Abstract
Tumors of the sellar and junxtasellar regions are common, accounting for in excess of 10–15% of all intracranial tumors [1]. Although the majority of these are benign tumors, mostly pituitary adenomas, they can account for significant morbidity and a shortened life expectancy. Pituitary adenomas are the most common sellar and suprasellar masses in adults, with meningiomas being the second most common. In children, craniopharyngiomas and chiasmatic/hypothalamic gliomas account for the vast majority of lesions in this region. Adenomas, meningiomas, craniopharyngiomas, chiasmatic/hypothalamic gliomas, and aneurysms account for 75% of sellar and junxtasellar masses [2]. Although the focus of our discussion is tumors, some nonneoplastic entities are discussed, since these can be difficult to distinguish from tumors and must be differentiated, since the treatment approach can be very different.
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Elster AD (1993) Modern imaging of the pituitary. Radiology 187:1–14
Johnsen DE, Ww W, Allen IS et al (1991) MR imaging of the sellar and junxtasellar regions. Radiographics 11:727–758
Miki Y, Matsuo M, Nishizawa S et al (1990) Pituitary adenomas and normal pituitary tissue: enhancement patterns on Gadopentetate-enhanced MR imaging. Radiology 177:36
Bartynski WS, Lin L (1997) Dynamic and conventional spin-echo MR of pituitary microlesions. AJNR Am J Neuroradiol 18(5):965–972
Naidich MJ, Russell EJ (1999) Current approaches to imaging of the sellar region and pituitary. Endocrinol Metab Clin North Am 28(1):45–79
Miller DL, Doppman JL, Nieman LK et al (1990) Petrosal sinus sampling: discordant lateralization of ACTH-secreting pituitary microadenomas before and after stimulation with corticotropin-releasing hormone. Radiology 176:429
Graham KE, Samuel MH, Nesbit GM et al (1999) Cavernous sinus sampling is highly accurate in distinguishing cushing’s disease from the ectopic adrenocorticotropin syndrome and in predicting intrapituitary tumor location. J Clin Endocrinol Metab 84(5):1602–1610
Mamelak AN, Dowd CF, Tyrrell JB, McDonald JF, Wilson CB (1996) Venous angiography is needed to interpret inferior petrosal sinus and cavernous sinus sampling data for lateralizing adrenocorticotropin-secreting adenomas. J Clin Endocrinol Metab 81(2):475–481
Oliverio PJ, Monsein LH, Wand GS, Debrun GM (1996) Bilateral simultaneous cavernous sinus sampling using corticotropin-releasing hormone in the evaluation of cushing disease. AJNR 17:1669–1674
Freda PU, Wardlaw SL (1999) Clinical review 110: diagnosis and treatment of pituitary tumors. J Clin Endocrinol Metab 84(11):3859–3866
Asa SL (1999) The pathology of pituitary tumors. Clin North Am 28(1):13–43
Kovacs K, Scheithauer B, Horvath E, Lloyd R (1996) The world health organization classification of adenohypophysial neoplasms. Cancer 78(3):502–510
Mindermann T (1997) Letter to the editor: classification of pituitary adenomas. Acta Neurochir (Wien) 139:267–270
Pernicone PJ, Scheithauer BW, Sebo TJ (1997) Pituitary carcinoma. Cancer 79:804–812
Poussaint TY, Barnes PD, Anthony DC, Spack N, Scott RM, Tarbell NJ (1996) Hemorrhagic pituitary adenomas of adolescence. AJNR 17(10):1907–1912
Liuzzi A, Vittorio T, Pirro MT et al (1996) Nonfunctioning adenomas of the pituitary. Metabolism 45(9 suppl 1):80–82
De Boucaud L, Dousset V, Caillaud P, Viaud B, Guerin J, Caille JM (1999) Metastases from a pituitary ademonma: MRI. Neuroradiology 41(10):785–787
Brada M, Burchell L, Ashley S, Traish D (1999) The incidence of cerebrovascular accidents in patients with pituitary adenoma. Int J Radiation Oncology Biol Phys 45(3):693–698
Nilsson B, Gustavsson-Kadaka E, Bengtsson B, Jonsson B (2000) Pituitary adenomas in Sweden between 1958 and 1991: incidence, survival and mortality. J Clin Endocrinol Metab 85(4):1420–1425
Popovic V, Damjanovic S, Micic D et al (1998) Increased incidence of neoplasia in patients with pituitary adenomas. Clin Endocrinol 49:441–445
Simonetta AB (1999) Imaging of suprasellar and parasellar tumors. Neuroimaging Clin N Am 9(4):717–732
Majos C, Coll S, Aguilera C, Acebes JJ, Pons LC (1998) Imaging of giant pituitary adenomas. Neuroradiology 40:651–655
Scotti G, Yu C, Dillon WP et al (1988) MR Imaging of cavernous sinus involvement by pituitary adenomas. AJR 151:799–806
Levy RA, Quint DJ (1998) Giant pituitary adenoma with unusual orbital and skull base extension. AJR Am J Roentgenol 170(1):194–196
Freda PU, Post KD (1999) Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am 28(1):81–117
Melmed S (1996) Acromegaly. Metabolism 45(8):51–52
Pinzone JJ, Katznelson L, Danila DC, Pauler DK, Miller CS, Klibanski A (2000) Primary medical therapy of micro- and macroprolactinomas in men. J Clin Endocrinol Metab 85(9):3053–3057
Lundin P, Bergstrom K, Nyman R et al (1992) Macroprolactinomas: serial MR imaging in long-term bromocriptine therapy. AJNR 13:1287
Yousem DM, Arrington JA, Zinreich JS, Kumar AJ, Bryan RN (1989) Pituitary adenomas: possible role of bromocriptine in intratumoral hemorrhage. Radiology 170(1):239–243
Randeva H, Schoebel J, Byrne J, Esiri M, Adams CBT, Wass JAH (1999) Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol 51:181–188
Sanno N, Ishii Y, Sugiyama M et al (1999) Subarachnoid hemorrhage and vasospasm due to pituitary apoplexy after pituitary function tests. Acta Neurochir 141:1009–1010
Giovanelli M, Losa M, Mortini P (1996) Surgical therapy of pituitary adenomas. Metabolism 45(8):115–116
Cappabianca P, Cirillo S, Alfieri A et al (1999) Pituitary macroadenoma and diaphragma sellae meningioma: differential diagnosis on MRI. Neuroradiology 41:22–26
Sen C, Hague K (1997) Meningiomas involving the cavernous sinus: histological factors affecting the degree of resection. J Neurosurg 87:535–543
Young SC, Zimmerman REA, Nowell MA et al (1987) Giant cystic craniopharyngiomas. Neuroradiology 29:468
Khafaga Y, Jenkin D, Kanaan I, Hassounah M, Shabanah MA, Gray A (1998) Craniopharyngioma in children. Int J Radiation Oncology Biol Phys 42(3):601–606
Gupta k, Kuhn MJ, Shevlin DW, Wacaser LE (1999) Metastatic craniopharyngioma. AJNR Am J Neuroradiol 20:1059–1060
Sartoretti-Schefer S, Wichmann W, Aguzzi A, Valavanis A (1997) MR differentiation of adamantinous and squamous-papillary craniopharyngiomas. AJNR Am J Neuroradiol 18(1):77–87
Harrison MJ, Morgello S, Post KD (1994) Epithelial cystic lesions of the sellar and parasellar region: a continuum of ectodermal derivatives? J Neurosurg 80:1018–1025
Lafferty AR, Chrousos GP (1999) Pituitary tumors in children and adolescents. J Clin Endocrinol Metab 84(12):4317–4323
Shin JL, Asa SL, Woodhouse LJ, Smyth HS, Ezzat S (1999) Cystic lesions of the pituitary: clinicopathological features distinguishing craniopharyngioma, Rathke’s cleft cyst, and arachnoid cyst. J Clin Endocrinol Metab 84(11):3972–3982
Pusey E, Kortman KE, Flannigan BD et al (1987) MR of craniopharyngiomas: tumor delineation and characterization. AJNR 8:443
Laws ER, Vance ML (1999) Radiosurgery for pituitary tumors and caniopharyngiomas. Neurosurg Clin N Am 10(2):327–336
Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M (1999) Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90:237–250
Janss AJ, Grundy R, Cnaan A et al (1995) Optic pathway and hypothalamic/chiasmatic gliomas in children younger than age 5 years with a 6-year follow-up. Cancer 75(4):1051–1059
Rodriguez LA, Edwards MS, Levin VA (1990) Management of hypothalamic gliomas in children: an analysis of 33 cases. Neurosurgery 26(2):242–246
Collet-Solberg PF, Sernyak H, Satin-Smith M, Katz LL, Sutton L, Molloy P, Moshang T Jr (1997) Endocrine outcome in long-term survivors of low-grade hypothalamic/chiasmatic glioma. Clin Endocrinol (Oxf) 47(1):79–85
Barbaro NM, Rosenblum ML, Maitland CG, Hoyt WF, Davis RL (1982) Malignant optic glioma presenting radiologically as a “cystic” suprasellar mass: case report and review of the literature. Neurosurgery 11(6):787–789
Albert A, Lee BC, Saint-Louis L, Deck MD (1986) MRI of optic chiasm and optic pathways. AJNR Am J Neuroradiol 7(2):255–258
Alshail E, Rutka JT, Becker LE, Hoffman HJ (1997) Optic chiasmatic-hypothalamic glioma. Brain Pathol 7(2):799–806
Nishio S, Takeshita I, Fujiwara S, Fukui M (1993) Optico-hypothalamic glioma: an analysis of 16 cases. Childs Nerv Syst 9(6):334–338
Sugiyama K, Uozumi T, Kiya K et al (1992) Intracranial germ cell tumor with synchronous lesions in the pineal and suprasellar regions: six cases and review of the literature. Surg Neurol 38:114–120
Kollias SS, Barkovich AJ, Edwards MS (1991) Magnetic resonance analysis of suprasellar tumors of childhood. Pediatr Neurosurg 17(6):284–303
Packer RJ, Cohen BH, Consy K (2000) Intracranial germ cell tumors. Oncologist 5(4):312–320
Sawamura Y, de Tribolet N, Ishii N, Abe H (1997) Management of primary intracranial germinomas: diagnostic surgery or radical resection. J Neurosurg 87(2):262–266
Matsutani M, Sano K, Takakura K et al (1997) Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 863:446–455
Yaşargil MG, Abernathey CD, Sarioglu AÇ (1989) Microsurgical treatment of intracranial dermoid and epidermoid tumors. Neurosugery 23(4):561–567
Mori K, Handa H, Moritake K, Takeuchi J, Nakano Y (1982) Suprasellar epidermoid. Neurochirurgia (Stuttg) 25(4):138–142
Yamakawa K, Shitara N, Genka S, Manaka S, Takakura K (1989) Clinical course and surgical prognosis of 33 cases of intracranial epidermoid tumors. Neurosurgery 24(4):568–573
Horowitz BL, Chari MV, James R, Bryan RN (1990) MR of intracranial epidermoid tumors: correlation of in vivo imaging with in vitro 13C spectroscopy. AJNR Am J Neuroradiol 11(2):299–302
Netsky MG (1988) Epidermoid tumors. Review of the literature. Surg Neurol 29(6):477–483
Braun IF, Naidich TP, Leeds NE, Koslow M, Zimmerman HM, Chase NE (1977) Dense intracranial epidermoid tumors. Computed tomographic observations. Radiology 122(3):717–719
Wilms G, Casselman J, Demaerel P, Plets C, De Haene I, Baert AL (1991) CT and MRI of ruptured intracranial dermoids. Neuroradiology 33(2):149–151
Smith AS, Benson JE, Blaser SI, Mizushima A, Tarr RW, Bellon EM (1991) Diagnosis of ruptured intracranial dermoid cyst: value MR over CT. AJNR Am J Neuroradiol 12(1):175–180
Cohen JE, Abdallah JA, Garrote M (1997) Massive rupture of suprasellar dermoid cyst into ventricles. Case illustration. J Neurosurg 87(6):963
Kumpe DA, Rao KCVG, Garcia JIH, Hechk AF (1979) Intracranial neurosarcoidosis. J Comp Assist Tomogr 3:324–330
Khalil MK, Arthus BP, Burnier MN (1996) Sarcoidosis of the sella turcica in association with bilateral sarcoidosis of the lacrimal glands. Can J Ophthalmol 31(1):32–35
Hayes WS, Sherman JL, Stern BJ et al (1987) Magnetic resonance and CT evaluation of intracranial sarcoidosis. AJR 8:1043
Lexa FJ, Grossman RI (1994) MR of sarcoidosis in the head and spine: spectrum of manifestations and radiographic response to steroid therapy. AJNR 15:973
Bakshi R, Fenstermaker A, Bates V, Ravidhandran TP, Goodloe S, Kinkel WR (1998) Neurosarcoidosis presenting as a large suprasellar mass: magnetic resonance imaging findings. Clin Imaging 22(5):323–326
Hahn FJ, Leinbrock LG, Huseman CA, Makos MM (1988) The MR appearance of hypothalamic hamartoma. Neuroradiology 30:67
Lim S, Elston MS, Swarbrick MJ, Conaglen JV (2009) Lymphocytic hypophysitis with associated thyroiditis in a man with aseptic meningitis. Pituitary 12:375–379
Gutenberg A, Hans V, Puchner MJA et al (2006) Primary hypophysitis: clinical-pathological correlations. Eur J Endocrinol 155(1):101–107
Caturegli P, Newschaffer C, Olivi A, Pomper MG, Burger PC, Rose NR (2005) Autoimmune hypophysitis. Endocr Rev 26:599–614
Schultz AB, Brat DJ, Oyesiku NM, Hunter SB (2000) Intrasellar pituicytoma in a patient with other endocrine neoplasms. Arch Pathol Lab Med 125(4):527–530
Wolfe SQ, Bruce J, Morcos JJ (2008) Pituicytoma: case report. Neurosurgery 63(1):E173–E174
Tien RD, Newton TH, McDermott MW et al (1990) Thickened pituitary stalk on MR images in patients with diabetes insipidus and Langerhans cell histiocytosis. AJNR 11:707
Bourekas EC, Tzalonikou M, Christoforidis GA (2000) Cavernous hemangioma of the optic chiasm. AJR 175(3):888–891
Nishizawa S, Yokoyama T, Hinokuma K et al (1997) Pituitary astrocytoma: magnetic resonance and hormonal characteristics. J Neurosurg 87:131
Moskowitz SI, Hamrahian A, Prayson RA, Pineyro M, Lorenz RR, Weil RJ (2006) Concurrent lymphocytic hypophysitis and pituitary adenoma. Case report and review of the literature. J Neurosurg 105(2):309–314
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Bourekas, E.C., Slone, H.W., Ray-Chaudhury, A. (2011). Masses of the Sellar and Junxtasellar Region. In: Drevelegas, A. (eds) Imaging of Brain Tumors with Histological Correlations. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-87650-2_12
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DOI: https://doi.org/10.1007/978-3-540-87650-2_12
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