FROM DIABETES INSIPIDUS TO SELLAR XANTHOGRANULOMA - A "YELLOW BRICK ROAD" DEMANDING TEAM-WORK.

Autor: Stojanovic M; Clinic for Endocrinology, Diabetes and Metabolic Diseases - Department of Neuroendocrinology, Belgrade, Serbia.; Medical Faculty, University of Belgrade - Department of Internal Medicine, Belgrade, Serbia., Manojlovic-Gacic E; Institute of Pathology, University of Belgrade, Medical Faculty, Belgrade, Serbia., Pekic S; Clinic for Endocrinology, Diabetes and Metabolic Diseases - Department of Neuroendocrinology, Belgrade, Serbia.; Medical Faculty, University of Belgrade - Department of Internal Medicine, Belgrade, Serbia., Milojevic T; Clinic for Neurosurgery, Clinical Centre of Serbia, Belgrade, Serbia., Miljic D; Clinic for Endocrinology, Diabetes and Metabolic Diseases - Department of Neuroendocrinology, Belgrade, Serbia.; Medical Faculty, University of Belgrade - Department of Internal Medicine, Belgrade, Serbia., Doknic M; Clinic for Endocrinology, Diabetes and Metabolic Diseases - Department of Neuroendocrinology, Belgrade, Serbia.; Medical Faculty, University of Belgrade - Department of Internal Medicine, Belgrade, Serbia., Nikolic Djurovic M; Clinic for Endocrinology, Diabetes and Metabolic Diseases - Department of Neuroendocrinology, Belgrade, Serbia.; Medical Faculty, University of Belgrade - Department of Internal Medicine, Belgrade, Serbia., Jemuovic Z; Clinic for Endocrinology, Diabetes and Metabolic Diseases - Department of Neuroendocrinology, Belgrade, Serbia., Petakov M; Clinic for Endocrinology, Diabetes and Metabolic Diseases - Department of Neuroendocrinology, Belgrade, Serbia.; Medical Faculty, University of Belgrade - Department of Internal Medicine, Belgrade, Serbia.
Jazyk: angličtina
Zdroj: Acta endocrinologica (Bucharest, Romania : 2005) [Acta Endocrinol (Buchar)] 2019 Apr-Jun; Vol. 15 (2), pp. 247-253.
DOI: 10.4183/aeb.2019.247
Abstrakt: Xanthogranulomas are inflammatory lesions exceptionally rarely occurring in the sellar region. Sellar xanthogranulomas (SXG) result from secondary hemorrhage, infarction, inflammation or necrosis upon existing craniopharyngioma (CP), Rathkès cleft cyst (RCC) or pituitary adenoma (PA), or represent a stage in xanthomatous hypophysitis evolution. "Pure SXG" are independent of a preexisting lesion. A 70 year old male patient, laryngeal cancer survivor, presented with central diabetes insipidus (CDI). MRI revealed an intra-suprasellar mass of uncertain origin. Transsphenoidal surgery resulted in an efficient lesion resection with maximal pituitary sparing. Pathological report has confirmed SXG without conclusive identification of preexisting sellar lesion. Age at presentation and gender were atypical for SXG. The most frequent presenting signs of SXG were absent. Most SXG are initially misdiagnosed as CP, RCC or PA. Preoperative clinical and radiological uncertainty may impact operative planning. Differentiating from CP is crucial, due to divergent operative target goals and prognosis. Intraoperative frozen section analysis could guide surgical extensiveness. Close collaboration must include endocrinologist, neuroradiologist, neurosurgeon and pathologist. Quantity and quality of provided tissue are essential for avoiding bias in pathohistological analysis of cystic or heterogenous lesions. Awareness is needed of new pathological entities in the sellar-parasellar region. SXG should be considered in differential diagnosis of CDI-causing sellar lesions.
Competing Interests: The authors declare that they have no conflict of interest.
Databáze: MEDLINE
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