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

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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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

Keywords

  • Sella
  • Endoscopic
  • Endonasal
  • Transsphenoidal
  • Xanthogranuloma