Angiolipoma in sellar, suprasellar and parasellar region: report on two new cases and review of literature.

Angiolipomas of CNS are very rare; more than 90% involve the spinal canal. There are only a few case reports documenting the tumor in the sellar/suprasellar region. We report 2 cases of angiolipoma involving sellar/suprasellar and right parasellar region in two female patients. On histopathology the lesion was composed of vascular component which was of cavernous type in one patient and of capillary caliber in the other with admixture of mature adipocytes. The MRI findings were distinctive as the lesion was predominantly iso-to-hypointense on T1W sequence, hyperintense on T2WI and FLAIR sequence. In addition, a few small hyperintense areas were noted on plain T1W images which may represent intralesional fat. One of the cases also showed lipid lactate peak on MR spectroscopy. To the best of our knowledge only 8 other cases of sellar, parasellar angiolipomas have been reported in indexed literature. MRI with fat suppression sequences should be routinely performed in lesions in such locations with hyperintense areas on T1WI as the incidence of intraoperative blood loss is very high. A preoperative suspicion of the diagnosis might help in reducing the patient morbidity.

Reduction in Size of a Large Rathke's Cleft Cyst on Treatment with Low Dose of Corticosteroid.

Rathke's cleft cyst is a non-neoplastic sellar cyst, which is increasingly reported on radiological investigation performed for unrelated intra-cranial pathology. When symptomatic, it is associated with headache, visual symptoms, and pituitary dysfunction. We report a case of an 18 year-old male patient with Rathke's cleft cyst, who presented with failing vision, headache, and hypocortisolism. After defaulting on planned surgery, the patient continued to take a replacement dose of prednisolone for a year. He reported significant improvement in vision and remarkable reduction in cyst size on repeat imaging after a year. Surgery was later performed in view of persisting severe headache. The authors discuss the reduction in cyst size in relation to long-term usage of replacement steroid. They postulate that selected patients with Rathke's cleft cyst with radiological evidence of inflammatory fluid can be given a trial of glucocorticoids and assessed for cyst shrinkage and changes in imaging characteristics.

Co-existing thyrotropin secreting pituitary adenoma and low grade glioma: clinical considerations and literature review.

The authors report an extremely rare co-occurrence of a thyrotropin secreting pituitary adenoma and a low grade glioma. A 35-year old patient was initially misdiagnosed and treated as a case of primary hyperthyroidism till he presented with visual symptoms and seizures. On evaluation he was also found to have a right frontal glioma. They discuss the presentation, clinical and diagnostic implications, treatment options and possible molecular pathways which help us understand the molecular biology of such tumor associations. They review literature of 12 previous indexed reports of pituitary tumors associated with various grades of gliomas. Though there are 3 previous reports of functioning pituitary tumors and gliomas, this is the first report of a thyrotropin secreting pituitary adenoma and an associated low grade glioma.

Multiple fourth ventricular hydatidosis.

Hydatid disease caused by ingestion of eggs of the cestode Echinococcus granulosus is endemic in the Middle East, Mediterranean countries, South America, North Africa and Australia.(1) Infratentorial occurrence of hydatid cyst is rare. We present a report of an extremely rare case of multiple exclusive fourth ventricular hydatid cysts, both primary and secondary, and discuss problems with the diagnosis and management of this condition.