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Sellar Cholesterol Granuloma Mimicking Cystic Sellar Lesions: A Report of Three Cases and Literature Review.
World Neurosurg. 2020 12; 144:250-255.WN

Abstract

BACKGROUND

Cystic lesions in the sellar region include a variety of entities, such as craniopharyngioma, Rathke cleft cyst (RCC), intrasellar arachnoid cyst, cystic pituitary adenomas, cholesterol granulomas (CGs), and xanthogranulomas (XGs). The distinction among them remains a preoperative challenge due to similarities in their clinical and radiologic findings.

CASE DESCRIPTION

We describe 3 cases with cystic sellar lesions. The first patient is a woman who presented with headache and hormonal disturbances, including high levels of prolactin, with a sellar and suprasellar cystic lesion discovered on magnetic resonance imaging. She was initially treated with dopamine agonists with normalization of prolactin levels but no changes on the size of the lesion. She underwent an endoscopic endonasal resection and the histology resulted in a CG/XG. The second patient is a woman who consulted for an incidentally discovered sellar cyst. During the follow-up, the lesion demonstrated enlargement with compression of the optic chiasm. With a preoperative diagnosis of RCC, the lesion was removed through an endoscopic endonasal transsellar approach. Final pathologic diagnosis was consistent with CG/XG. The third case was that of a man who presented with refractory headaches and vision loss, with a sellar/suprasellar cystic lesion on magnetic resonance imaging. He underwent endoscopic endonasal transsellar surgery for resection of what preoperatively was thought to be a giant RCC; final pathology again was consistent with CG/XG.

CONCLUSIONS

CG/XG is an uncommon pathology with unspecific clinical and radiologic features. However, this pathology should be considered in the differential diagnosis of mixed cystic/solid lesions in the sellar region.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Pilonieta M
Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.
Martin M
Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.
Revuelta Barbero JM
Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.
Hardesty DA
Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.
Carrau RL
Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.
Otto BA
Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.
Otero J
Department of Pathology, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.
Ghalib L
Department of Endocrinology, Diabetes, and Metabolism, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.
Prevedello DM
Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA. Electronic address: daniel.prevedello@osumc.edu.

MeSH

AdultCholesterolCystsDiagnosis, DifferentialEndovascular ProceduresFemaleGranulomaHumansMagnetic Resonance ImagingMaleNeurosurgical ProceduresPituitary DiseasesSella TurcicaTreatment Outcome

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32781144

Citation

Pilonieta, Martin, et al. "Sellar Cholesterol Granuloma Mimicking Cystic Sellar Lesions: a Report of Three Cases and Literature Review." World Neurosurgery, vol. 144, 2020, pp. 250-255.
Pilonieta M, Martin M, Revuelta Barbero JM, et al. Sellar Cholesterol Granuloma Mimicking Cystic Sellar Lesions: A Report of Three Cases and Literature Review. World Neurosurg. 2020;144:250-255.
Pilonieta, M., Martin, M., Revuelta Barbero, J. M., Hardesty, D. A., Carrau, R. L., Otto, B. A., Otero, J., Ghalib, L., & Prevedello, D. M. (2020). Sellar Cholesterol Granuloma Mimicking Cystic Sellar Lesions: A Report of Three Cases and Literature Review. World Neurosurgery, 144, 250-255. https://doi.org/10.1016/j.wneu.2020.07.234
Pilonieta M, et al. Sellar Cholesterol Granuloma Mimicking Cystic Sellar Lesions: a Report of Three Cases and Literature Review. World Neurosurg. 2020;144:250-255. PubMed PMID: 32781144.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sellar Cholesterol Granuloma Mimicking Cystic Sellar Lesions: A Report of Three Cases and Literature Review. AU - Pilonieta,Martin, AU - Martin,Monica, AU - Revuelta Barbero,Juan M, AU - Hardesty,Douglas A, AU - Carrau,Ricardo L, AU - Otto,Bradley A, AU - Otero,Jose, AU - Ghalib,Luma, AU - Prevedello,Daniel M, Y1 - 2020/08/08/ PY - 2020/01/08/received PY - 2020/07/14/revised PY - 2020/07/16/accepted PY - 2020/8/12/pubmed PY - 2021/5/18/medline PY - 2020/8/12/entrez KW - Cholesterol granuloma KW - Cystic pituitary lesions KW - Hyperprolactinemia KW - Sellar KW - Xanthogranuloma SP - 250 EP - 255 JF - World neurosurgery JO - World Neurosurg VL - 144 N2 - BACKGROUND: Cystic lesions in the sellar region include a variety of entities, such as craniopharyngioma, Rathke cleft cyst (RCC), intrasellar arachnoid cyst, cystic pituitary adenomas, cholesterol granulomas (CGs), and xanthogranulomas (XGs). The distinction among them remains a preoperative challenge due to similarities in their clinical and radiologic findings. CASE DESCRIPTION: We describe 3 cases with cystic sellar lesions. The first patient is a woman who presented with headache and hormonal disturbances, including high levels of prolactin, with a sellar and suprasellar cystic lesion discovered on magnetic resonance imaging. She was initially treated with dopamine agonists with normalization of prolactin levels but no changes on the size of the lesion. She underwent an endoscopic endonasal resection and the histology resulted in a CG/XG. The second patient is a woman who consulted for an incidentally discovered sellar cyst. During the follow-up, the lesion demonstrated enlargement with compression of the optic chiasm. With a preoperative diagnosis of RCC, the lesion was removed through an endoscopic endonasal transsellar approach. Final pathologic diagnosis was consistent with CG/XG. The third case was that of a man who presented with refractory headaches and vision loss, with a sellar/suprasellar cystic lesion on magnetic resonance imaging. He underwent endoscopic endonasal transsellar surgery for resection of what preoperatively was thought to be a giant RCC; final pathology again was consistent with CG/XG. CONCLUSIONS: CG/XG is an uncommon pathology with unspecific clinical and radiologic features. However, this pathology should be considered in the differential diagnosis of mixed cystic/solid lesions in the sellar region. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/32781144/Sellar_Cholesterol_Granuloma_Mimicking_Cystic_Sellar_Lesions:_A_Report_of_Three_Cases_and_Literature_Review_ DB - PRIME DP - Unbound Medicine ER -