Abstract
BACKGROUNDAlthough craniopharyngioma and pituitary adenoma are common tumors of the sellar or suprasellar region, the development of papillary craniopharyngioma in the same sellar region after resection of a nonfunctioning pituitary adenoma has not been reported.OBSERVATIONSHere the authors report the first case of craniopharyngioma that developed long after resection of a pituitary adenoma. A 66-year-old male patient underwent endoscopic transsphenoidal resection for a large sellar mass, which histopathologically confirmed the diagnosis of a pituitary adenoma. He had an excellent recovery after surgery. For several years, he had no clinical or imaging evidence of tumor recurrence and then was lost to follow-up. Seven years after the initial surgery, the patient returned with a one-month history of visual field defects, and imaging confirmed a heterogeneous, cystic suprasellar mass. Endoscopic transsphenoidal resection of the tumor was performed, and histological examination showed it to be a papillary craniopharyngioma.LESSONSNeurosurgeons should be aware that after pituitary adenoma resection, a recurrent mass could be a craniopharyngioma, with implications for very different management recommendations.
Highlights
Craniopharyngioma and pituitary adenoma are common tumors of the sellar or suprasellar region, the development of papillary craniopharyngioma in the same sellar region after resection of a nonfunctioning pituitary adenoma has not been reported
Observations To our knowledge, this is the first reported case of a papillary CP (PCP) developing in a patient with a resected Nonfunctioning PAs (NPAs) years after the initial surgery
Collision lesions of the sellar region of CPs and Pituitary adenomas (PAs) have been described in a total of 17 cases, but there has only been one report of a patient presenting with both a PCP and an NPA synchronously
Summary
Craniopharyngioma and pituitary adenoma are common tumors of the sellar or suprasellar region, the development of papillary craniopharyngioma in the same sellar region after resection of a nonfunctioning pituitary adenoma has not been reported. CPs are much rarer than PAs, composing 1% to 4% of all intracranial tumors.[7] They originate from ectodermal remnants of Rathke’s pouch between the adenohypophysis and neurohypophysis in the region of the pars tuberalis.[8] There are two different subtypes of CPs that differ clinically and pathologically: the adamantinomatous CP (ACP) and papillary CP (PCP) types. They have a bimodal distribution, with peak incidence in children at 5–15 years of age and adults with an age >40 years. To the best of our knowledge, since 1971, there have been only 17 cases of synchronous collision tumors, rare clinical entities wherein two histologically distinct tumor types occur at the same anatomical location simultaneously or within 6 months of one another.[12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28] Metachronous collision of NPAs and CPs being diagnosed at least 6 months apart have been reported only twice in the previous literature, with a CP arising in a patient after surgery for a functioning PA.[29,30] To our knowledge, this is the first reported case of a PCP developing in a patient after resection of an NPA
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