Brain Tumor Res Treat.  2018 Oct;6(2):82-85. 10.14791/btrt.2018.6.e10.

Giant Sellar Xanthogranuloma after Surgical Treatment of Symptomatic Rathke's Cleft Cyst

• Cho SM
• Cho HR
• Park YS
• Chang HG

• KMID: 2423979
• DOI: http://doi.org/10.14791/btrt.2018.6.e10

Abstract

Extremely massive sellar xanthogranuloma (XG) are rare, and the surgical outcome and prognosis are not well known. XG remain unknown whether they are derived from Rathke's cleft cysts (RCCs) or craniopharyngiomas (CPs) following extensive inflammation and metaplasia, to the point that no epithelium is readily identifiable. These lesions usually tend to occur in younger patients (mean 28.3 years), have a smaller diameter, and remain primarily intrasellar region with infrequent calcification. This 36-year-old man presented our hospital with visual deterioration. At the time of visit, there were no neurological problems other than visual field defect and hormonal disorder. He visited our hospital in 2007 due to headache and decreased vision, and underwent transphenoid surgery for pituitary RCC. Since then, he has received treatment at our hospital for postoperative hormonal disorders. Through preoperative imaging study, the author suspected CP and underwent surgery. During the operation, the adhesion of the tumor to the surrounding major neurovascular structures was severe in the naked eyes, but the tumor could be removed more easily than expected. The postoperative histological findings were confirmed as XG. The postoperative course was uneventful. Compared to the previous literature, this case is a case where the size of XG is very large in a sellar region and it can be proved that it originated from the RCC. And regular follow-up is necessary to confirm the prognosis after surgery.

Keyword

Xanthogranuloma; Sella; Rathke

MeSH Terms

Adult
Central Nervous System Cysts
Craniopharyngioma
Epithelium
Follow-Up Studies
Headache
Humans
Inflammation
Metaplasia
Prognosis
Visual Fields

Figure

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  Fig. 1 Preoperative MRI and CT scans. A: T1-weighted imaging reveals heterogeneous intensity of the tumor. B: Sellar tumor extends to the right mesial temporal lobe and prepeduncular cistern on the T1-weighted image. C: Preoperative CT shows calcification in the superior and posterior cystic wall of the tumor.

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  Fig. 2 Pathological findings. A: Foamy macrophages are found around cholesterol clefts. Inflammatory infiltrates are seen within dense fibrous tissues (hematoxylin and eosin, original magnification ×100). B: Epithelial membranes of the cyst wall are clearly positive for β-catenin (original magnification ×400).

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  Fig. 3 Postoperative MRI. Tumor is completely removed.

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