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Secondary headache due to aspergillus sellar abscess simulating a pituitary neoplasm: case report and review of literature.

Hong W, Liu Y, Chen M, Lin K, Liao Z, Huang S - Springerplus (2015)

Bottom Line: Milk-like pus and a mass of ash black mixed and necrotic material were found and removed.Histopathology revealed numerous aspergillus hyphae.No recurrence was observed during follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China.

ABSTRACT
Fungal sellar abscess is rare. A 42-year-old man was admitted with 2-month headache characterized by right peri-orbital pain. An intrasellar mass was found to be simulated a pituitary neoplasm after magnetic resonance imaging examination, and operated on via an endoscopic trans-sphenoidal approach. Milk-like pus and a mass of ash black mixed and necrotic material were found and removed. Histopathology revealed numerous aspergillus hyphae. Itraconazole was given on a dosage of 200 mg twice a day orally for 6 weeks. No recurrence was observed during follow-up. Complete surgical resection through endoscopic trans-sphenoidal approach combined with systemic anti-fungal therapy, should be considered as the optimal treatment.

No MeSH data available.


Related in: MedlinePlus

(Hematoxylin and eosin ×100) Photomicrograph of the intra sellar mass showing fungal organisms with septate hyphae and spores, which was consistent with aspergillus
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Fig2: (Hematoxylin and eosin ×100) Photomicrograph of the intra sellar mass showing fungal organisms with septate hyphae and spores, which was consistent with aspergillus

Mentions: With a preoperative diagnosis of pituitary neoplasm, endoscopic trans-sphenoidal surgery was planned. After the diminished sphenoidal sinus was entered, some milk-like pus and thickened mucosa were excised. When the paper-thin sellar floor bone and dura were opened, more milk-like pus and a mass of ash black mixed and necrotic material were found and removed. The pituitary gland and the diaphragma sellae were found to be intact after the removal of the lesion. The specimens were negative for aerobic and anaerobic bacterial cultures. Histopathological examination of the necrotic material consisted of numerous hyphae, according with characteristic of aspergillus species (Fig. 2). Plasma (1 → 3)-beta-d glucan determination was done and showed a elevated level (203.5 Pg/mL, normal, 0–100.5 Pg/mL). Itraconazole was given on a dosage of 200 mg twice a day orally for 6 weeks.Fig. 2


Secondary headache due to aspergillus sellar abscess simulating a pituitary neoplasm: case report and review of literature.

Hong W, Liu Y, Chen M, Lin K, Liao Z, Huang S - Springerplus (2015)

(Hematoxylin and eosin ×100) Photomicrograph of the intra sellar mass showing fungal organisms with septate hyphae and spores, which was consistent with aspergillus
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4582039&req=5

Fig2: (Hematoxylin and eosin ×100) Photomicrograph of the intra sellar mass showing fungal organisms with septate hyphae and spores, which was consistent with aspergillus
Mentions: With a preoperative diagnosis of pituitary neoplasm, endoscopic trans-sphenoidal surgery was planned. After the diminished sphenoidal sinus was entered, some milk-like pus and thickened mucosa were excised. When the paper-thin sellar floor bone and dura were opened, more milk-like pus and a mass of ash black mixed and necrotic material were found and removed. The pituitary gland and the diaphragma sellae were found to be intact after the removal of the lesion. The specimens were negative for aerobic and anaerobic bacterial cultures. Histopathological examination of the necrotic material consisted of numerous hyphae, according with characteristic of aspergillus species (Fig. 2). Plasma (1 → 3)-beta-d glucan determination was done and showed a elevated level (203.5 Pg/mL, normal, 0–100.5 Pg/mL). Itraconazole was given on a dosage of 200 mg twice a day orally for 6 weeks.Fig. 2

Bottom Line: Milk-like pus and a mass of ash black mixed and necrotic material were found and removed.Histopathology revealed numerous aspergillus hyphae.No recurrence was observed during follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China.

ABSTRACT
Fungal sellar abscess is rare. A 42-year-old man was admitted with 2-month headache characterized by right peri-orbital pain. An intrasellar mass was found to be simulated a pituitary neoplasm after magnetic resonance imaging examination, and operated on via an endoscopic trans-sphenoidal approach. Milk-like pus and a mass of ash black mixed and necrotic material were found and removed. Histopathology revealed numerous aspergillus hyphae. Itraconazole was given on a dosage of 200 mg twice a day orally for 6 weeks. No recurrence was observed during follow-up. Complete surgical resection through endoscopic trans-sphenoidal approach combined with systemic anti-fungal therapy, should be considered as the optimal treatment.

No MeSH data available.


Related in: MedlinePlus