CT showing the isodensity in the suprasellar area and the prepontine cistern (arrow). (B) MRI showing a partial contrasting mass in the suprasellar area (arrow).
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Figure 4: CT and MRI scans 11 months after the first operation. (A) Sagittal CT showing the isodensity in the suprasellar area and the prepontine cistern (arrow). (B) MRI showing a partial contrasting mass in the suprasellar area (arrow).

Mentions: After 4 months, a follow-up MRI showed an enlarged region of isodensity in the suprasellar and prepontine areas (Figure 3, arrow point). An enlarged mass corresponding to the ‘cystic lesion’ area was observed in the preoperative image (Figure 1A and E, arrow point). After retrospective analysis, the cystic expansion was believed to be a result of the decompression caused by pituitary tumor resection. The patient was followed up because she had no other clinical symptoms or signs. At 9 months after the initial operation, the patient complained that the visual acuity of her left eye had deteriorated again. Two months later, she came back to our hospital for further examination. Ophthalmologic examination revealed that the status of her left eye was very poor, with almost no visual acuity, and she was not able to maintain visual field detection. Her right eye visual acuity had decreased slightly compared with the previous evaluation (from 5/4 to 5/5), and its visual field was also decreased. Ophthalmic fundus examination of both eyes did not show any obvious abnormality. Endocrinological testing showed normal levels of prolactin, ACTH, follicle-stimulating hormone, luteinizing hormone, growth hormone, and free T4 with only slightly decreased levels of free T3 (1.72 nmol/l, reference value: 2.2 nmol/l to 4.2 nmol/l) and thyroid-stimulating hormone (0.3 μIU/ml, reference value: 0.47 μIU/ml to 4.95 μIU/ml). Sagittal CT and MRI showed an abnormal mixed signal in the suprasellar area and the prepontine cistern, corresponding to a partial contrasting mass with clear edges (Figure 4, arrow point). The patient was diagnosed with recurrent 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)

CT and MRI scans 11 months after the first operation. (A) Sagittal CT showing the isodensity in the suprasellar area and the prepontine cistern (arrow). (B) MRI showing a partial contrasting mass in the suprasellar area (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: CT and MRI scans 11 months after the first operation. (A) Sagittal CT showing the isodensity in the suprasellar area and the prepontine cistern (arrow). (B) MRI showing a partial contrasting mass in the suprasellar area (arrow).
Mentions: After 4 months, a follow-up MRI showed an enlarged region of isodensity in the suprasellar and prepontine areas (Figure 3, arrow point). An enlarged mass corresponding to the ‘cystic lesion’ area was observed in the preoperative image (Figure 1A and E, arrow point). After retrospective analysis, the cystic expansion was believed to be a result of the decompression caused by pituitary tumor resection. The patient was followed up because she had no other clinical symptoms or signs. At 9 months after the initial operation, the patient complained that the visual acuity of her left eye had deteriorated again. Two months later, she came back to our hospital for further examination. Ophthalmologic examination revealed that the status of her left eye was very poor, with almost no visual acuity, and she was not able to maintain visual field detection. Her right eye visual acuity had decreased slightly compared with the previous evaluation (from 5/4 to 5/5), and its visual field was also decreased. Ophthalmic fundus examination of both eyes did not show any obvious abnormality. Endocrinological testing showed normal levels of prolactin, ACTH, follicle-stimulating hormone, luteinizing hormone, growth hormone, and free T4 with only slightly decreased levels of free T3 (1.72 nmol/l, reference value: 2.2 nmol/l to 4.2 nmol/l) and thyroid-stimulating hormone (0.3 μIU/ml, reference value: 0.47 μIU/ml to 4.95 μIU/ml). Sagittal CT and MRI showed an abnormal mixed signal in the suprasellar area and the prepontine cistern, corresponding to a partial contrasting mass with clear edges (Figure 4, arrow point). The patient was diagnosed with recurrent 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