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CORRESPONDENCE
Year : 2017  |  Volume : 130  |  Issue : 2  |  Page : 249-250

Xanthogranuloma of the Sellar Region


Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

Date of Submission26-Sep-2016
Date of Web Publication10-Jan-2017

Correspondence Address:
Dr. Yong Yao
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.198025

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How to cite this article:
Dai CX, Guo XS, Liu XH, Bao XJ, Feng M, Zhong DR, Ma WB, Wang RZ, Yao Y. Xanthogranuloma of the Sellar Region. Chin Med J 2017;130:249-50

How to cite this URL:
Dai CX, Guo XS, Liu XH, Bao XJ, Feng M, Zhong DR, Ma WB, Wang RZ, Yao Y. Xanthogranuloma of the Sellar Region. Chin Med J [serial online] 2017 [cited 2018 Jul 19];130:249-50. Available from: http://www.cmj.org/text.asp?2017/130/2/249/198025

To the Editor: A 36-year-old female patient was admitted to Peking Union Medical College Hospital complaining of 6 years of headache. Magnetic resonance imaging (MRI) showed an intrasellar lesion with homogeneous hyperintense on T1-weighted images and T2-weighted images and inhomogeneous contrast enhancement by the gadolinium administration [Figure 1]a and [Figure 1]b. Rathke's cleft cyst was initially diagnosed preoperatively, and the tumor was totally resected by transsphenoidal surgery. Histopathology revealed that granulomatous tissue consisted of cholesterol clefts, lymphoplasmacellular infiltrates, marked hemosiderin deposits, and multinucleated foreign body giant cells around cholesterol clefts [Figure 1]e-[Figure 1]g. Immunohistochemical staining showed strong positive of CD68, but negative of S100 and SMA [Figure 1]h-[Figure 1]j, which was consistent with a diagnosis of xanthogranuloma of the sellar region. Postoperatively, MRI scans showed that there is no residual tumor [Figure 1]c and [Figure 1]d, and her severe headache was improved rapidly, the endocrine laboratory tests indicated that all the results were within normal limits. The most recent follow-up MRI was scanned at 36 months postoperatively and there was no sign of tumor recurrence.
Figure 1: (a and b) Magnetic resonance imaging showing an intrasellar mass (12 mm × 18 mm × 15 mm) with well-defined borders, extending into suprasellar and compressing the optic chiasma. The lesion showed homogeneous hyperintense on T1-weighted images (a) and T2-weighted images (b). (c and d) Postoperative magnetic resonance imaging revealing no residual tumor in (c) coronal T1-weighted image and (d) coronal T2-weighted images. (e-j) Histological and immunohistochemical results of the resected tumor. Photomicrograph of surgical specimen revealing granulomatous tissue comprising (e) foamy macrophage (HE staining, original magnification ×200), (f) fibrocytes and multinucleated giant cells (HE staining, original magnification ×100), (g) cholesterol cleft (HE staining, original magnification ×100); immunohistochemical staining showing strong positive of CD68 (h), negative of S100 (i) and SMA (j) in the tissue.

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Xanthogranulomas, known as cholesterol granulomas, are characterized by both granuloma and xanthoma. Xanthogranulomas in central nervous system mainly arise in the choroid plexus and most of them are located in the trigone of the lateral ventricle. [1] However, xanthogranulomas of the sellar region are very rare, and it is difficult to preoperatively diagnose xanthogranulomas of the sellar region because there is no specific clinical and radiological feature. Therefore, it is necessary to clarify the natural history, pathogenesis, treatment, and prognosis of xanthogranulomas by accumulating more cases with xanthogranuloma.

Although the histogenesis and pathogenesis of xanthogranulomas still remain unclear, it has been generally postulated that xanthogranuloma is granulomatous degeneration induced by chronic inflammatory processes, hemorrhage, or infarction in circumscribed area. [2]

There are no typical radiological features for xanthogranulomas of the sellar region. According to the previously reported literatures, about 70% of xanthogranulomas show marked hyperintensity of the lesion on T1-weighted images and 65% of them reveal iso- to hyper-intensity on T2-weighted images. [3] However, it is difficult to differentiate xanthogranuloma from craniopharyngioma, Rathke's cleft cyst, and hemorrhagic pituitary adenoma only by MRI findings. [4] Xanthogranulomas of the sellar region are rare but they should be considered in the differential diagnosis of the sellar lesions.

In summary, it is difficult to preoperatively diagnose xanthogranulomas of the sellar region because there is no specific clinical and radiological feature. Although the incidence of xanthogranuloma of the sellar region is very low, xanthogranuloma should be included in the differential diagnosis of lesion of the sellar region.

Financial support and sponsorship

This work was supported by grants from the National Natural Science Foundation of China (No. 81502639 and No. 81372414).

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Miranda P, Lobato RD, Ricoy JR, Lagares A, Ramos A. Xanthogranuloma of the choroid plexus of the third ventricle: Case report and literature review. Neurocirugia (Astur) 2005;16:518-22. doi: 10.1016/S1130-1473(05)70381-X.  Back to cited text no. 1
[PUBMED]    
2.
Sugata S, Hirano H, Yatsushiro K, Yunoue S, Nakamura K, Arita K. Xanthogranuloma in the suprasellar region. Neurol Med Chir (Tokyo) 2009;49:124-7. doi: 10.2176/nmc.49.124.  Back to cited text no. 2
[PUBMED]    
3.
Kamoshima Y, Sawamura Y, Motegi H, Kubota K, Houkin K. Xanthogranuloma of the sellar region of children: Series of five cases and literature review. Neurol Med Chir (Tokyo) 2011;51:689-93. doi: 10.2176/nmc.51.689.  Back to cited text no. 3
[PUBMED]    
4.
Choi SH, Kwon BJ, Na DG, Kim JH, Han MH, Chang KH. Pituitary adenoma, craniopharyngioma, and Rathke cleft cyst involving both intrasellar and suprasellar regions: Differentiation using MRI. Clin Radiol 2007;62:453-62. doi: 10.1016/j.crad.2006.12.001.  Back to cited text no. 4
[PUBMED]    


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