Neuroendocrine Clinical Center Bulletin

Most, but not all, sellar abnormalities are pituitary adenomas. We recently reviewed our series of transsphenoidal procedures done between 1998 and 2009 to determine the incidence and characteristics of non-pituitary sellar lesions (1). Over this period, 1,469 transsphenoidal procedures were performed. One hundred sixteen cases (7.9%) were not pituitary tumors. These were divided into four major pathologic groups, including cystic lesions (53%), benign neoplasms (22%), malignancies (16%) and inflammatory lesions (9%). The most common lesions were Rathke’s cleft cysts, which comprised 42% of the series. The most common presenting symptoms were visual field abnormalities (51%) and headache (34%). Endocrine abnormalities were present in 58% of cases, most commonly hyperprolactinemia (35%), hypogonadism (23%), and hypocortisolism (23%). Presenting symptoms typically improved postoperatively, with resolution of headache in 63%, and resolution of visual symptoms in 65%. Case History. A 37 year old female presented with six weeks of progressive headaches and sinus congestion. She was treated empirically with antibiotics for presumed sinusitis without relief. She returned with imaging shown in Figure 1C. The formal interpretation was of a pituitary adenoma with acute sphenoid sinusitis. Transsphenoidal resection was planned, but she underwent drainage of the sphenoid prior to tumor removal in an attempt to clear any residual infection. The sphenoid mucosa was biopsied and cultured; pathology showed chronic inflammation. Definitive surgery was planned after an additional two weeks of antibiotics. In the interim, she developed sudden loss of vision OD with a VIth nerve palsy. Apoplexy was suspected. Transsphenoidal debulking was performed; her vision improved and her VIth nerve palsy resolved. Pathology showed a poorly differentiated squamous cell carcinoma. Evaluation was consistent with a lung primary. Although her intracranial disease initially responded to radiation and chemotherapy, she died of widespread metastatic disease three months later.