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1.
J Laryngol Otol ; 134(4): 369-371, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32234087

RESUMEN

OBJECTIVE: This paper presents a case of an isolated pituitary fossa metastasis on a background of a previously treated tonsillar squamous cell carcinoma. CASE REPORT: A 64-year-old male, diagnosed with a primary p16-negative squamous cell carcinoma in the right tonsil, was treated with a course of chemoradiotherapy with curative intent. Positron emission tomography/computed tomography, performed at six months post-treatment, revealed a good local response and no distant metastases. The patient was placed on routine follow up at two-monthly intervals. Two months into follow up, he presented with a right-sided oculomotor nerve palsy and partial Horner's syndrome. Imaging and biopsy revealed a pituitary fossa metastasis (p16-negative squamous cell carcinoma), and a further positron emission tomography/computed tomography visualised this lesion. He was deemed unsuitable for further intervention and underwent palliative radiotherapy for symptom control. CONCLUSION: This case represents the first reported isolated pituitary fossa metastasis from a tonsillar squamous cell carcinoma. A high degree of clinical suspicion is recommended, along with a low threshold for biopsy and a cautioned use of positron emission tomography/computed tomography, when investigating such patients.


Asunto(s)
Carcinoma de Células Escamosas/secundario , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Silla Turca/patología , Neoplasias Tonsilares/patología , Biopsia/métodos , Carcinoma de Células Escamosas/terapia , Quimioradioterapia/métodos , Síndrome de Horner/diagnóstico , Síndrome de Horner/etiología , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia/patología , Recurrencia Local de Neoplasia , Enfermedades del Nervio Oculomotor/diagnóstico , Enfermedades del Nervio Oculomotor/etiología , Cuidados Paliativos/métodos , Radioterapia/métodos , Silla Turca/diagnóstico por imagen , Silla Turca/efectos de la radiación , Resultado del Tratamiento
2.
Medicine (Baltimore) ; 99(8): e18572, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080071

RESUMEN

Stereotactic biopsy (STB) is commonly used in the pathological diagnosis of intracranial lesions. The associated complication and mortality rates are low, but few reports with large sample sizes have assessed the complications of STB for lesions in the brain midline.To evaluate the complications of STB of lesions in the sellar region, pineal region, and brainstem.This was a retrospective analysis of patients who underwent STB of lesions in the sellar region, pineal region, and brainstem at the Neurosurgery Department, Sixth Medical Center, PLA General Hospital, China, between January 2015 and December 2017. The rates of and possible reasons for surgical complications (including bleeding) and mortality were analyzed.A total of 145 patients underwent STB of midline brain lesions, including 16 (11.0%) in the sellar region, 18 (12.4%) in the pineal region, and 111 (76.6%) in the brainstem. Successful biopsy of the sellar region, pineal region, and brainstem was achieved in 16/16 (100%), 18/18 (100%), and 107/111 (96.4%) patients, respectively. There were no complications following STB of lesion in the sellar or pineal regions. Complications occurred in 17/111 patients (15.3%) during/after brainstem biopsy, three of whom died (2.7%). The main clinical manifestations were facioplegia, facial pain, changes in blood pressure and heart rate, and difficulty breathing.STB of lesions in the sellar region, pineal region, and brainstem had a high success rate, but mortality was 2.7%. The occurrence of complications (15.3%) was closely related to the anatomical and functional characteristics of the region biopsied.


Asunto(s)
Neoplasias Encefálicas/patología , Glándula Pineal/patología , Silla Turca/patología , Técnicas Estereotáxicas/efectos adversos , Adolescente , Adulto , Biopsia/efectos adversos , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Tronco Encefálico/diagnóstico por imagen , Tronco Encefálico/patología , China/epidemiología , Femenino , Hemorragia/epidemiología , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Glándula Pineal/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Silla Turca/diagnóstico por imagen , Técnicas Estereotáxicas/mortalidad , Adulto Joven
3.
J Craniofac Surg ; 31(1): e68-e69, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31633667

RESUMEN

Pituitary adenomas are a group of tumors arising from the anterior pituitary gland, and with the exception of prolactin-secreting adenomas, transsphenoidal resection is the cornerstone of treatment. Although most adenomas are located within the pituitary fossa, ectopic adenomas have been reported, primarily occurring along the route of embryologic development. In this article, we present the case of an ectopic pituitary adenoma in the nasolabial fold that likely resulted from seeding during transsphenoidal resection via sublabial approach.


Asunto(s)
Síndrome de Nelson/cirugía , Prolactinoma/cirugía , Anciano , Femenino , Humanos , Síndrome de Nelson/diagnóstico por imagen , Prolactinoma/diagnóstico por imagen , Recurrencia , Silla Turca/patología
4.
Pan Afr Med J ; 34: 55, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31762921

RESUMEN

Intrasellar arachnoid cysts are benign malformations. They are extremely rare (approximately 3% of cases). Their pathophysiology is still poorly elucidated. We here report a case of intrasellar arachnoid cyst with suprasellar extension whose treatment was based on endoscopic transsphenoidal fenestration. The epidemiological, clinical, pathophysiological, radiological, therapeutic and evolutionary features have been analyzed. Neuroendoscopic procedures are performed with increasing frequency in surgery. Prognosis is good and recurrences are frequent, even after several years of evolution.


Asunto(s)
Quistes Aracnoideos/diagnóstico , Endoscopía/métodos , Silla Turca/patología , Adulto , Quistes Aracnoideos/cirugía , Femenino , Humanos , Pronóstico , Silla Turca/cirugía
5.
No Shinkei Geka ; 47(8): 901-907, 2019 Aug.
Artículo en Japonés | MEDLINE | ID: mdl-31477634

RESUMEN

OBJECTIVES: Intracranial chordomas are thought to arise from remnants of the notochord and usually occur at the parasellar region. We present a case of a primary intrasellar chondroid chordoma in a patient who was initially diagnosed with a pituitary adenoma. CASE: A 77-year-old woman had a history of two surgeries for a tumor in the sella turcica(17 months after the 1st surgery). On initial MRI, the intrasellar mass showed low signal intensity on T1WI, very high signal intensity on T2WI, and inhomogeneous enhancement. On bone reconstructive CT, the sellar floor was thin, and no abnormalities were observed at the top of the clivus. Transsphenoidal surgery was performed. The pathological diagnosis was pituitary adenoma in both cases. Seventy-two months after the 1st(31 months after the 2nd)surgery, she developed right-sided oculomotor and abducent nerve palsies again. Since recurrence occurred during the relatively short period, the surgical specimens obtained from the 1st and 2nd surgeries were reexamined. Reexamination of the previously obtained specimen demonstrated areas of chondroid tissue that were embedded in a mucoid stroma and tumor cells that were composed of round or pleomorphic nuclei with vacuolated cytoplasm(physaliphorus cells)that were compatible with chondroid chordoma. The third surgery was performed. Postoperatively, her symptoms improved, and cyber knife therapy was administered for the residual part of the tumor. CONCLUSIONS: Although intrasellar chondroid chordomas are extremely rare, they should be considered in the differential diagnosis of tumors located in the sella turcica.


Asunto(s)
Adenoma , Cordoma , Neoplasias Hipofisarias , Adenoma/diagnóstico , Adenoma/cirugía , Anciano , Cordoma/diagnóstico , Cordoma/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Recurrencia Local de Neoplasia , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/cirugía , Silla Turca/patología
6.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(3): 386-391, July-Sept. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1041333

RESUMEN

ABSTRACT Objective: To present two clinical cases of pediatric Cushing disease caused by adrenocorticotropic hormone secreting pituitary adenomas, which were diagnosed by magnetic resonance imaging using 3 Tesla technology. Case description: Two cases of Cushing disease in 9-year-old children are reported. Both children presented pituitary adenomas that were smaller than 5 mm at their largest diameter, and which were not seen by standard 1.5 Tesla resonance. One of the patients was submitted to bilateral and simultaneous catheterization of the inferior petrosal sinus, but the result was undetermined. In both cases, the pituitary adenoma was detected by 3 Tesla magnetic resonance imaging. Both patients underwent transsphenoidal surgery and were cured. Comments: Cushing disease presents high morbidity. Therefore, early diagnosis and prompt treatment are essential. It is usually caused by adenomas that are smaller than 5 mm in diameter. Surgery is the first line of treatment, and effective methods of locating the adenoma are necessary for greater therapeutic success. This report suggests that the 3 Tesla magnetic resonance imaging is more sensitive, and thus able to detect pituitary microadenomas (largest diameter <10 mm). This exam may be indicated as a low-morbidity diagnostic tool for finding pituitary microadenomas in Cushing disease that are not visualized by 1.5 Tesla magnetic resonance imaging.


RESUMO Objetivo: Apresentar dois casos clínicos de Doença de Cushing infantil decorrentes de adenoma hipofisário secretor de hormônio adrenocorticotrófico, cujo diagnóstico foi realizado por meio da ressonância magnética pela tecnologia 3 Tesla. Descrição do caso: São relatados dois casos de Doença de Cushing em crianças aos nove anos. Ambas apresentavam adenomas menores que 5 mm em seu maior diâmetro que não foram visualizados por meio de ressonância magnética de sela turca utilizando tecnologia 1,5 Tesla. Uma das pacientes foi submetida ao cateterismo bilateral e simultâneo do seio petroso inferior, porém com resultado indeterminado. Nas duas, o adenoma hipofisário foi visualizado mediante ressonância magnética utilizando tecnologia 3 Tesla. Ambas foram submetidas à cirurgia transesfenoidal e evoluíram para cura. Comentários: A Doença de Cushing apresenta alta morbidade, necessitando de diagnóstico e tratamento precoces, e geralmente é causada por adenomas com diâmetro inferior a 5 mm. O tratamento é cirúrgico, sendo preciso utilizar métodos eficazes de localização do adenoma para maior sucesso terapêutico. Esses relatos sugerem que a ressonância magnética 3 Tesla tem mais sensibilidade na detecção de microadenomas hipofisários (maior diâmetro <10 mm), podendo-se indicar esse exame como uma ferramenta diagnóstica de baixa morbidade na localização de microadenomas hipofisários na Doença de Cushing não visualizados pela ressonância magnética 1,5 Tesla.


Asunto(s)
Humanos , Femenino , Niño , Silla Turca/diagnóstico por imagen , Imagen por Resonancia Magnética , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/diagnóstico por imagen , Silla Turca/patología , Valor Predictivo de las Pruebas , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/patología
7.
World Neurosurg ; 132: 1-3, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31442637

RESUMEN

BACKGROUND: This report presents a rare presentation of a ganglioglioma in the sellar/suprasellar region. On the basis of the patient's presentation and imaging characteristics, the initial diagnosis was craniopharyngioma. While gangliogliomas are already rare brain tumors that are usually found in the frontal and temporal lobes of young patients, the presentation of this tumor in the sellar region is exceedingly rare. CASE DESCRIPTION: A 25-year-old male presented to the emergency department with headache, agitation, and combativeness. A head computed tomography scan showed a sellar/suprasellar mass with mixed solid and cystic components and peripheral calcifications. The mass compressed the third ventricle and cerebral aqueduct, resulting in obstructive hydrocephalus. The patient was intubated for decline in mental status and combativeness. A ventricular drain was placed emergently. A pituitary function panel did not show endocrine dysfunction. Magnetic resonance imaging showed a 3.6 cm × 4.2 cm solid mass in the sellar/suprasellar region with a cystic component. The mass displaced the adenohypophysis and extended into the prepontine and interpedicular cisterns. The clinical presentation and radiologic characteristics led to an initial diagnosis of craniopharyngioma. The patient underwent a right pterional craniotomy and transsylvian approach for resection of mass without complication, although a subtotal resection was achieved due to adherence of the tumor to optic nerves and carotid arteries. The resected specimen was diagnosed as ganglioglioma. CONCLUSIONS: This case is a reminder of how much the field of neurosurgery relies on imaging modalities but also emphasizes the importance of histopathology in the field of brain tumors.


Asunto(s)
Neoplasias Encefálicas/cirugía , Ganglioglioma/cirugía , Silla Turca/cirugía , Adulto , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/patología , Craneofaringioma/diagnóstico , Craneotomía , Diagnóstico Diferencial , Ganglioglioma/complicaciones , Ganglioglioma/diagnóstico por imagen , Ganglioglioma/patología , Humanos , Hidrocefalia/etiología , Imagen por Resonancia Magnética , Masculino , Neoplasias Hipofisarias/diagnóstico , Silla Turca/diagnóstico por imagen , Silla Turca/patología , Ventriculostomía
8.
World Neurosurg ; 132: e577-e584, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31442639

RESUMEN

OBJECTIVE: The surgery of parasellar meningiomas is crucial. There are only a few reports of the use of intraoperative magnetic resonance imaging (iMRI) for resection of these lesions. We discuss the safety and usefulness of this technique in achieving the planned surgical goal and analyze patients' outcomes. METHODS: Nineteen cases of parasellar meningioma were treated in our institution using iMRI. We classified the tumors according to their primary location: tuberculum sellae, clinoidal, and cavernous sinus meningiomas. We evaluated the history of previous surgery, outcome, residual (if present) tumor volume, degree of resection, achievement of the surgical goal, and number of iMRI scans. RESULTS: The preoperative surgical goal was achieved in all patients. In 7 of 19 patients, (37%) further tumor resection was performed after the first iMRI scan. Regarding the cavernous sinus group, the surgical resection was continued after the first iMRI in 56% of patients, obtaining substantial additional volume reduction. No complications were found related to the use of iMRI scan. CONCLUSIONS: iMRI has been effective in safely increasing the extent of parasellar meningioma resection mainly for recurrent and invasive tumors. Its usefulness has been seen mostly in cavernous sinus lesions, in which it allowed the further safe resection in 56% of cases. Moreover, this tool was particularly useful in recurrent or residual meningiomas with extension in extracranial compartments.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Neuroimagen/métodos , Cirugía Asistida por Computador/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/diagnóstico por imagen , Persona de Mediana Edad , Silla Turca/patología
9.
Rev. medica electron ; 41(4): 879-888, jul.-ago. 2019. tab
Artículo en Español | LILACS, CUMED | ID: biblio-1094095

RESUMEN

RESUMEN Introducción: diversos autores reflejan que la morfología de la silla turca constituye un factor predisponente para algunas enfermedades. Por ejemplo, se considera que existe correlación entre la morfología de esta estructura anatómica y varias patologías; como el síndrome de la silla turca vacía, síndrome de Williams, paladar hendido, entre otras. Objetivo: describir las variaciones anatómicas de la silla turca que se observan en las radiografías laterales de cráneo del Hospital Universitario "Faustino Pérez" de la ciudad de Matanzas, en el período de enero del 2017 a enero del 2018. Materiales y métodos: el universo fue 140 radiografías laterales de cráneo, de estas 85 pertenecieron al sexo femenino y 55 al masculino. Las variables estudiadas fueron edad, sexo y variaciones anatómicas de la silla turca. Se emplearon métodos teóricos y empíricos. Resultados: se observó un predominio de la variación anatómica de la silla turca en forma de U, en ambos sexos. Seguido de la forma de J, predominando la variación en forma de U en el grupo etario de 41 a 50 años y la forma de J en los pacientes mayores de 60 años. Conclusiones: es imprescindible el conocimiento de la anatomía normal de la silla turca y de sus variaciones anatómicas, tanto para las especialidades quirúrgicas como para las no quirúrgicas. Un análisis exhaustivo de la morfología de esta estructura es necesario para establecer parámetros que excluyan determinadas patologías.


ABSTRACT Introduction: several authors declare that sella turcica morphology is a predisposing factor to several diseases. For example, it is considered that there is a correlation between the morphology of this anatomical structure and several pathologies like empty sella turcica syndrome, Williams syndrome, cleft palate and others. Objective: to describe the anatomical variants of sella turcica observed in side cranial radiographies of the University Hospital ¨Faustino Perez¨ of Matanzas, in the period January 2017-January 2018. Materials and methods: the universe was 140 side cranial radiography: 85 belonged to female patients and 55 to male patients. The studied variables were age, sex and sella turcica anatomical variables. Theoretic and empirical methods were used. Results: it was observed a predominance of the U-shaped sella turcica anatomical variant in both sexes, followed by the J-shaped one. The U-shaped form predominated in the 41-50-years-old age-group and the J-shaped form in patients elder than 60 years. Conclusions: it is essential to know sella turcica normal anatomy and its anatomical variables, both for the surgical specialties and for the non-surgical ones. It is necessary the exhaustive analysis of this structure to establish parameters excluding several pathologies.


Asunto(s)
Humanos , Adulto , Anciano , Silla Turca/anomalías , Silla Turca/patología , Silla Turca/diagnóstico por imagen , Enfermedades Estomatognáticas/diagnóstico , Enfermedades Estomatognáticas/epidemiología , Síndrome de Williams/epidemiología , Síndrome de Williams/diagnóstico por imagen , Síndrome de Silla Turca Vacía/epidemiología , Síndrome de Silla Turca Vacía/diagnóstico por imagen , Enfermedades del Sistema Endocrino/diagnóstico , Enfermedades del Sistema Endocrino/epidemiología , Epidemiología Descriptiva , Causalidad , Anatomía Transversal , Predisposición Genética a la Enfermedad , Estudio Observacional
10.
J Craniofac Surg ; 30(5): e400-e402, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31299791

RESUMEN

The study reported a case of an intrasellar arachnoid cyst with visual disturbances as the main symptom. Arachnoid cyst is a common intracranial benign space-occupying lesion, but rarely seen in intrasellar region with less than 100 cases reported available in English language literature. Therefore, it is still controversial about the diagnosis and treatment of such patients. This article reviewed previous literature and discussed the differential diagnosis and surgical strategies of intrasellar arachnoid cyst in combination with our own case.


Asunto(s)
Quistes Aracnoideos/diagnóstico , Diagnóstico Diferencial , Adulto , Quistes Aracnoideos/cirugía , Femenino , Humanos , Silla Turca/patología
11.
Rev. chil. endocrinol. diabetes ; 12(3): 162-164, jul. 2019. ilus
Artículo en Español | LILACS | ID: biblio-1006497

RESUMEN

La acromegalia, originada por un exceso de producción de Hormona de crecimiento (Gh), se caracteriza por crecimiento somático exagerado, alto riesgo cardio-metabólico, así como reducción de la expectativa de vida. Tiene una incidencia de 3-4 casos por millón de habitantes. El diagnóstico se retrasa hasta 10 años aumentando la morbi-mortalidad. Las alternativas terapéuticas incluyen medicamentos y cirugía, que van encaminados a reducir los efectos de masa tumoral, normalizar los parámetros bioquímicos y resolver las manifestaciones clínicas. En casos muy infrecuentes, el tumor hipofisario que la origina se asocia a silla turca vacía.


Acromegaly, caused by an excess production of growth hormone (Gh), it is characterized by exaggerated somatic growth, high cardio-metabolic risk, as well as reduction of life expectancy. It has an incidence of 3-4 cases per million population. The diagnosis is delayed up to 10 years increasing morbidity and mortality. The therapeutic alternatives include medications and surgery, which are aimed at reduce the effects of tumor mass, normalize biochemical parameters and resolve clinical manifestations. In very infrequent cases, the pituitary tumor that originates it is associated with empty sella syndrome. Key words: Acromegaly, Empty sella syndrome, Pituitary tumor.


Asunto(s)
Humanos , Femenino , Anciano , Neoplasias Hipofisarias/complicaciones , Acromegalia/complicaciones , Acromegalia/diagnóstico , Síndrome de Silla Turca Vacía/complicaciones , Silla Turca/patología , Factor I del Crecimiento Similar a la Insulina/análisis , Hormona del Crecimiento/análisis , Imagen por Resonancia Magnética , Prueba de Tolerancia a la Glucosa
12.
World Neurosurg ; 130: e150-e159, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31203060

RESUMEN

BACKGROUND: Xanthogranuloma is a chronic inflammatory mass characterized by cholesterol crystal deposition, which is rarely seen in the sellar region. The objective of this study is to identify the clinical features and cause of sellar xanthogranulomas. METHODS: We retrospectively analyzed manifestation, radiographic, and endocrinologic presentation in 9 patients (7 women and 2 men) whom we had previously treated. RESULTS: The patients were between 26 and 73 years of age (median, 56 years). The chief symptoms were visual symptoms in 3, polyuria in 3, headache in 4, and tiredness in 4 patients. Perimetry found visual field deficit in 6 patients. Anterior pituitary provocation tests disclosed impairment of ≥1 hormone in all patients: growth hormone in 8 patients and adrenocorticotropic hormone-cortisol axis in 8 patients. The lesions were suprasellar in 2 patients, intrasellar in 2 patients, and intrasuprasellar region in 5 patients. Three of the lesions were solid and 6 were single cystic to multicystic. Very low intensity area on T2-weighted magnetic resonance imaging was observed in 4 lesions. Postcontrast study performed in 7 lesions showed enhancement in solid parts or cyst walls. Surgical decompression improved visual disturbance in half of the patients but rarely improved hormonal deficits. Follow-up (median, 47 months) found no recurrence of the lesion. In addition to these 9 cases, we found 2 xanthogranulomatous lesions pathologically associated with ciliated epithelia, which also presented with severe hypopituitarism. CONCLUSIONS: Xanthogranuloma seems to be the last stage of the chronic inflammation affecting Rathke cleft cyst or craniopharyngioma presenting with severe anterior pituitary insufficiency.


Asunto(s)
Granuloma/complicaciones , Granuloma/patología , Hipopituitarismo/complicaciones , Neoplasias Hipofisarias/complicaciones , Silla Turca/patología , Xantomatosis/complicaciones , Xantomatosis/patología , Adulto , Anciano , Femenino , Granuloma/diagnóstico por imagen , Humanos , Hipopituitarismo/diagnóstico , Hipopituitarismo/patología , Masculino , Persona de Mediana Edad , Adenohipófisis/diagnóstico por imagen , Adenohipófisis/patología , Neoplasias Hipofisarias/diagnóstico por imagen , Neoplasias Hipofisarias/patología , Estudios Retrospectivos , Silla Turca/diagnóstico por imagen , Xantomatosis/diagnóstico por imagen
13.
Rev Paul Pediatr ; 37(3): 386-391, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31090849

RESUMEN

OBJECTIVE: To present two clinical cases of pediatric Cushing disease caused by adrenocorticotropic hormone secreting pituitary adenomas, which were diagnosed by magnetic resonance imaging using 3 Tesla technology. CASE DESCRIPTION: Two cases of Cushing disease in 9-year-old children are reported. Both children presented pituitary adenomas that were smaller than 5 mm at their largest diameter, and which were not seen by standard 1.5 Tesla resonance. One of the patients was submitted to bilateral and simultaneous catheterization of the inferior petrosal sinus, but the result was undetermined. In both cases, the pituitary adenoma was detected by 3 Tesla magnetic resonance imaging. Both patients underwent transsphenoidal surgery and were cured. COMMENTS: Cushing disease presents high morbidity. Therefore, early diagnosis and prompt treatment are essential. It is usually caused by adenomas that are smaller than 5 mm in diameter. Surgery is the first line of treatment, and effective methods of locating the adenoma are necessary for greater therapeutic success. This report suggests that the 3 Tesla magnetic resonance imaging is more sensitive, and thus able to detect pituitary microadenomas (largest diameter <10 mm). This exam may be indicated as a low-morbidity diagnostic tool for finding pituitary microadenomas in Cushing disease that are not visualized by 1.5 Tesla magnetic resonance imaging.


Asunto(s)
Imagen por Resonancia Magnética , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/diagnóstico por imagen , Silla Turca/diagnóstico por imagen , Niño , Femenino , Humanos , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/patología , Valor Predictivo de las Pruebas , Silla Turca/patología
14.
Endocr Pathol ; 30(2): 81-89, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30903445

RESUMEN

Although most pituitary neuroendocrine tumors (PitNETs) show benign behavior, a significant number of PitNETs exhibit an aggressive course including cavernous sinus (CS) invasion. To date, the cause of CS invasion has not been fully elucidated. In this study, we analyzed the relationship between CS invasion in PitNETs and the expression of PITX2 and SNAIL1, which are the transcription factors associated with the morphogenesis of pituitary gland. Sixty cases with non-functional PitNETs were classified into four types: type 1a, none of CS invasion and suprasellar expansion; type 1b, suprasellar expansion without CS invasion; type 2a, CS invasion without suprasellar expansion; and type 2b, CS invasion with suprasellar expansion. We analyzed the expression of PITX2 and SNAIL1 employing quantitative real-time polymerase chain reaction (qPCR) and immunohistochemistry. Other parameters such as mitotic count, Ki-67 index, and p53 expression were also analyzed, which were previously reported as potential tumor proliferative markers in PitNETs. PITX2 expression was significantly higher in PitNETs with CS invasion than PitNETs without CS invasion (P = 0.019). Expression of SNAIL1 was significantly elevated in PitNETs with suprasellar expansion compared with PitNETs without suprasellar expansion (P = 0.02). There was no apparent relationship between CS invasion and mitotic count, Ki-67 index, and p53 expression (mitotic count, P = 0.11; Ki-67 index, P = 0.61; p53, P = 0.66). High PITX2 expression was observed in non-functional PitNETs with CS invasion, suggesting that PITX2 may be involved in CS invasion of PitNETs.


Asunto(s)
Seno Cavernoso/patología , Proteínas de Homeodominio/genética , Tumores Neuroendocrinos/genética , Neoplasias Hipofisarias/genética , Factores de Transcripción/genética , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/genética , Femenino , Proteínas de Homeodominio/análisis , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/patología , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/patología , Reacción en Cadena de la Polimerasa , Silla Turca/patología , Factores de Transcripción de la Familia Snail/análisis , Factores de Transcripción de la Familia Snail/genética , Factores de Transcripción/análisis
17.
J Clin Endocrinol Metab ; 104(6): 2395-2402, 2019 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-30722009

RESUMEN

CONTEXT: Neurocytoma (NC) is a rare, low-grade tumor of the central nervous system, with a 10-year survival rate of 90% and local control rate of 74%. However, 25% of NCs will be atypical, with an elevated Ki-67 labeling index >2%, and will exhibit a more aggressive course, with a high propensity for local recurrence and/or craniospinal dissemination. Although no standard treatment regimen exists for these atypical cases, adjuvant stereotactic or conventional radiotherapy and/or chemotherapy have been typically offered but have yielded inconsistent results. CASE DESCRIPTION: We have described the case of a patient with a vasopressin-secreting atypical NC of the sellar and cavernous sinus region. After subtotal resection via endoscopic transsphenoidal surgery, the residual tumor showed increased fluorodeoxyglucose uptake and high somatostatin receptor (SSTR) expression on a 68Ga-DOTA-TATE positron emission tomography/CT scan. Somatostatin receptor ligand (SRL) therapy with lanreotide (120 mg every 28 days) was initiated. Four years later, the residual tumor was stable with decreased fluorodeoxyglucose tumor uptake. Immunocytochemical SSTR2 and SSTR5 expression >80% was further confirmed in a series of NC tissues. CONCLUSIONS: To the best of our knowledge, we have described the first use of SRL therapy for an atypical NC. Our results support consideration of adjuvant SRL therapy for NC refractory to surgical removal. Our findings further raise the possibility of SSTR-directed peptide receptor radionuclide therapy as NC therapy.


Asunto(s)
Neoplasias Encefálicas/tratamiento farmacológico , Neurocitoma/tratamiento farmacológico , Péptidos Cíclicos/uso terapéutico , Somatostatina/análogos & derivados , Adolescente , Neoplasias Encefálicas/química , Neoplasias Encefálicas/diagnóstico por imagen , Seno Cavernoso/patología , Fluorodesoxiglucosa F18 , Humanos , Masculino , Neurocitoma/química , Neurocitoma/diagnóstico por imagen , Receptores de Somatostatina/análisis , Silla Turca/patología , Somatostatina/uso terapéutico , Vasopresinas/metabolismo
18.
J Neurooncol ; 142(3): 545-555, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30796744

RESUMEN

BACKGROUND: Approach selection paradigm for tuberculum sellae meningiomas (TSMs) is still a point of discussion. The trans-eyebrow supraorbital keyhole approach (TSKA) is a minimally invasive transcranial approach and has been used for the treatment of TSMs during recent years. In this study, we presented a series of 30 cases of TSMs treated via TSKA with a long-term follow-up. METHOD: Thirty patients with TSMs underwent surgery via TSKA between December 2006 and August 2018. The medical data and follow-up results were retrospectively analyzed. RESULTS: A total of 5 males and 25 females were included in this study. Three patients presented with recurrent TSMs. The mean tumor size was 25.3 ± 7.3 mm (range, 10-48 mm). The mean follow-up period was 58.0 months (interquartile range, 33.5-86.3 months). Gross total resection (GTR) was achieved in 27 patients (90.0%). One recurrence (3.3%) occurred 9 years after surgery. Out of 29 patients with preoperative visual impairment, 17 (58.6%) improved, eight (27.6%) remained stable, and four (13.8%) deteriorated. No peri-operative death, CSF rhinorrhea, or permanent endocrine dysfunction occurred. All patients exhibited satisfactory cosmetic results. At the last follow-up, the glasgow outcome scale score was five in 27 patients (90.0%). CONCLUSION: The TSKA is characterized by minimal invasion with a satisfactory cosmetic outcome. Based on the tumor characteristics and surgeon's experience, this approach can be employed as an alternative minimally invasive approach for the treatment of TSMs.


Asunto(s)
Frente/cirugía , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Recurrencia Local de Neoplasia/patología , Silla Turca/cirugía , Neoplasias de la Base del Cráneo/cirugía , Agudeza Visual , Adulto , Anciano , Craneotomía , Femenino , Estudios de Seguimiento , Frente/patología , Humanos , Masculino , Neoplasias Meníngeas/patología , Meningioma/patología , Persona de Mediana Edad , Órbita , Pronóstico , Estudios Retrospectivos , Silla Turca/patología , Neoplasias de la Base del Cráneo/patología
19.
Curr Pain Headache Rep ; 23(1): 7, 2019 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-30712067

RESUMEN

PURPOSE OF REVIEW: Sellar and parasellar lesions are numerous and varying in terms of their patholphysiology and physical and radiographic characteristics but often incite pain syndromes that are similar in semiology. The goal of this review was to familiarize the reader with a variety of sellar and parasellar lesions grouped together based on common clinical symptomatology, with a focus on important imaging characteristics that are often distinguishing features diagnostically. RECENT FINDINGS: In most cases, tissue acquisition via surgical resection or stereotactic biopsy are the mainstay for definitive diagnosis of sellar and parasellar lesions. With advances in MRI technology in particular in terms of resolution and the inclusion of new techniques including dynamic imaging with delayed contrast, imaging studies of lesions in the sellar and parasellar regions have become increasingly important for diagnostic purposes, with pituitary adenomas and schwannomas as prime examples. In the case of chordoid gliomas, molecular features of the tumor also help distinguish it from other disease processes similar in presentation, which have dramatic impacts on management. Advances in surgical approaches and radiation techniques offer more precise and targeted therapy to lesions in an area with increased risk of clinical morbidity given the high concentration of critically important structures that must be spared during treatment. Sellar and parasellar lesions have the potential to cause significant morbidity and mortality, highlighting the importance of clinical recognition of warning signs/symptoms, obtaining high-quality imaging studies in various modalities for diagnostic purposes, and prompt management which often involves a multimodal approach that includes surgical resection, radiation, and/or medical therapy. Future advanced imaging techniques will only improve presurgical diagnostic accuracy and lead to more prompt and efficient management.


Asunto(s)
Imagen por Resonancia Magnética , Dolor/diagnóstico por imagen , Dolor/patología , Hipófisis/patología , Neoplasias Hipofisarias/patología , Silla Turca/patología , Neoplasias Craneales/patología , Diagnóstico Diferencial , Humanos , Neoplasias Hipofisarias/diagnóstico por imagen , Neoplasias Craneales/diagnóstico por imagen , Síndrome
20.
World Neurosurg ; 122: e130-e138, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30266706

RESUMEN

OBJECTIVE: Pituitary macroadenomas extend into the extrasellar space, such as the sphenoid sinus, cavernous sinuses, and suprasellar region. However, factors that regulate the direction of their extensions into the surrounding anatomical structures remain unknown. METHODS: This retrospective study included 162 patients who were treated for pituitary adenomas that had maximum diameters greater than 20 mm. According to the direction of adenoma extension, patients were divided into 4 groups: group A, inferior into the sphenoid sinus; group B, lateral into the cavernous sinus; group C, suprasellar region with enlarged sella turcica; and group D, supraellar region without enlarged sella turcica. Several anatomical structures surrounding the sella turcica were evaluated statistically, and multivariate logistic regression analysis was performed if the structures met the determining factors of adenomas extensions. RESULTS: The maximum diameter of adenomas was significantly larger in groups A and D. The maximum diameter of the diaphragmatic foramen was largest in group C (19.3 mm) and was significantly narrower in groups B (12.7 mm) and D (12.5 mm). Intrasphenoid septation, attached on the midline of the sella turcica, was observed most frequently in group D (78.6%) and was not detectable in group A (0%). Extension into the cavernous sinus, classified as dural discontinuity, was highly prevalent in group B (80.0%) and was uncommon in group C (12.3%). Erosion of the posterior clinoid process was most apparent in group B (92.0%). CONCLUSIONS: The integrity of the sella dura and the intrasphenoid septation can regulate adenoma extension by encouraging their growth towards paths of least resistance.


Asunto(s)
Adenoma/diagnóstico por imagen , Duramadre/diagnóstico por imagen , Neoplasias Hipofisarias/diagnóstico por imagen , Adenoma/patología , Adenoma/fisiopatología , Progresión de la Enfermedad , Duramadre/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/fisiopatología , Estudios Retrospectivos , Silla Turca/diagnóstico por imagen , Silla Turca/patología , Carga Tumoral
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