[Ectopic relapse of an operated craniopharyngioma. Case report and review of the literature]. / Recidiva a distancia de craneofaringioma intervenido. Caso clínico y revisión de laliteratura.

INTRODUCTION. Craniopharyngioma is an embrionary tumor of the sellar and/suprasellar region derived from fusiform cells of Rathke´s cleft. Although locoregional relapse is the way classically proposed for relapse after treatment, it has been described, in a few cases, the possibility of ectopic relapse out of the sellar-suprasellar region, by direct seeding of cells during surgery on the surgical field, or by cell dissemination in the cerebrospinal fluid (CSF). It is proposed to report the case of a patient with relapse of a craniopharyngioma in the frontal lobe, who was previously operated ten years after, as well as to review the similar cases reported in the literature to the date. RESULTS. A systematic review of the literature has allowed to find 21 cases previously reported. Direct cellular seeding was the most frequent implantation mechanism. In all cases, the preferred treatment was radical surgical removal when this was possible. The time of latency between first surgery and relapse differed from 1 to 21 years. CONCLUSIONS. It is interesting, in the differential diagnosis, to bear in mind the possibility of ectopic relapse of craniopharyngioma in patients who have been operated because of this type of tumor and who present a new mass in nervous central system (CNS). In view of the long time of latency that can pass between the resection of a craniopharyngioma and his relapse, there becomes necessary a long follow-up of these patients by periodic imaging tests.

Physiologic Growth Hormone-Replacement Therapy and Craniopharyngioma Recurrence in Pediatric Patients: A Meta-Analysis.

OBJECTIVE: A systematic review and meta-analysis were conducted to examine the effect of growth hormone-replacement therapy (GHRT) on the recurrence of craniopharyngioma in children. METHODS: PubMed, Embase, and Cochrane databases were searched through April 2017 for studies that evaluated the effect of GHRT on the recurrence of pediatric craniopharyngioma. Pooled effect estimates were calculated with fixed- and random-effects models. RESULTS: Ten studies (n = 3487 patients) met all inclusion criteria, including 2 retrospective cohorts and 8 case series. Overall, 3436 pediatric patients were treated with GHRT after surgery and 51 were not. Using the fixed effect model, we found that the overall craniopharyngioma recurrence rate was lower among children who were treated by GHRT (10.9%; 95% confidence interval 9.80%-12.1%; I2 = 89.1%; P for heterogeneity <0.01; n = 10 groups) compared with those who were not (35.2%; 95% confidence interval 23.1%-49.6%; I2 = 61.7%; P for heterogeneity = 0.11; n = 3); the P value comparing the 2 groups was <0.01. Among patients who were treated with GHRT, subgroup analysis revealed that there was a greater prevalence of craniopharyngioma recurrence among studies conducted outside the United States (P < 0.01), single-center studies (P < 0.01), lower impact factor studies (P = 0.03), or studies with a lower quality rating (P = 0.01). Using the random-effects model, we found that the results were not materially different except for when stratifying by GHRT, impact factor, or study quality; this led to nonsignificant differences. Both Begg's rank correlation test (P = 0.7) and Egger's linear regression test (P = 0.06) indicated no publication bias. CONCLUSIONS: This meta-analysis demonstrated a lower recurrence rate of craniopharyngioma among children treated with GHRT than those who were not.

Growth hormone replacement therapy reduces risk of cancer in adult with growth hormone deficiency: A meta-analysis.

The risk of growth hormone on cancer in adult with growth hormone deficiency remains unclear. We carried out a meta-analysis to evaluate the risk of cancer in adult with and without growth hormone replacement therapy. We searched PubMed, Web of Science, China National Knowledge Infrastructure, and WanFang databases up to 31 July 2016 for eligible studies. Pooled risk ratio (RR) with 95% confidence interval (CI) was calculated using fixed-or random-effects models if appropriate. The Newcastle-Ottawa Scale was used to assess the study quality. Two retrospective and seven prospective studies with a total of 11191 participants were included in the final analysis. The results from fixed-effects model showed this therapy was associated with the deceased risk of cancer in adult with growth hormone deficiency (RR=0.69, 95%CI: 0.59-0.82), with low heterogeneity within studies (I2=39.0%, P=0.108). We performed sensitivity analyses by sequentially omitting one study each time, and the pooled RRs did not materially change, indicating that our results were statistically stable. Begger's and Egger's tests suggested that there was no publication bias (Z=-0.63, P=0.520; t=0.16, P=0.874). Our study suggests that growth hormone replacement therapy could reduce risk of cancer in adult with growth hormone deficiency.

Craneofaringioma. Estudio multicéntrico retrospectivo en cinco centros hospitalarios de la ciudad de Guayaquil

Se realizó un estudio multicéntrico retrospectivo en 5 hospitales de la ciudad de Guayaquil, desde 1984 a 1993 recopilándose 20 casos con los datos suficientes para el estudio- De los 20 casos, 12 fueron del sexo masculino (60 por ciento ) y 8 del sexo femenino (40 por ciento). El grupo de edad de mayor incidencia fue entre los 5 a 14 años con 12 casos (60 por ciento). El cuadro clínico más largo de evolución fue de 5 años en 2 casos (10 por ciento). el motivo de ingreso más frecuente fue la cefalea en 19 pacientes (95 por ciento). El síndrome neurológico que más se presentó fue el de hipertensión endocraneal que se presentó en todos los pacientes y dentro de éste la cefalea fue el síntoma más referido en los 19 casos. En todos los pacientes se realizó estudios radiológicos de cráneo siendo el hallazgo más frecuente las calcificaciones en 6 pacientes. El estudio por medio de tomografía computarizada (TC) demostró que el 50 por ciento de los tumores eran supreselar; en 9 casos del tumor fue mixto (45 por ciento), solo cinco tumores (25 por ciento) reportó calcificaciones, la prouección tumoral hacia el III ventrículo fue la más observada. La técnica quirúrgica más usada fue la subfrontal con 12 pacientes siendo el tipo de resección subtotal en 19 casos el más usado. Las complicaciones postquirúrgicas más observadas fue la diabetes insípida en 11 casos (55 por ciento) la mortalidad de la serie fue del 40 por ciento...