Rahmani Redi, Sukumaran Madhav, Donaldson Angela M, Akselrod Olga, Lavi Ehud, Schwartz Theodore H
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire;
J Neurosurg. 2015 Apr;122(4):812-7. doi: 10.3171/2014.12.JNS14542. Epub 2015 Jan 23.
Xanthogranulomas are rare inflammatory masses most often found in the skin and eye. The incidence of intracranial xanthogranulomas is 1.6%-7%, with those found in the sellar and parasellar region being exceedingly rare and their etiology controversial. Sellar and parasellar xanthogranulomas are rarely reported in the western hemisphere, and their incidence in Western countries is unknown.
A prospectively acquired database of all endonasal endoscopic transsphenoidal surgeries performed at Weill Cornell Medical College was queried. Patients with histologically confirmed xanthogranulomas who were diagnosed and treated between 2003 and 2013 were included in the study. Patient history, demographic data, histological findings, and surgical approach were also evaluated.
A total of 643 endonasal endoscopic procedures had been performed at the time of this study. Four patients (0.6%) were identified as having a histologically confirmed xanthogranuloma of the parasellar region, compared with an incidence of 6.7% for craniopharyngioma (CP) and 2% for Rathke cleft cyst (RCC). The most common symptom was visual loss, followed by headache. Preoperative diagnosis was CP in all cases. All patients underwent extended endonasal endoscopic transsphenoidal surgery with gross-total resection. Two patients developed panhypopituitarism after surgery. There were no CSF leaks. The mean follow-up was 61 months, at which time there were no recurrences. The key histological features differentiating xanthogranulomas from CPs were accumulation of foamy macrophages, multinucleated foreign body giant cells, cholesterol clefts, and hemosiderin deposits without stratified squamous epithelium. These histological features appear commonly as part of the spectrum of a secondary inflammatory response in an RCC.
Parasellar xanthogranulomas most closely approximate CPs clinically but pathological evidence may suggest an RCC origin. Gross-total resection can be achieved through extended endonasal endoscopic transsphenoidal approaches, and is curative.
黄色肉芽肿是一种罕见的炎性肿块，最常见于皮肤和眼部。颅内黄色肉芽肿的发病率为1.6%-7%，而蝶鞍和鞍旁区域的黄色肉芽肿极为罕见，其病因存在争议。在西半球，蝶鞍和鞍旁黄色肉芽肿鲜有报道，其在西方国家的发病率尚不清楚。
查询了威尔康奈尔医学院所有经鼻内镜经蝶窦手术的前瞻性数据库。纳入2003年至2013年间诊断并治疗的组织学确诊为黄色肉芽肿的患者。对患者病史、人口统计学数据、组织学检查结果及手术方式进行评估。
在本研究开展时，共进行了643例经鼻内镜手术。4例患者（0.6%）被确诊为组织学证实的鞍旁黄色肉芽肿，相比之下，颅咽管瘤（CP）的发病率为6.7%，拉克氏囊肿（RCC）的发病率为2%。最常见的症状是视力丧失，其次是头痛。所有病例术前均诊断为CP。所有患者均接受了扩大经鼻内镜经蝶窦手术并实现了全切除。2例患者术后出现全垂体功能减退。无脑脊液漏。平均随访61个月，此时无复发。将黄色肉芽肿与CP区分开来的关键组织学特征是泡沫状巨噬细胞、多核异物巨细胞、胆固醇裂隙和含铁血黄素沉积的聚集，且无分层鳞状上皮。这些组织学特征通常作为RCC继发性炎症反应谱的一部分出现。
鞍旁黄色肉芽肿在临床上与CP最为相似，但病理证据可能提示其起源于RCC。通过扩大经鼻内镜经蝶窦入路可实现全切除，且具有治愈性。
