Concurrent Papillary Craniopharyngioma and Growth Hormone-Secreting Pituitary Adenoma: A Rare and Aggressive Collision Tumor

Use of "enhanced contact endoscopy for pituitary surgery" in a collision sellar tumor (papillary craniopharyngioma + non-functional pituitary adenoma): Representative case illustration and two-dimensional operative video

Background

Collision sellar tumors are rare disease entities. Less than 30 cases have been reported in the literature in the last 20 years. We present the case of one patient diagnosed with a collision sellar tumor and describe the use of Enhanced Contact Endoscopy for pituitary gland and tumoral identification not previously described in the literature.

Case Description

The patient is a 57-year-old man who presented with visual field deficits and intense frontal headache accompanied by a slight hypothyroidism. Magnetic resonance imaging shows two different lesions in the sellar area, with a pendular effect of the pituitary stalk displaced to the side of the pituitary adenoma. The patient was operated on with an endoscopic endonasal subsellar approach, aiding with an enhanced contact endoscopy to demarcate the pituitary gland from the tumor adequately. Pathology diagnosis was compatible with pituitary adenoma (First lesion) and papillary craniopharyngioma (Second lesion). A short surgical video was added to complement the learning of the technique for enhanced contact endoscopy for a description of the microvasculature pattern.

Conclusion

Collision sellar tumors are a rare pathology in the sellar region and could benefit from a variety of combined treatments for optimal outcomes. Enhanced contact endoscopy for pituitary surgery could be useful for distinguishing the normal pituitary gland from the tumor.