Rare neurohypophyseal tumor presenting as giant pituitary macroadenoma with cavernous sinus invasion – A case report and review of literature

Background: Granular cell tumors (GCTs) of the pituitary are rare tumors of posterior pituitary that can present as giant pituitary macroadenoma due to the slow indolent growth of the tumor. We are reporting this case due to the rarity of GCT and usually these tumors are confined to the suprasellar region since they are arising from the pituitary stalk. GCTs that attain such giant size with cavernous sinus invasion are still rarer. Case Description: A 38-year-old female who presented with progressive deterioration of vision and on evaluation by magnetic resonance imaging showed a giant pituitary macroadenoma with bilateral cavernous sinus invasion. The patient underwent pterional craniotomy and near-total excision of the lesion was done due to high vascularity and firmness of the tumor. Histopathology examination of the lesion showed spindle to globular cells with granular cytoplasm and was reported as GCT of the pituitary. Conclusion: GCTs are WHO grade1 non-neuroendocrine tumors arising from neurohypophysis and infundibulum. Complete excision is usually difficult due to the high vascularity, firm consistency, and local invasion of the tumor to the cavernous sinus and optic apparatus.

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Evaluation of MRI Criteria for Cavernous Sinus Invasion in Pituitary Macroadenoma

Journal of Neuroimaging ◽

10.1111/j.1552-6569.2012.00710.x ◽

2012 ◽

Vol 24 (5) ◽

pp. 498-503 ◽

Cited By ~ 12

Author(s):

Yu Li Sol ◽

Seung-Koo Lee ◽

Hyun Seok Choi ◽

Yun Hee Lee ◽

Jinna Kim ◽

...

Keyword(s):

Cavernous Sinus ◽

Pituitary Macroadenoma ◽

Cavernous Sinus Invasion

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Smooth Auricular Cutaneous Granular Cell Tumor Mimics Epidermoid Cyst

Journal of Audiology & Otology ◽

10.7874/jao.2019.00269 ◽

2020 ◽

Vol 24 (2) ◽

pp. 103-106

Author(s):

Jeong Hwan Choi

Keyword(s):

Schwann Cell ◽

Epidermoid Cyst ◽

Granular Cell Tumor ◽

Clinical Presentation ◽

Benign Neoplasm ◽

Granular Cell ◽

Cell Tumor ◽

Complete Excision ◽

Histopathological Evaluation ◽

Granular Cytoplasm

Granular cell tumor (GCT) is a rare, benign neoplasm of Schwann cell origin. GCT is composed of cells with eosinophilic granular cytoplasm. GCT presents as a solitary painless nodule. Because of their subtle clinical presentation, GCTs are often misdiagnosed. This report of a 47-year-old woman with an auricular GCT serves to highlight that complete excision and histopathological evaluation should be attempted even in apparently benign cases, to ensure complete cure.

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Predictive Value of Cavernous Sinus Invasion on Extent of Resection Following Endoscopic Transsphenoidal Resection of Pituitary Macroadenomas

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336162 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Christopher Farrell ◽

Sonia Teufack ◽

Mary Petrone ◽

Rahul Sharma ◽

Tyler Kenning ◽

...

Keyword(s):

Cavernous Sinus ◽

Predictive Value ◽

Extent Of Resection ◽

Cavernous Sinus Invasion ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

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Robotic Radiosurgery for Persistent Postoperative Acromegaly in Patients with Cavernous Sinus-Invading Pituitary Adenomas—A Multicenter Experience

Cancers ◽

10.3390/cancers13030537 ◽

2021 ◽

Vol 13 (3) ◽

pp. 537

Author(s):

Felix Ehret ◽

Markus Kufeld ◽

Christoph Fürweger ◽

Alfred Haidenberger ◽

Paul Windisch ◽

...

Keyword(s):

Disease Control ◽

Effective Treatment ◽

Cavernous Sinus ◽

Treatment Options ◽

Cavernous Sinus Invasion ◽

Robotic Radiosurgery ◽

Patient Morbidity ◽

Biochemical Remission ◽

Patients Experience

Background: The rates of incomplete surgical resection for pituitary macroadenomas with cavernous sinus invasion are high. In growth hormone-producing adenomas, there is a considerable risk for persistent acromegaly. Thus, effective treatment options are needed to limit patient morbidity and mortality. This multicenter study assesses the efficacy and safety of robotic radiosurgery (RRS) for patients with cavernous sinus-invading adenomas with persistent acromegaly. Methods: Patients who underwent RRS with CyberKnife for postoperative acromegaly were eligible. Results: Fifty patients were included. At a median follow-up of 57 months, the local control was 100%. The pretreatment insulin-like growth factor 1 (IGF-1) levels and indexes were 381 ng/mL and 1.49, respectively. The median dose and prescription isodose were 18 Gy and 70%, respectively. Six months after RRS, and at the last follow-up, the IGF-1 levels and indexes were 277 ng/mL and 1.14, as well as 196 ng/mL and 0.83, respectively (p = 0.0001 and p = 0.0002). The IGF-1 index was a predictor for biochemical remission (p = 0.04). Nine patients achieved biochemical remission and 24 patients showed biochemical disease control. Three patients developed a new hypopituitarism. Conclusions: RRS is an effective treatment for this challenging patient population. IGF-1 levels are decreasing after treatment and most patients experience biochemical disease control or remission.

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Extradural anterior clinoidectomy in surgical management of clinoidal meningiomas

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00336-x ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

K. El-Bahy ◽

Ashraf M. Ibrahim ◽

Ibrahim Abdelmohsen ◽

Hatem A. Sabry

Keyword(s):

Cavernous Sinus ◽

Tumor Resection ◽

Visual Outcome ◽

Extent Of Resection ◽

Optic Canal ◽

Falciform Ligament ◽

Cavernous Sinus Invasion ◽

Anterior Clinoidectomy ◽

Microsurgical Techniques

Abstract Background Despite the recent advances in skull base surgery, microsurgical techniques, and neuroimaging, yet surgical resection of clinoidal meningiomas is still a major challenge. In this study, we present our institution experience in the surgical treatment of anterior clinoidal meningiomas highlighting the role of extradural anterior clinoidectomy in improving the visual outcome and the extent of tumor resection. This is a prospective observational study conducted on 33 consecutive patients with clinoidal meningiomas. The surgical approach utilized consisted of extradural anterior clinoidectomy, optic canal deroofing with falciform ligament opening in all patients. The primary outcome assessment was visual improvement and secondary outcomes were extent of tumor resection, recurrence, and postoperative complications. Results The study included 5 males and 28 females with mean age 49.48 ± 11.41 years. Preoperative visual deficit was present in 30 (90.9%) patients. Optic canal involvement was present in 24 (72.7%) patients, ICA encasement was in 16 (48.5%), and cavernous sinus invasion in 8 (24.2%). Vision improved in 21 patients (70%), while 6 patients (20%) had stationary course and 1 patient (3%) suffered postoperative new visual deterioration. Gross total resection was achieved in 24 patients (72.7%). The main factors precluding total removal were cavernous sinus involvement and ICA encasement. Mortality rate was 6.1%; mean follow-up period was 27 ± 13 months. Conclusions In this series, the use of extradural anterior clinoidectomy provided a favorable visual outcome and improved the extent of resection in clinoidal meningioma patients.

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

Neurosurgery ◽

10.1227/01.neu.0000317321.79106.37 ◽

2008 ◽

Vol 62 (3) ◽

pp. 717-723 ◽

Cited By ~ 39

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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