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Azab WA, Khan T, Alqunaee M, Al Bader A, Yousef W. Endoscopic Endonasal Surgery for Uncommon Pathologies of the Sellar and Parasellar Regions. Adv Tech Stand Neurosurg 2023; 48:139-205. [PMID: 37770685 DOI: 10.1007/978-3-031-36785-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Endoscopic skull base surgery has become an integral part of the present neurosurgical armamentarium. The pioneering efforts in which the purely endoscopic transsphenoidal approach was introduced have triggered a growing tide of using the endoscopic endonasal procedures for a large variety of skull base lesions. Because of their anatomical peculiarities, lesions of the sellar and parasellar regions lend themselves very well to the endoscopic endonasal approaches. Apart from the common pathological entities, many other less frequent pathologies are encountered in the sellar and parasellar area. In this chapter, we review the surgical technique of the endoscopic endonasal transsphenoidal approach and its extensions applied to a variety of rare and uncommon pathological entities involving the sella turcica and clivus. An overview of these pathological entities is also presented and exemplified.
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Affiliation(s)
- Waleed A Azab
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Tufail Khan
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Marwan Alqunaee
- Rhinology - Endoscopic Sinus and Skull Base Surgery, Zain Hospital, Kuwait City, Kuwait
| | - Abdullah Al Bader
- Rhinology - Endoscopic Sinus and Skull Base Surgery, Jaber Al Ahmad Hospital, Kuwait City, Kuwait
| | - Waleed Yousef
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
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Iglesias P, Fernández-Mateos C, Tejerina E. Symptomatic salivary gland choristoma of the pituitary gland. ENDOCRINOL DIAB NUTR 2022; 69:544-546. [PMID: 36084990 DOI: 10.1016/j.endien.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/09/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | | | - Eva Tejerina
- Department of Pathology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Symptomatic salivary gland choristoma of the pituitary gland. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Feola T, Gianno F, De Angelis M, Colonnese C, Esposito V, Giangaspero F, Jaffrain-Rea ML. Salivary gland tissues and derived primary and metastatic neoplasms: unusual pitfalls in the work-up of sellar lesions. A systematic review. J Endocrinol Invest 2021; 44:2103-2122. [PMID: 33939106 PMCID: PMC8421317 DOI: 10.1007/s40618-021-01577-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/10/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE Salivary gland (SG) tissue and derived neoplasms may occur in the sellar region. As the current literature is mostly limited to case reports, the puzzling case of an inflammatory SG removed by transsphenoidal surgery (TS) and mimicking a prolactinoma prompted us to perform the first systematic review of these unusual conditions. METHODS A systematic literature search was conducted according to the PRISMA guidelines. Forty-four individual cases-non-neoplastic enlarged salivary glands (NNESG, n = 15), primary benign (n = 7) and malignant (n = 8) ectopic salivary tumours (ST) and sellar metastasis from eutopic primary ST (n = 14)-were suitable for the analysis of clinical, radiological and pathological characteristics. Therapeutic outcome was reviewed as a secondary endpoint. RESULTS All cases were diagnosed after surgery. NNESG commonly affected young and/or female patients, typically leading to headaches and hyperprolactinemia and originating close to the neurohypophysis. Submucosal SG should be excluded before concluding to an intrasellar NNESG after TS. No gender or age predominance was found for primary ectopic ST, which present as large tumors, with histological phenotypes similar to common ST. Hypopituitarism and diabetes insipidus were more frequent in ST than in NNESG. NNESG and benign ectopic ST rarely recur. Malignant ectopic ST should be distinguished from secondary localizations of eutopic ST reaching the sella by contiguity or metastatic spread; both share a frequent unfavorable outcome. CONCLUSION Sellar neoplasms derived from SG are rare but misleading conditions and pituitary dysfunction is likely to be more common than currently reported. Appropriate pathological evaluation and multidisciplinary approach are required.
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Affiliation(s)
- T Feola
- Neuromed Institute, IRCCS, Pozzilli, IS, Italy
- Department of Experimental Medicine, University "La Sapienza", Rome, RM, Italy
| | - F Gianno
- Neuromed Institute, IRCCS, Pozzilli, IS, Italy
- Department of Radiological, Oncological and Pathological Sciences, University "La Sapienza", Rome, RM, Italy
| | | | - C Colonnese
- Neuromed Institute, IRCCS, Pozzilli, IS, Italy
| | - V Esposito
- Neuromed Institute, IRCCS, Pozzilli, IS, Italy
- Department of Neurology and Psychiatry, University "La Sapienza", Rome, RM, Italy
| | - F Giangaspero
- Neuromed Institute, IRCCS, Pozzilli, IS, Italy
- Department of Radiological, Oncological and Pathological Sciences, University "La Sapienza", Rome, RM, Italy
| | - M-L Jaffrain-Rea
- Neuromed Institute, IRCCS, Pozzilli, IS, Italy.
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, Coppito 2, 67100, L'Aquila, AQ, Italy.
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Abstract
Introduction: Cystic sellar salivary gland-like lesions (CSSLs) are exceedingly rare, with fewer than a dozen case reports. They contain amorphous colloid identical to Rathke cleft cyst contents, but the cyst wall additionally shows cohesive aggregates of benign salivary glands. We report three new examples. Materials and methods: Two cases were seen at University of Colorado Denver and one at Memorial Sloan Kettering (MSK). Molecular testing was attempted on two of three. Results: Case 1 is a 20-year-old female who presented with panhypopituitarism and was found to have a suprasellar mass that proved to be a CSSL. She received no postoperative adjuvant therapy, but recurrence of headaches and blurred vision 2 years later prompted return to medical attention. A much smaller local cyst recurrence was now accompanied by a thickened, bulbous infundibular stalk. Second resection yielded a gliotic infundibular stalk and amorphous mucin, but no residual salivary-like glands. She is without further recurrence on 6-year follow-up. Case 2 is a 29-year-old female with headache; while seen initially at a tertiary care center, diagnosis was only made after consultation at MSK. Case 3 is 68-year-old female who had originally presented with apoplexy to an outside hospital 7 years prior to surgery and diagnosis. Molecular testing was uninformative on case 1 and negative for mutations or fusions on case 3. Conclusion: Few pathologists or neuropathologists have encountered CSSLs in their practices; case 1 produced recurrence and significant infundibular stalk damage, and case 3 originally manifested apoplexy, features not previously reported.
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Lavin V, Callipo F, Donofrio CA, Ellwood-Thompson R, Metcalf R, Djoukhadar I, Higham CE, Kearney T, Colaco R, Gnanalingham K, Roncaroli F. Primary epithelial-myoepithelial carcinoma of the pituitary gland. Neuropathology 2020; 40:261-267. [PMID: 31900996 DOI: 10.1111/neup.12628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/10/2019] [Accepted: 11/10/2019] [Indexed: 12/30/2022]
Abstract
Primary salivary gland-like tumors of the sella are rare and often challenging to diagnose. They reportedly derive from serous and mucinous glands that remain trapped in the infundibulum during embryogenesis. We report a 68-year-old man who presented with partial left third cranial nerve palsy, visual loss in the left eye without visual field defects, headache, weight loss and reduced muscle bulk. Neuroimaging studies demonstrated a solid and cystic, avidly enhancing lesion expanding the pituitary fossa and extending to the left cavernous sinus. The patient underwent craniotomy and the tissue removed showed features of epithelial-myoepithelial carcinoma similar to the salivary gland, skin and breast counterpart. No primary tumor was found outside the sella. The lesion behaved aggressively despite radio-chemotherapy and the patient died 22 months from the onset. The tumor showed a novel TP53 in-frame deletion (Gly154del) while no variants were found in H-RAS hotspot regions (codons 12, 13 and 61). Our report expands the spectrum of salivary gland-like tumors primarily occurring in the sella and emphasizes the need for specialist review of rare, non-neuroendocrine tumors of the pituitary and sella regions.
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Affiliation(s)
- Victoria Lavin
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | - Fabio Callipo
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Carmine A Donofrio
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rhianedd Ellwood-Thompson
- All Wales Medical Genetics Laboratory, Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - Robert Metcalf
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | | | - Claire E Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Tara Kearney
- Department of Endocrinology, Salford Royal Foundation Trust, Salford, UK
| | - Rovel Colaco
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | | | - Federico Roncaroli
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Liu Z, Zhang Y, Feng R, Tian Z, Rao Y, Lu Y, Xu J. Intrasellar symptomatic salivary gland: case series and literature review. Pituitary 2019; 22:640-646. [PMID: 31677129 DOI: 10.1007/s11102-019-01002-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Ectopic salivary glands have been found in both extracranial and intracranial locations, however, intrasellar symptomatic salivary gland is extremely rare and its clinical manifestation, radiological characteristics and outcome have not been systematically studied. Here we present a case series of intrasellar symptomatic salivary gland and perform a literature review to better characterize this disease. METHODS We retrospectively reviewed the data of three patients with intrasellar symptomatic salivary gland from our institutional and other cases available in literatures. Information for sex, age at diagnosis, clinical symptoms, radiological features, treatment strategy and prognosis were recorded. RESULTS A total of 11 cases (including our own) were identified. There were three men and eight women, with an average age at diagnosis of 28.3 years. The peak incidence was in the second and the third decade (72.7% of all cases). The most common symptom was headache (81.8% of all patients). About 63.6% patients had one or more abnormal hormone levels, and prolactin was likely the most vulnerable hormone. The radiological appearances of intrasellar salivary gland were various, and four cases mimicked pituitary adenoma radiologically. All patients underwent transsphenoidal surgery with no mortality. CONCLUSION Although intrasellar symptomatic salivary gland is rare, it should be considered in the differential diagnosis of intrasellar lesions. Preoperative diagnosis is challenging since it mimics pituitary neoplasm in clinical and radiological manifestations, and confirmation for this disease could only be conducted through pathological examination. Transsphenoidal surgical resection is the preferred therapy and the patient prognosis is usually good.
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Affiliation(s)
- Zhiyong Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ridong Feng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zerong Tian
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yaping Rao
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Ya Lu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
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Shammassian B, Manjila S, Cox E, Onwuzulike K, Wang D, Rodgers M, Stearns D, Selman WR. Mature salivary gland rests within sonic hedgehog-positive medulloblastoma: case report and insights into the molecular genetics and embryopathology of ectopic intracranial salivary gland analogs. J Neurosurg Pediatr 2016; 25:708-712. [PMID: 27635979 DOI: 10.3171/2016.6.peds15575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial ectopic salivary gland rests within dural-based lesions are reported very infrequently in the literature. The authors report the unique case of a 12-year-old boy with a cerebellar medulloblastoma positive for sonic hedgehog (Shh) that contained intraaxial mature ectopic salivary gland rests. The patient underwent clinical and radiological monitoring postoperatively, until he died of disseminated disease. An autopsy showed no evidence of salivary glands within disseminated lesions. The intraaxial presence of salivary gland rests and concomitant Shh positivity of the described tumor point to a disorder in differentiation as opposed to ectopic developmental foci, which are uniformly dural based in the described literature. The authors demonstrate the characteristic "papilionaceous" appearance of the salivary glands with mucicarmine stain and highlight the role of Shh signaling in explaining the intraaxial presence of seromucous gland analogs. This article reports the first intraaxial posterior fossa tumor with heterotopic salivary gland rests, and it provides molecular and embryopathological insights into the development of these lesions.
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Affiliation(s)
| | - Sunil Manjila
- Department of Neurological Surgery, The Neurological Institute, and
| | - Efrem Cox
- Department of Neurological Surgery, The Neurological Institute, and
| | - Kaine Onwuzulike
- Department of Neurological Surgery, The Neurological Institute, and
| | - Dehua Wang
- Department of Pathology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark Rodgers
- Department of Pathology, University Hospitals Case Medical Center, Cleveland
| | - Duncan Stearns
- Division of Pediatric Neuro-Oncology, Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland; and
| | - Warren R Selman
- Department of Neurological Surgery, The Neurological Institute, and
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