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Case Reports
. 2013 Aug 7:11:178.
doi: 10.1186/1477-7819-11-178.

Collision tumors of the sella: coexistence of pituitary adenoma and craniopharyngioma in the sellar region

Guishan Jin  1 , Shuyu Hao, Jian Xie, Ruifang Mi, Fusheng Liu
Affiliations
Case Reports

Collision tumors of the sella: coexistence of pituitary adenoma and craniopharyngioma in the sellar region

Guishan Jin et al. World J Surg Oncol. .

Abstract

Collision tumors of the sellar region are relatively uncommon and consist mainly of more than one type of pituitary adenoma or a cyst or cystic tumor. The association of a pituitary adenoma and a craniopharyngioma is particularly rare. This study describes a rare occurrence in which a pituitary adenoma and a craniopharyngioma coexisted in the sellar region. The case involves a 47-year-old woman who underwent transsphenoidal surgery with subtotal tumor resection and reoperation using an interhemispheric transcallosal approach for total microsurgical resection of the tumor because the visual acuity in her left eye had re-deteriorated. Histopathological and immunohistochemical examinations of the excised tissue revealed a pituitary adenoma in the first operation and a craniopharyngioma in the second operation. Retrospective analysis found the coexistence of a pituitary adenoma and a craniopharyngioma, known as a collision tumor. Instead of the transsphenoidal approach, a craniotomy should be performed, to explore the suprasellar region.

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Figures

Figure 1
Figure 1
Preoperative images of computed tomography (CT) and magnetic resonance imaging (MRI) scans. (A) Sagittal CT showing isodensity or slightly higher density in the sellar and suprasellar areas (arrow indicates the cystic mass in the suprasellar areas). (B,C) Transverse MRI showing a short T1-weighted signal in the sellar area and prepontine cistern and a short T2-weighted signal (arrows indicate the mass). (D-F) Contrast MRI showing an enhanced mass in the sellar and suprasellar areas with a cystic mass in the prepontine cistern (D,F; arrows indicate the mass. E; arrow indicates the cystic mass in the prepontine cistern).
Figure 2
Figure 2
Photomicrographs of the pathological specimen. (A) Features of pituitary adenoma (H &E, ×100). Negative immunohistochemical staining for: (B) growth hormone, (C) prolactin, (D) follicle-stimulating hormone, (E) thyroid-stimulating hormone, (F) luteinizing hormone, (G) ACTH.
Figure 3
Figure 3
Post-operative MRI scan showing subtotal tumor resection (arrow indicated the enlarged cystic mass).
Figure 4
Figure 4
CT and MRI scans 11 months after the first operation. (A) Sagittal CT showing the isodensity in the suprasellar area and the prepontine cistern (arrow). (B) MRI showing a partial contrasting mass in the suprasellar area (arrow).
Figure 5
Figure 5
Photomicrographs of the pathological specimen showing the features of craniopharyngioma: (A) wet keratin (arrow, H & E, ×100), (B) multiple layers of squamous epithelium (H & E, ×200).
Figure 6
Figure 6
Sagittal T1-weighted MRI scan obtained 3 months after second surgery, revealing total tumor resection.
See this image and copyright information in PMC

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