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Cholesterol granulomas presenting as sellar masses: a similar, but clinically distinct entity from craniopharyngioma and Rathke’s cleft cyst

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Abstract

Purpose

Cholesterol granulomas in the sella are rare and can mimic the appearance of craniopharyngioma or Rathke’s cleft cysts. Information regarding the clinical presentation, imaging characteristics, and clinical course of sellar cholesterol granulomas can help clinicians to differentiate these lesions from other sellar cystic lesions.

Methods

We present three cases of sellar cholesterol granulomas. A literature review was performed for all cases of sellar cholesterol granulomas with individual patient data reported.

Results

We identified 24 previously reported cases in addition to our three cases. Mean age was 36.6 years (range 5–68). There were 16 (59%) females. The most common (74%) presenting symptom was endocrinological deficits, typically either isolated diabetes insipidus (DI) or panhypopituitarism. Location was intrasellar in 3 (11%), suprasellar in 6 (22%), and intrasellar/suprasellar in 18 (67%) patients. Lesions were most commonly (83%) T1 hyperintense. Gross total resection was achieved in 16 (64%) and subtotal resection in 9 (36%) patients. Of the seventeen (63%) patients presenting with varying degrees of bitemporal hemianopsia, all had improvement in vision postoperatively. It is worth noting that no cases of preoperative hypopituitarism or DI improved postoperatively. Even though gross total resection was only achieved in 64%, there was only one recurrence reported.

Conclusion

Sellar cholesterol granulomas are characterized by T1 hyperintensity, younger age, and more frequent and severe endocrinological deficits on presentation. Our review demonstrates high rates of improvement of visual deficits, but poor rates of endocrine function recovery. Recurrence is uncommon even in cases of subtotal resection.

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References

  1. Yonezawa K, Shirataki K, Sakagami Y, Kohmura E (2003) Panhypopituitarism induced by cholesterol granuloma in the sellar region–case report. Neurol Med Chir (Tokyo) 43(5):259–262

    Article  Google Scholar 

  2. Eytan DF, Kshettry VR, Sindwani R, Woodard TD, Recinos PF (2014) Surgical outcomes after endoscopic management of cholesterol granulomas of the petrous apex: a systematic review. Neurosurg Focus 37(4):E14. doi:10.3171/2014.7.FOCUS14344

    Article  PubMed  Google Scholar 

  3. Farrior B, Kampsen E, Farrior JB (1981) The positive pressure of cholesterol granuloma idiopathic blue eardrum. differential diagnosis. Laryngoscope 91(8):1286–1297

    Article  CAS  PubMed  Google Scholar 

  4. Graham MD, Kemink JL, Latack JT, Kartush JM (1985) The giant cholesterol cyst of the petrous apex: a distinct clinical entity. Laryngoscope 95(11):1401–1406

    Article  CAS  PubMed  Google Scholar 

  5. Jackler RK, Cho M (2003) A new theory to explain the genesis of petrous apex cholesterol granuloma. Otol Neurotol 24(1):96–106 discussion 106

    Article  PubMed  Google Scholar 

  6. Shirataki K, Okada S, Matsumoto S (1988) Histopathological study of the “cholesterol granuloma reaction” in the sellar and juxta-sellar tumors. No To Shinkei 40(2):133–139

    CAS  PubMed  Google Scholar 

  7. Paulus W, Honegger J, Keyvani K, Fahlbusch R (1999) Xanthogranuloma of the sellar region: a clinicopathological entity different from adamantinomatous craniopharyngioma. Acta Neuropathol 97(4):377–382

    Article  CAS  PubMed  Google Scholar 

  8. Zada G, Lin N, Ojerholm E, Ramkissoon S, Laws ER (2010) Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships. Neurosurg Focus 28(4):E4. doi:10.3171/2010.2.FOCUS09318

    Article  PubMed  Google Scholar 

  9. Jung CS, Schanzer A, Hattingen E, Plate KH, Seifert V (2006) Xanthogranuloma of the sellar region. Acta Neurochir (Wien) 148(4):473–477. doi:10.1007/s00701-005-0700-6

    Article  CAS  Google Scholar 

  10. Kamoshima Y, Sawamura Y, Motegi H, Kubota K, Houkin K (2011) Xanthogranuloma of the sellar region of children: series of five cases and literature review. Neurol Med Chir (Tokyo) 51(10):689–693

    Article  Google Scholar 

  11. Luginbuhl AJ, Campbell PG, Evans J, Rosen M (2010) Endoscopic repair of high-flow cranial base defects using a bilayer button. Laryngoscope 120(5):876–880. doi:10.1002/lary.20861

    PubMed  Google Scholar 

  12. Eisenberg MB, Haddad G, Al-Mefty O (1997) Petrous apex cholesterol granulomas: evolution and management. J Neurosurg 86(5):822–829. doi:10.3171/jns.1997.86.5.0822

    Article  CAS  PubMed  Google Scholar 

  13. Arai A, Nishihara M, Sasayama T, Aihara H, Hosoda K, Itoh T, Sakagami Y, Kuwamura K, Kohmura E (2010) Xanthogranuloma of the sellar region–case report. Neurol Med Chir (Tokyo) 50(6):488–491

    Article  Google Scholar 

  14. Rahmani R, Sukumaran M, Donaldson AM, Akselrod O, Lavi E, Schwartz TH (2015) Parasellar xanthogranulomas. J Neurosurg 122(4):812–817. doi:10.3171/2014.12.JNS14542

    Article  PubMed  Google Scholar 

  15. Teramoto A, Hirakawa K, Sanno N, Osamura Y (1994) Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology 193(1):161–164. doi:10.1148/radiology.193.1.8090885

    Article  CAS  PubMed  Google Scholar 

  16. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114(2):97–109. doi:10.1007/s00401-007-0243-4

    Article  PubMed  PubMed Central  Google Scholar 

  17. Amano K, Kubo O, Komori T, Tanaka M, Kawamata T, Hori T, Okada Y (2013) Clinicopathological features of sellar region xanthogranuloma: correlation with Rathke’s cleft cyst. Brain Tumor Pathol 30(4):233–241. doi:10.1007/s10014-012-0130-0

    Article  PubMed  Google Scholar 

  18. Rennert J, Doerfler A (2007) Imaging of sellar and parasellar lesions. Clin Neurol Neurosurg 109(2):111–124. doi:10.1016/j.clineuro.2006.11.001

    Article  PubMed  Google Scholar 

  19. Miyajima Y, Oka H, Utsuki S, Fujii K (2011) Rathke’s cleft cyst with xanthogranulomatous change–case report. Neurol Med Chir (Tokyo) 51(10):740–742

    Article  Google Scholar 

  20. Nakasu Y, Nakasu S, Nakajima M, Itoh R, Matsuda M (1999) Atypical Rathke’s cleft cyst associated with ossification. AJNR Am J Neuroradiol 20(7):1287–1289

    CAS  PubMed  Google Scholar 

  21. Nishiuchi T, Murao K, Imachi H, Kushida Y, Haba R, Kawai N, Tamiya T, Ishida T (2012) Xanthogranuloma of the intrasellar region presenting in pituitary dysfunction: a case report. J Med Case Rep 6:119. doi:10.1186/1752-1947-6-119

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sugata S, Hirano H, Yatsushiro K, Yunoue S, Nakamura K, Arita K (2009) Xanthogranuloma in the suprasellar region. Neurol Med Chir (Tokyo) 49(3):124–127

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA, 19107, USA

    Raúl A. Hernández-Estrada & James J. Evans

  2. Department of Neurosurgery, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Dominguez 1000, Independencia Oriented, 44340, Guadalajara, Jal., Mexico

    Raúl A. Hernández-Estrada

  3. Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, 132 10th Street, Main Building Suite 262, Philadelphia, PA, 19107, USA

    Ashley N. Vogel & Mark T. Curtis

  4. Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH, 44195, USA

    Varun R. Kshettry

Authors
  1. Raúl A. Hernández-Estrada
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  2. Varun R. Kshettry
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  3. Ashley N. Vogel
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  4. Mark T. Curtis
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  5. James J. Evans
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Corresponding author

Correspondence to Varun R. Kshettry.

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Conflict of interest

Varun R. Kshettry (Consultant for Medprin), James J. Evans (Consultant for Stryker, Royalties from Mizuho for surgical instrument development).

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Hernández-Estrada, R.A., Kshettry, V.R., Vogel, A.N. et al. Cholesterol granulomas presenting as sellar masses: a similar, but clinically distinct entity from craniopharyngioma and Rathke’s cleft cyst. Pituitary 20, 325–332 (2017). https://doi.org/10.1007/s11102-016-0775-5

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  • DOI: https://doi.org/10.1007/s11102-016-0775-5

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