Primary Intrasellar Coccidioidomycosis Simulating a Pituitary Adenoma

Neurosurgery ◽  
1991 ◽  
Vol 28 (5) ◽  
pp. 748-751 ◽  
Author(s):  
M. Scanarini ◽  
A. Rotilio ◽  
L. Rigobello ◽  
A. Pomes ◽  
A. Parenti ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Cavernous Sinus ◽  
Transsphenoidal Approach ◽  
Mass Lesion ◽  
Pituitary Mass ◽  
Radiological Studies

Abstract The case of a 68-year-old woman who had relatively acute, unilateral ophthalmoplegia is reported. Radiological studies indicated a mass lesion involving the pituitary gland and left cavernous sinus. Pathological tissue obtained by the transsphenoidal approach revealed the presence of a Coccidioides granuloma. This pathological entity should be considered when evaluating patients with a pituitary mass and ophthalmoplegia.

Giant cell granuloma involving the pituitary gland

1980 ◽  
Vol 52 (4) ◽  
pp. 584-587 ◽  
Author(s):  
Charles Taylon ◽  
Thomas A. Duff
Keyword(s):  
Pituitary Gland ◽  
Giant Cell ◽  
Cavernous Sinus ◽  
Mass Lesion ◽  
Giant Cell Granuloma ◽  
Content Type ◽  
Pituitary Tissue ◽  
Autopsy Tissue ◽  
Radiological Studies ◽  
Fine Print

✓ The case is reported of a middle-aged man who had developed relatively acute, unilateral ophthalmoplegia. Radiological studies indicated a mass lesion involving the pituitary gland and right cavernous sinus. Pituitary tissue obtained by transsphenoidal hypophysectomy contained giant cell granuloma. In previous cases, the documentation of giant cell granuloma of the pituitary gland has been limited to autopsy tissue.

scholarly journals A Rare Case of Sellar Mass Composed of Primary Leiomyosarcoma and Pituitary Adenoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A567-A567
Author(s):  
Young Ki Kim ◽  
In Sun Goak ◽  
Yu Ji Kim ◽  
Heung Yong Jin ◽  
Tae Sun Park ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Rare Case ◽  
Smooth Muscle Actin ◽  
Brain Mri ◽  
Sinus Surgery ◽  
Pituitary Mass ◽  
Post Surgery ◽  
Composite Tumor ◽  
Malignant Lesions

Abstract Background: Nonfunctioning pituitary adenomas (NFPAs) are most common pituitary tumors, and primary pituitary gland malignancies are extremely rare. Most malignant pituitary gland lesions metastasize from other sites. Primary malignant lesions, such as sarcomas, usually develop after radiotherapy or chemotherapy for other diseases. We report a rare case of primary sellar leiomyosarcoma (LMS) without prior therapy that arose concurrently with a pituitary adenoma. Clinical Case: A 56-year-old woman with ptosis of the right eye, headache, and progressive visual deficits visited our neurosurgery department. She had no medical history besides hypertension. Twelve months ago, she was referred to us because of decreased visual acuity and a 3.5×3.6-cm-sized pituitary mass detected on brain MRI. Normal pituitary functions with mild hyperprolactinemia suggested a nonfunctioning pituitary mass with stalk compression. After transsphenoidal surgery, histopathology revealed a pituitary adenoma; MRI immediately post-surgery revealed no grossly remnant lesion. However, during the current visit, sellar MRI revealed a re-growing mass in the pituitary fossa extending to the sphenoid sinus and compressing the optic chiasm with a suprasellar extension. Functional endoscopic sinus surgery was performed, and histopathology revealed a composite tumor, i.e., a mesenchymal tumor with a pituitary adenoma. On immunohistochemical staining, smooth muscle actin, synaptophysin, and chromagranin were positive; tumor cell mitosis was observed at 7/10 high-power fields. Finally, a composite tumor of myxoid leiomyosarcoma and pituitary adenoma was diagnosed. Hence, systemic chemotherapy with radiotherapy was planned for the remnant lesion. Hormonal replacement therapy with hydrocortisone and thyroxine was also started for subsequent hypopituitarism. Conclusion: NFPA is benign and has good prognosis if it is not grow in size or is completely resected. Conversely, primary sarcomas, such as LMS, show rapid extension and aggressive local invasion. Although their incidence is extremely rare, few primary pituitary sarcoma cases with or without pituitary adenoma have been reported. In the former case, initial diagnosis of pituitary adenoma may lead to delayed diagnosis of combined malignant lesions. Thus, clinicians should consider this possibility and high index of suspicion is required when diagnosing a pituitary mass.

Evaluation of Pure Endoscopic Endonasal Approach in Management of Giant Pituitary Adenoma

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mina M Gerges ◽  
Hatem Sabry ◽  
Hasan Jalalod din ◽  
Mohamed Ashraf Ghobashy ◽  
Theodore H Schwartz
Keyword(s):  
Radiation Therapy ◽  
Pituitary Adenoma ◽  
Cavernous Sinus ◽  
Transsphenoidal Approach ◽  
Csf Leak ◽  
Tumor Diameter ◽  
Giant Pituitary Adenoma ◽  
Postoperative Hematoma ◽  
Extended Transsphenoidal Approach

Abstract Background Giant pituitary adenoma represents one of the challenging tumor for neurosurgeons. Many microsurgical approaches in the past were used for its management. Recently and with evolution of the endoscopic equipment and instruments, extended endoscopic transsphenoidal approach become one of the preferable approaches for its surgical excision. Methods We prospectively document the clinical , surgical and follow up data for all patients presented with giant pituitary adenoma to Ain-Shams university hospital and Weill Cornell Medical College, Presbyterian hospital and were surgically treated with extended transsphenoidal approach from 2015 till 2019. Results Our group study formed of 44 patients with mean age 53.03 (range 14.7-82.4) and a male predominance (59%). The main presentation was visual problems in 75% followed by partial hypopituitarism in 31.81% while headache was in 13.64%. Only 4 patients had functioning adenoma (3 prolactinoma and 1 acromegaly). Average tumor volume was 26.95 ± 17.25 cm3, while the mean maximum tumor diameter was 4.73 cm (range 4.0-8.0 cm). Radiographic invasion was found in 97.73% to suprasellar cistern, 61.36% to the cavernous sinus and in 34% to the sphenoid sinus. GTR was achieved in 45.45% with Knosp score is the only significant predictor factor for resection rate (p = 0.04). Visual improvement achieved in 75.76%. 50% (2 patient) of the patients with functioning adenoma were cured. Complications included CSF leak in 3 patients, permanent DI in 4 patients and postoperative hematoma in 2 patients. Recurrence and progression rates without upfront radiation therapy were 5.00 % and 31.81% respectively after mean follow up period 57.90 months. Conclusions Extended endoscopic approaches for achieving maximum resection with minimal morbidity for giant pituitary adenoma are very effective. Lateral tumor extension with cavernous sinus invasion represents the limiting point in achieving gross total resection. Upfront radiation therapy for patients with residual adenoma can be avoided but regular follow up should be warranted.

Typical Cluster Headache Caused by Granulomatous Pituitary Involvement

Cephalalgia ◽  
2007 ◽  
Vol 27 (2) ◽  
pp. 173-176 ◽  
Author(s):  
I Favier ◽  
J Haan ◽  
SG van Duinen ◽  
MD Ferrari
Keyword(s):  
Cluster Headache ◽  
Pituitary Gland ◽  
Young Woman ◽  
Granulomatous Inflammation ◽  
Mass Lesion ◽  
Pituitary Mass ◽  
Transsphenoidal Resection

A young woman had typical cluster headache attacks and a pituitary mass lesion. The headache attacks resolved after transsphenoidal resection of the tumour, which was diagnosed as a granulomatous inflammation. The association between cluster headache and granulomatous enlargement of the pituitary gland has never been described before. This case reinforces the growing evidence that even in typical cases of cluster headache, neuroimaging is mandatory to exclude structural lesions.

Hypophysial transposition (hypophysopexy) for radiosurgical treatment of pituitary tumors involving the cavernous sinus

2003 ◽  
Vol 14 (5) ◽  
pp. 1-5 ◽  
Author(s):  
James K. Liu ◽  
Meic H. Schmidt ◽  
Joel D. Macdonald ◽  
Randy L. Jensen ◽  
William T. Couldwell
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Radiation Exposure ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Pituitary Tumors ◽  
Residual Tumor ◽  
Normal Pituitary Gland ◽  
Fascia Graft ◽  
Normal Functional

Stereotactic radiosurgery (SRS) is performed with increasing frequency in the treatment of residual or recurrent pituitary adenomas. Its major associated risk in these cases of residual or recurrent pituitary tumor adjacent to normal functional pituitary gland is radiation exposure to the pituitary, which frequently leads to the development of hypopituitarism. The authors describe a technique of pituitary transposition to reduce the radiation dose to the normal pituitary gland in cases of planned radiosurgical treatment of residual pituitary adenoma within the cavernous sinus. A sellar exploration for tumor resection is performed, the pituitary gland is transposed from the region of the cavernous sinus, and a fat and fascia graft is interposed between the normal pituitary gland and the residual tumor in the cavernous sinus. The residual tumor may then be treated with SRS. The increased distance between the normal pituitary gland and the residual tumor facilitates treatment of the tumor with radiosurgery and reduces radiation exposure to the normal pituitary gland.

scholarly journals Magnetic resonance imaging of cavernous sinus invasion by pituitary adenoma diagnostic criteria and surgical findings

2004 ◽  
Vol 62 (2b) ◽  
pp. 437-443 ◽  
Author(s):  
Joaquim O. Vieira Jr. ◽  
Arthur Cukiert ◽  
Bernardo Liberman
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Cavernous Sinus ◽  
Predictive Value ◽  
Lateral Wall ◽  
Preoperative Imaging ◽  
Cavernous Sinus Invasion ◽  
Normal Pituitary Gland ◽  
Sensitivity Specificity ◽  
Dural Wall

This study used MRI to define preoperative imaging criteria for cavernous sinus invasion (CSI) by pituitary adenoma (PA). MR images of 103 patients with PA submitted to surgery (48 with CSI) were retrospectively reviewed. The following MR signs were studied and compared to intraoperative findings (the latter were considered the gold standard for CSI detection): presence of normal pituitary gland between the adenoma and CS, status of the CS venous compartments, CS size, CS lateral wall bulging, displacement of the intracavernous internal carotid artery (ICA) by adenoma, grade of parasellar extension (Knosp-Steiner classification) and percentage of intracavernous ICA encased by the tumor. Statistical analysis was performed using qui-square testing and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were obtained for each MR finding. The following signs have been found to represent accurate criteria for non-invasion of the CS: 1- normal pituitary gland interposed between the adenoma and the CS (PPV, 100%); 2- intact medial venous compartment (PPV, 100%); 3- percentage of encasement of the intracavernous ICA lower than 25% (NPV, 100%) and 4- medial intercarotid line not crossed by the tumor (NPV, 100%). Criteria for CSI were: 1- percentage of encasement of the intracavernous ICA higher than 45%; 2- occlusion of three or more CS venous compartments and 3- occlusion of the CS lateral venous compartment. The CS was very likely to be invaded if the inferior venous compartment was not detected (PPV. 92,8%), if the lateral intercarotid line was crossed (PPV. 96,1%) or if a bulging lateral dural wall of the CS was seen (PPV, 92,3%). The preoperative diagnosis of CSI by PA is extremely important since endocrinological remission is rarely obtained after microsurgery alone in patients with invasive tumors. The above mentioned MR imaging criteria may be useful in advising most of the patients preoperatively on the potential need for complimentary therapy after surgery.

scholarly journals Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma

2021 ◽  
Author(s):  
Gianluca Agresta ◽  
Alberto Campione ◽  
Fabio Pozzi ◽  
Pierlorenzo Veiceschi ◽  
Martina Venturini ◽  
...  
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Conformal Radiotherapy ◽  
Residual Tumor ◽  
Complete Recovery ◽  
Tumor Location ◽  
Transsphenoidal Approach ◽  
Low Grade ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction

Abstract Objective We illustrate a cavernous sinus chondrosarcoma treated with an endoscopic endonasal transethmoidal-transsphenoidal approach. Design Case report of a 15-year-old girl with diplopia and esotropia due to complete abducens palsy. Preoperative images showed a right cavernous sinus lesion with multiple enhanced septa and intralesional calcified spots (Fig. 1). Considering tumor location and the lateral dislocation of the carotid artery, an endoscopic endonasal approach was performed to relieve symptoms and to optimize the target geometry for adjuvant conformal radiotherapy. Setting The study was conducted at University of Insubria, Department of Neurosurgery, Varese, Italy. Participants Skull base team was participated in the study. Main Outcome Measures A transethmoidal-transsphenoidal approach was performed by using a four-hand technique. We used a route lateral to medial turbinate to access ethmoid and the sphenoid sinus. During the sphenoid phase, we exposed the medial wall of the cavernous sinus (Fig. 2) and the lesion was then removed using curette. Skull base reconstruction was performed with fibrin glue and nasoseptal flap. Results No complications occurred after surgery, and the patient experienced a complete recovery of symptoms. A postoperative magnetic resonance imaging showed a small residual tumor inside the cavernous sinus (Fig. 1). After percutaneous proton-bean therapy, patient experienced only temporary low-grade toxicity with local control within 2 years after treatment completion. Conclusion Endoscopic endonasal extended approach is a safe and well-tolerated procedure that is indicated in selected cases (intracavernous tumors, soft tumors not infiltrating the vessels and/or the nerves). A tailored approach according to tumor extension is crucial for the best access to the compartments involved.The link to the video can be found at: https://youtu.be/TsqXjqpuOws.

scholarly journals The combination of 13N-ammonia and 11C-methionine in differentiation of residual/recurrent pituitary adenoma from the pituitary gland remnant after trans-sphenoidal Adenomectomy

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fangling Zhang ◽  
Qiao He ◽  
Ganhua Luo ◽  
Yali Long ◽  
Ruocheng Li ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Gray Matter ◽  
Standard Uptake Value ◽  
Visual Evaluation ◽  
Additional Surgery ◽  
Pet Ct ◽  
Histological Confirmation ◽  
G Ratio

Abstract Background This study aimed to assess the clinical usefulness of 13N-ammonia and 11C- Methionine (MET) positron emission tomography (PET)/ computed tomography (CT) in the differentiation of residual/recurrent pituitary adenoma (RPA) from the pituitary gland remnant (PGR) after trans-sphenoidal adenomectomy. Methods Between June 2012 and December 2019, a total of 19 patients with a history of trans-sphenoidal adenomectomy before PET/CT scans and histological confirmation of RPA after additional surgery in our hospital were enrolled in this study. Images were interpreted by visual evaluation and semi-quantitative analysis. In semi-quantitative analysis, the maximum standard uptake value (SUVmax) of the target and gray matter was measured and the target uptake/gray matter uptake (T/G) ratio was calculated. Results The T/G ratios of 13N-ammonia were significantly higher in PGR than RPA (1.58 ± 0.69 vs 0.63 ± 1.37, P < 0.001), whereas the T/G ratios of 11C-MET were obviously lower in PGR than RPA (0.78 ± 0.35 vs 2.17 ± 0.54, P < 0.001). Using the canonical discriminant analysis, we calculated the predicted accuracy of RPA (100%), PGR (92.9%), and the overall predicted accuracy (96.43%). Conclusions The combination of 13N-ammonia and 11C-MET PET/CT is valuable in the differentiation of RPA from PGR after trans-sphenoidal adenomectomy.

MICROSURGICAL ANATOMY OF THE DIAPHRAGMA SELLAE AND ITS ROLE IN DIRECTING THE PATTERN OF GROWTH OF PITUITARY ADENOMAS

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 717-723 ◽  
Author(s):  
Alvaro Campero ◽  
Carolina Martins ◽  
Alexandre Yasuda ◽  
Albert L. Rhoton
Keyword(s):  
Pituitary Adenoma ◽  
Cavernous Sinus ◽  
Dura Mater ◽  
Pituitary Adenomas ◽  
Potential Role ◽  
Pituitary Tumors ◽  
Microsurgical Anatomy ◽  
Suprasellar Region ◽  
Lateral Distance ◽  
Diaphragma Sellae

Abstract OBJECTIVE To evaluate the anatomic aspects of the diaphragma sellae and its potential role in directing the growth of a pituitary adenoma. METHODS Twenty cadaveric heads were dissected and measurements were taken at the level of the diaphragma sellae. RESULTS The diaphragma sellae is composed of two layers of dura mater. There is a remarkable variation in the morphology of the diaphragm opening. The average anteroposterior distance of the opening was 7.26 mm (range, 3.4–10.7 mm) and the average lateral-to-lateral distance was 7.33 mm (range, 2.8–14.1 mm). CONCLUSION The variability in the diameter of the opening of the diaphragma sellae could explain the growth of pituitary tumors toward the cavernous sinus or toward the suprasellar region.

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