Primary fibrosarcoma of the sella unrelated to previous radiation therapy

Abstract

Fibrosarcomas involving the sella turcica are rare lesions and, when encountered, have been associated with previous radiation of a pituitary adenoma. Although primary intracranial fibrosarcomas are well recognized, no case of primary fibrosarcoma of the sella turcica has been reported to date. We describe here a patient who presented with a 2-month history of headache, visual disturbances, and diabetes insipidus. Her past medical history was unremarkable, with no radiation therapy. Magnetic resonance imaging revealed a sellar/suprasellar lesion that at surgery appeared firm in consistency. A radical removal of the mass was performed through a transsphenoidal approach. The patient recovered promptly from the operation and 2 weeks later, given the aggressive histologic appearance of the lesion, underwent gamma knife radiosurgery. Seven months after diagnosis, the patient presented with local tumor recurrence. A subtotal surgical resection was performed, and additional postsurgical treatment is still under consideration. Although most often related to previous radiation of the pituitary gland, primary fibrosarcomas can occur in the sella. This possibility should be suspected in the differential diagnosis of sellar masses that lack the classical characteristics of the much more common pituitary adenomas.