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Sellar tumors

Bette K Kleinschmidt-DeMasters
PURPOSE OF REVIEW: Most pituitary region masses are pituitary adenomas; however, when other sellar region masses are encountered by clinicians or pathologists, the differential diagnosis can be broad. This review will focus on updates for pituitary adenomas, as well as briefly discuss some of these other entities: Rathke cleft cyst, hypophysitis, craniopharyngioma, pituicytoma, and spindle cell oncocytoma. RECENT FINDINGS: The use of new immunohistochemical (IHC) tools for assessing transcription factors, pituitary transcription factor-1, steroidogenic factor-1, and the not-yet-widely available Tpit IHC have provided insights into origin particularly of clinically silent and even hormone-negative pituitary adenomas...
October 18, 2016: Current Opinion in Endocrinology, Diabetes, and Obesity
June Yowtak, Suash Sharma, Scott E Forseen, Cargill H Alleyne
BACKGROUND: Mixed tumors of adenomatous and neuronal cells in the sellar region are an uncommon finding. The origins of these heterogeneous tumors are unknown and management of these lesions still debated. We report a very rare case of anterior gray matter pituicytic heterotopia with monomorphic anterior pituitary cells that likely represents a variant of non-secreting pituitary adenoma - neuronal choristoma (PANCH) without any ganglion cells. We also review the current literature for the different clinical presentations of PANCH...
October 12, 2016: World Neurosurgery
Robert Fenstermaker, Ajay Abad
PURPOSE OF REVIEW: This article reviews sellar and parasellar anatomy and the appearance of normal bone and soft tissue components on both CT and MRI. Pituitary gland structure and function are discussed with respect to hormone secretion, along with clinical syndromes caused by perturbations in hormone levels. Syndromes and specific diseases in the sellar and parasellar regions are discussed along with characteristic clinical features and imaging findings. RECENT FINDINGS: Bone and calcifications are best visualized with CT scans, while soft tissues are better defined using MRI...
October 2016: Continuum: Lifelong Learning in Neurology
Kornelija Ruskyte, Rasa Liutkevicienė, Alvita Vilkeviciute, Paulina Vaitkiene, Indre Valiulytė, Brigita Glebauskiene, Loresa Kriauciuniene, Dalia Zaliuniene
Pituitary adenoma (PA) is one of the most common abnormalities in the sellar region. Despite the fact that PA is a benign monoclonal neoplasm, it can cause serious complications, including ophthalmological, neurological and endocrinological abnormalities. Currently, the causes that increase the progression of tumors are unknown. Epigenetic silencing of the matrix metalloproteinase-14 (MMP-14) and transforming growth factor beta-1 (TGFβ-1) genes may be associated with the development of PA, since these genes are important in the processes of tumor metastasis and angiogenesis...
October 2016: Oncology Letters
Puja Sahai, Geetika Singh, Dodul Mondal, Vaishali Suri, Pramod Kumar Julka
The solitary fibrous tumor of central nervous system is rare. Herein, a case of solitary fibrous tumor arising from sellar region is described. A 60-year-old man underwent subtotal excision of the tumor because of extensive infiltration of optical and vascular structures. In view of the presence of residual tumor, he was treated with adjuvant radiation therapy. After a follow-up period of 1 year, there was no progression of the lesion evident on magnetic resonance imaging of the brain. Solitary fibrous tumor should be considered as one of the differential diagnosis of a mass lesion arising in sellar region...
October 2016: Asian Journal of Neurosurgery
Stefan Linsler, Sebastian Antes, Sebastian Senger, Joachim Oertel
OBJECTIVE: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. MATERIALS AND METHODS: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated...
October 2016: Journal of Neurosciences in Rural Practice
Teruyoshi Kageji, Takeshi Miyamoto, Yumiko Kotani, Tsuyoshi Kaji, Yoshimi Bando, Yoshifumi Mizobuchi, Kohei Nakajima, Shinji Nagahiro
PURPOSE: Craniopharyngiomas are 5-10 % of all pediatric tumors, but are seldomly encountered in the perinatal period. Only seven instances of a truly antenatal diagnosis of a congenital craniopharyngioma that subsequently underwent radical surgery have been reported. We present the case of a patient who received the diagnosis of a suprasellar tumor during the prenatal period and received radical surgery. METHODS: We report a case of a neonatal craniopharyngioma treated surgically...
September 26, 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Yuelong Wang, Jiaojiao Deng, Gang Guo, Aiping Tong, Xirui Peng, Haifeng Chen, Jianguo Xu, Yi Liu, Chao You, Liangxue Zhou
Annexin A2 (AnxA2) is a highly conserved Ca2(+)-regulated membrane binding protein, which affects cell mobility and tumor progression. Adamantinomatous craniopharyngioma (AdaCP) are a kind of epithelial tumors of the sellar region with high tendency to recur. Robust biomarkers are required to predict tumor behavior and to establish follow-up individualized treatment approaches. In this study, we firstly compared four surgical AdaCP samples with normal brain by two-dimensional gel electrophoresis (2DE) proteomic analysis...
September 17, 2016: Journal of Neuro-oncology
Hermann L Müller
PURPOSE: This report is a review of findings on the diagnosis, treatment, clinical course, follow-up, and prognosis of craniopharyngioma patients with special regard to clinical trials and long-term management. METHODS: Literature search on Pubmed for paper published after 1994. RESULTS: Craniopharyngiomas are rare, embryonic malformations of the sellar/parasellar region with low histological grade. Clinical manifestations are related to increased intracranial pressure, visual impairment, and hypothalamic/pituitary deficiencies...
September 7, 2016: Pituitary
Kazuhito Takeuchi, Tadashi Watanabe, Tetsuya Nagatani, Yuichi Nagata, Jonsu Chu, Toshihiko Wakabayashi
PURPOSE: The transsphenoidal approach (TSA) is regarded as the first line of treatment for sellar and suprasellar lesions. There are only few case reports of postoperative subdural hematoma after TSA and extended transsphenoidal approach (eTSA), and the detailed incidence and risk factors for this complication are still unknown. We reviewed the incidence and risk factors for subdural hematoma after TSA and eTSA. METHODS: Between January 1, 2013 and December 31, 2014, 165 consecutive patients underwent TSA or eTSA at Nagoya University Hospital and Nagoya Daini Red Cross Hospital...
September 3, 2016: Pituitary
Yasuhiko Hayashi, Daisuke Kita, Takuya Watanabe, Issei Fukui, Yasuo Sasagawa, Masahiro Oishi, Osamu Tachibana, Fumiaki Ueda, Mitsutoshi Nakada
PURPOSE: Diabetes insipidus (DI) remains a complication of transsphenoidal surgery (TSS) for sellar and parasellar tumors. Antidiuretic hormone (ADH) appears as hyper intensity (HI) in the pituitary stalk and the posterior lobe of the pituitary gland on T1-weighted magnetic resonance (MR) imaging. Its disappearance from the posterior lobe occurs with DI, indicating a lack of ADH. The appearance of HI in the pituitary stalk indicates disturbances in ADH transport. METHODS: This retrospective study included 172 patients undergoing TSS for sellar tumors at our institute from 2006 to 2014...
September 1, 2016: Pituitary
Qing Wang, Xiao-Jie Lu, Jun Sun, Jing Wang, Ci You Huang, Zhi Feng Wu
BACKGROUND: Ectopic thyrotropin (TSH)-secreting pituitary adenomas are rare and can often be misdiagnosed as primary hyperthyroidism. We present a case of an ectopic suprasellar TSH-secreting pituitary adenoma. A literature review of previously reported ectopic TSH-secreting and suprasellar pituitary adenomas is included to illustrate the clinical characteristics of this disease entity and the diversity of operative approaches to treating ectopic suprasellar pituitary adenomas. CASE DESCRIPTION: A 46-year-old man presented with typical clinical signs of hyperthyroidism and a history of progressive visual field impairment and vision loss...
August 24, 2016: World Neurosurgery
Martin Heinrichs, Heinrich Ernst
Craniopharyngiomas are extremely rare epithelial tumors of the sellar region in human beings and domestic and laboratory animals. A craniopharyngioma, 0.6 cm in diameter, was observed grossly in the sellar and parasellar regions of an untreated 23-month-old male Wistar-derived rat sacrificed moribund. The tumor was composed of cords, columns, and nests of neoplastic stratified squamous epithelium with marked hyperkeratosis and parakeratosis. Neoplastic cells formed solid or cystic areas, infiltrating the base of the skull, brain, and pituitary gland...
July 2016: Journal of Toxicologic Pathology
James Lubuulwa, Ting Lei
Craniopharyngiomas (CPs) are clinically relevant tumors of the sellar region and are associated with high morbidity and occasional mortality. There are two different subtypes of CPs that differ clinically and pathologically: adamantinomatous CP and papillary CP. The differential diagnosis is still challenging even with developments in preoperative imaging as several tumors of the sellar/parasellar region share a continuum of clinical characteristics and imaging similarities. Several topographical classifications of CPs have been mentioned in literature, but to date, there has not been a consensus on a standard reference classification system and there is need to a develop such a model...
July 2016: Journal of Neurological Surgery Reports
Hussam Abou-Al-Shaar, Ari M Blitz, Fausto J Rodriguez, Masaru Ishii, Gary L Gallia
BACKGROUND: Craniopharyngiomas are uncommon benign locally aggressive epithelial tumors mostly located in the sellar and suprasellar regions. An infrasellar origin of these tumors is rare. CASE DESCRIPTION: The authors report a 22-year-old male patient with a purely infrasellar adamantinomatous craniopharyngioma centered in the nasopharynx with extension into the posterior nasal septum, sphenoid sinus, and clivus. Gross total resection was achieved using an expanded endonasal endoscopic transethmoidal, transsphenoidal, transpterygoid, and transclival approach...
August 20, 2016: World Neurosurgery
Tom T Karnezis, Andrew B Baker, Zachary M Soler, Sarah K Wise, Shruthi K Rereddy, Zara M Patel, Nelson M Oyesiku, John M DelGaudio, Constantinos G Hadjipanayis, Bradford A Woodworth, Kristen O Riley, John Lee, Michael D Cusimano, Satish Govindaraj, Alkis Psaltis, Peter John Wormald, Steve Santoreneos, Raj Sindwani, Samuel Trosman, Janalee K Stokken, Troy D Woodard, Pablo F Recinos, W Alexander Vandergrift, Rodney J Schlosser
BACKGROUND: In patients undergoing transnasal endoscopic sellar surgery, an analysis of risk factors and predictors of intraoperative and postoperative cerebrospinal fluid leak (CSF) would provide important prognostic information. METHODS: A retrospective review of patients undergoing endoscopic sellar surgery for pituitary adenomas or craniopharyngiomas between 2002 and 2014 at 7 international centers was performed. Demographic, comorbidity, and tumor characteristics were evaluated to determine the associations between intraoperative and postoperative CSF leaks...
August 23, 2016: International Forum of Allergy & Rhinology
Q Lan, A L Chen, T Zhang, Q Zhu, T Xu
OBJECTIVE: Three dimensional (3D) printing technique was used to prepare the simulate craniocerebral models, which were applied to preoperative planning and surgical simulation. METHODS: The image data was collected from PACS system. Image data of skull bone, brain tissue and tumors, cerebral arteries and aneurysms, and functional regions and relative neural tracts of the brain were extracted from thin slice scan (slice thickness 0.5 mm) of computed tomography (CT), magnetic resonance imaging (MRI, slice thickness 1mm), computed tomography angiography (CTA), and functional magnetic resonance imaging (fMRI) data, respectively...
August 9, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Ioannis Petrakakis, Ariyan Pirayesh, Joachim K Krauss, Peter Raab, Christian Hartmann, Makoto Nakamura
OBJECTIVE: Apart from the "common" lesions (e.g. pituitary adenomas, Rathke's cleft cysts, meningiomas and craniopharyngiomas), there is a plethora of rare tumors or tumor-mimicking lesions in the sellar and suprasellar region (SSR). Due to a lack of characteristic imaging features, there is a dilemma in distinguishing these rare lesions from the more "common" ones preoperatively. Consequently, both diagnosis and definition of surgical goals, as well as further treatment strategies continue to be challenging for all attending physicians...
October 2016: Clinical Neurology and Neurosurgery
Shigetoshi Yano, Takuichiro Hide, Ken Uekawa, Yumi Honda, Yoshiki Mikami, Jun-Ichi Kuratsu
BACKGROUND: A gangliocytoma rarely coexists with a pituitary adenoma in a sellar lesion. Herein, we describe our experience in treating a mixed gangliocytoma and prolactinoma of the pituitary gland. CASE DESCRIPTION: A 16-year-old male presented with severe headache and vomiting. Magnetic resonance imaging showed a large pituitary tumor with hydrocephalus. Because of the increased levels of serum prolactin (PRL), we treated the patient with cabergoline, which decreased the tumor size and improved the hydrocephalus...
August 13, 2016: World Neurosurgery
Or Cohen-Inbar
Despite advances in neurosurgical technique, postoperative morbidity continues to taint open complete removal of many benign cranial base tumors (meningioma, pituitary adenomas, schwannomas). The incidence of temporary and permanent cranial nerve deficits is reported to be as high as 44% and 56% respectively, with postoperative mortality rates as high as 9%. As a consequence, many neurosurgeons choose to perform partial resections in order to preserve neurological functions. Progression rates after partial removal of a meningioma with no radiosurgery have been reported to be as high as 70%, compared to > 90% post-radiosurgical progression free survival rates...
May 2016: Harefuah
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