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DOI: 10.1055/s-0043-1777792
Pituitary Adenoma Coexistent with Sellar Clear Cell Meningioma Unattached to the Dura: Case Report and Treatment Considerations
Abstract
Collision tumors involving the sella are rare. Intrasellar collision tumors are most commonly composed of a combination of pituitary adenomas and pituitary neuroendocrine tumors; however, collision tumors consisting of a pituitary adenoma and intrasellar meningioma are exceedingly rare. The authors present the case of a 47-year-old man who presented with progressive right eye vision loss. Magnetic resonance imaging showed a large, heterogeneously enhancing sellar mass with suprasellar extension. Using a transcranial approach with a right subfrontal craniotomy, near-total resection of the mass was achieved. Histologic analysis confirmed a diagnosis of a gonadotroph adenoma with concomitant clear cell meningioma (CCM). This patient was discharged with improvement in visual acuity and no signs of diabetes insipidus. Given the indistinguishable radiographic characteristics of pituitary adenoma and CCM, a preoperative diagnosis of a collision tumor was difficult. This case was uniquely challenging since the CCM component lacked the classic dural attachment that is associated with meningiomas on neuroimaging. CCMs are classified as central nervous system (CNS) World Health Organization (WHO) grade 2 tumors and tend to behave more aggressively, therefore warranting close surveillance for signs of tumor recurrence. This is the first case to report a collision tumor consisting of pituitary adenoma and CCM.
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Introduction
Coexistent tumors of the sellar region are rare. A recent study that reviewed 16,283 autopsy and surgical pathology cases found that double or triple pituitary adenomas/pituitary neuroendocrine tumors (PitNETs) were the most frequent combination, comprising 40/232 (17.2%) of cases presenting with dual lesions.[1] The combination of meningioma and PitNET was one of the rarest combinations (6/232 [2.6%]), far behind PitNET + gangliocytoma (34/232 [14.7%) or PitNET + sellar metastasis (12/232 [5.2%]).[1] Individually, both PitNETs and sellar meningiomas can attain large sizes and cause similar symptoms due to compromise of the optic apparatus, making the diagnosis and treatment of coexisting sellar tumors, or “collision tumors,” difficult.
Herein we present the case of a 47-year-old man who underwent a right frontal craniotomy for resection of a large sellar/suprasellar mass, found only after histological examination to be a dual PitNET and suprasellar meningioma. A transcranial surgical approach was performed due to the extent of suprasellar extension of the tumor and the relative narrowing hourglass deformity seen on magnetic resonance imaging (MRI) at the level of the diaphragma sella. It was only intraoperatively that two separate tumors were identified. Interestingly, intraoperative recognition of the suprasellar lesion as a meningioma was challenging due to the lack of typical dural attachment or vascular pedicle, as is seen for most meningiomas. Histological examination revealed two noncontiguous tumors, a clear cell meningioma, central nervous system (CNS) World Health Organization (WHO) grade 2, and a gonadotroph adenoma. The nondural attachment characteristic of the clear cell meningioma, as well as its occurrence in an atypical anatomical site for this meningioma type, is discussed in conjunction with review of the literature on meningioma and PitNET.
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Case Description
History and Examination
The patient is a 47-year-old otherwise healthy man who presented to the optometrist with a 2-year history of progressive vision loss of the right eye. Formal visual acuity testing revealed sensitivity to hand-waving only, and an OS 20/60 with visual fields testing showing complete loss of vision in all four quadrants and sparing of the inferior nasal quadrant only in the left eye. An urgent MRI brain demonstrated a large homogeneously enhancing sellar mass with suprasellar extension ([Fig. 1]). It was noted to cause significant mass effect on adjacent neural structures including the optic chiasm/nerves with significant cavernous sinus invasion. Following admission to the neurosurgery service, a complete pituitary workup was obtained. The data at the time were the following: cortisol, 8 µg/dL; adrenocorticotropic hormone (ACTH), 11.0 pg/mL; follicle stimulating hormone (FSH), 9.1 mIU/mL; luteinizing hormone (LH), 2.1 mIU/mL; prolactin (PRL), 11.1 ng/mL; free T4, 1.55 ng/dL; thyroid-stimulating hormone (TSH), 1.41 mIU/L; insulinlike growth factor 1 (IGF-1), 208 ng/mL.
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Operation and Postoperative Course
Due to the radiographical evidence of significant suprasellar extension of the tumor toward the tuberculum sella along with a relative narrowing of the tumor at the level of the diaphragma sella, a transcranial approach was chosen over a transsphenoidal surgery. Although experienced with both the microscopic and endoscopic transnasal transsphenoidal approaches, we were concerned with our ability to safely access the suprasellar portion of the tumor, as well as the portion extending laterally over the right internal carotid artery. Therefore, the patient underwent a right frontal craniotomy and the dissection was carried out subfrontally to access the tumor. Intraoperative gross pathological findings revealed a well-circumscribed encapsulated suprasellar tumor that was dissected from of the brain parenchyma without obvious dural attachments. A frozen specimen section was suggestive of meningioma. As expected from preoperative imaging, it was significantly displacing the optic nerves and chiasm laterally and posteriorly ([Fig. 2]). Following resection of the suprasellar lesion, the neurosurgeons were able to clearly visualize the pituitary stalk displaced to the left leading to the diaphragma sella. At this point, as no tumoral connection was seen between the resected suprasellar tumor and the diaphragma sella, a decision was made to open the diaphragma sella adjacent to the pituitary stalk on the right ([Fig. 2]). At that point, intrasellar tumor was encountered, which was classic for a pituitary adenoma. Tumor was removed from within the sella using pituitary curettes through a transdiaphragmatic approach. Two separate tumor samples were sent for permanent pathology.
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Histopathology
Microscopically, there were two distinct tumors. The meningioma showed numerous bands of collagen, with cells manifesting clear cytoplasm ([Fig. 3A]). Immunohistochemical (IHC) staining for somatostatin receptor confirmed a meningothelial tumor ([Fig. 3B]), while histochemical staining for periodic acid–Schiff (PAS) highlighted the glycogen-rich cytoplasm ([Fig. 3C], left). Diastase digestion proved the presence of glycogen by the absence of PAS staining after treatment, pathognomonic for clear cell meningioma ([Fig. 3C], right). The other, separate component of the resection showed pituitary adenoma/PitNET with patternless sheets of cells ([Fig. 3D]), diffuse nuclear immunostaining for steroidogenic factor 1 (SF-1; [Fig. 3E]), and the typical patchy immunostaining for FSH ([Fig. 3F]) indicative of gonadotroph adenoma/PitNET.
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Literature Search Strategy
A literature review was conducted using PubMed to identify available case reports and case series on collision tumors occurring in the sellar or suprasellar region of the brain from 1986 to 2022, linking “collision tumor” and “sella” or “suprasellar” or “parasellar” or “pituitary.” The search regarding clear cell meningioma utilized the search terms “clear cell meningioma” and “without dural attachment.” After independent evaluation for content and relevance, we identified a total of 30 articles published from the years 1986 to 2022 that describe collision tumors comprising PitNETs and various co-occurring tumors, and 6 articles published from 2009 to 2021 describing the diagnosis of clear cell meningioma without a dural attachment. The results of this literature review are shown in [Tables 1] [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] and [2].[31] [32] [33] [34] [35] [36] [37]
Study |
Patient age (y) |
Sex |
Clinical presentation |
Tumor type 1 |
Tumor type 2 |
Surgical approach |
Additional comment |
---|---|---|---|---|---|---|---|
Yamada et al[2] |
52 |
F |
Headache with disturbances in visual acuity and galactorrhea |
PA |
Meningioma |
Frontal osteoplastic craniotomy |
Complete relief of headache and visual disturbance, with galactorrhea controlled with bromocriptine |
Tajika et al[3] |
56 |
F |
Mild acromegaly |
GH-secreting PA |
Gangliocytoma |
Transsphenoidal excision |
N/A |
Prevedello et al[4] |
52 |
F |
Continuous headache with right eye temporal visual field loss |
PA |
Meningioma |
Endoscopic transsphenoidal excision |
Postoperative resolution of headache, complete resolution of visual loss, and preservation of preoperative pituitary function |
50 54 |
M M |
Headache, sleep difficulties, decreased libido, hot flashes Proximal muscle weakness, central weight gain, back/hip pain, easy bruising, hypertension, decreased libido, erectile dysfunction, insomnia, and nocturia |
Gonadotropic PA Corticotropic PA |
Adamantinomatous craniopharyngioma Rathke's cleft cyst |
Endoscopic transsphenoidal excision Endoscopic transsphenoidal excision |
Postoperative hypogonadism requiring testosterone replacement therapy Postoperative diabetes insipidus and panhypopituitarism |
|
Moshkin et al[6] |
12 |
M |
Incidental finding |
Silent PA subtype 3 |
Adamantinomatous craniopharyngioma |
Right craniotomy |
N/A |
42 60 47 38 52 49 76 46 |
F M F M F F M F |
Cushing's disease Hypogonadism and hyperprolactinemia Acromegaly and hypopituitarism Acromegaly, headache, and decreased libido Acromegaly Acromegaly, amenorrhea, and hyperprolactinemia Hypopituitarism Acromegaly and headache |
ACTH-secreting PA Nonfunctioning PA GH-secreting PA GH-secreting PA GH-secreting PA GH-secreting PA Nonfunctioning PA GH-secreting PA |
Rathke's cleft cyst Neurosarcoidosis Gangliocytoma Schwannoma Gangliocytoma Prolactinoma Rathke's cleft cyst Gangliocytoma |
Transsphenoidal excision Transsphenoidal excision Transsphenoidal excision Transsphenoidal excision Transsphenoidal excision Transsphenoidal excision Transsphenoidal excision Transsphenoidal excision |
Postoperative hypocortisolism Persistent hypogonadism and tumor recurrence requiring reoperation Persistent hypopituitarism N/A Tumor recurrence requiring somatostatin analog treatment and radiotherapy Required dopamine agonist for persistent hyperprolactinemia Required hormone replacement therapy for persistent panhypopituitarism N/A |
|
Rivera et al[8] |
58 |
M |
Rapid-onset diplopia |
Prolactinoma |
Plasmacytoma (multiple myeloma) |
Stereotactic radiosurgery + cabergoline (prolactinoma) Nonoperative treatment regimen (plasmacytoma): Thalidomide Dexamethasone Pamidronate Bone marrow transplant |
Postoperative secondary hypogonadism and hypothyroidism |
Sahli et al[9] |
74 |
M |
Progressive neuro-ophthalmologic deterioration |
Gonadotropic PA |
Osteochondroma |
Endoscopic transsphenoidal excision with adjuvant radiotherapy |
Partial residual pituitary insufficiency with persistent FSH level elevation |
Jin et al[10] |
37 |
F |
Intermittent left eye blurring and headache |
PA |
Craniopharyngioma |
Transsphenoidal excision (primary tumor) Interhemispheric transcallosal approach (residual tumor) |
Transient postoperative diabetes insipidus and hyponatremia |
Mahvash et al[11] |
36 |
F |
Frontal headache with visual field disturbance in the right eye |
PA |
Meningioma |
Endoscopic transsphenoidal excision |
Gross total resection with sufficient decompression of the optic apparatus |
Karsy et al[12] |
70 |
F |
Altered mental status, mutism, and incontinence |
PA |
Meningioma |
Endoscopic transsphenoidal excision |
Discharged home with permanent ventriculoperitoneal shunt and no significant neurological deficits |
51 59 58 63 |
F M F F |
Acromegaly and menstrual irregularities Headache and visual disturbances Headache and diplopia Acromegaly, headache, and sleep apnea syndrome |
Somatotroph PA Somatotroph PA Somatotroph PA Somatotroph PA |
Gangliocytoma Gangliocytoma Gangliocytoma Gangliocytoma |
Transsphenoidal excision with adjuvant radiosurgery Endoscopic transsphenoidal excision Transsphenoidal excision Transsphenoidal excision |
Persistent postoperative acromegaly with hypopituitarism N/A N/A N/A |
|
Lim et al[14] |
65 |
F |
Visual disturbances and vertigo |
Nonfunctioning PA |
Meningioma |
Endoscopic transsphenoidal excision |
Improvement in visual symptoms with normal postoperative hormonal studies |
Ban et al[15] |
74 |
M |
Bilateral retro-orbital pain, left-sided ptosis, diplopia, headache, and nausea |
FSH-secreting PA |
DLBCL |
Endoscopic transsphenoidal excision (PA) Chemotherapy (DLBCL) |
N/A |
Heng et al[16] |
46 |
F |
Headache and decrease in visual acuity |
Nonfunctioning PA |
Gangliocytoma |
Endoscopic transsphenoidal excision |
Required Gamma Knife radiosurgery due to tumor recurrence |
58 58 |
F F |
Acromegaly Acromegaly |
GH-secreting PA GH-secreting PA |
Meningioma Meningioma |
Transsphenoidal excision (PA) Craniotomy (meningioma) Transsphenoidal excision (PA) Craniotomy (meningioma) |
N/A N/A |
|
37 42 |
F M |
Oligomenorrhea, headache, diplopia, and progressive visual impairment Acromegaly, decreased visual acuity with bitemporal hemianopsia |
Prolactinoma GH-secreting PA |
Meningioma Meningioma |
Right pterional craniotomy with tumor resection (meningioma) Cabergoline (PA) Transsphenoidal excision (failed) with subsequent right pterional craniotomy with tumor resection |
Continuous postoperative treatment with cabergoline Postoperative improvement in vision with no evidence of tumor recurrence |
|
Levitus and Charitou[19] |
44 |
F |
Incidental finding following head injury |
GH-secreting PA |
Gangliocytoma |
Endoscopic transsphenoidal excision |
Transient postoperative central adrenal insufficiency and permanent diabetes insipidus No tumor recurrence |
Malli et al[20] |
64 |
M |
Bitemporal hemianopsia |
Prolactinoma |
Pilocytic astrocytoma |
Endoscopic transsphenoidal excision with subfrontal craniotomy |
N/A |
Miyazaki et al[21] |
48 |
M |
Memory disturbance, depression, and hemiplegia |
PA |
Adamantinomatous craniopharyngioma |
Transsphenoidal excision (PA) Left frontoparietal craniotomy with tumor resection and cyst drainage (craniopharyngioma) |
Improvement in all symptoms |
Snyder et al[22] |
49 |
F |
Headache, dizziness, blurred vision, and nausea |
Corticotropic PA |
Craniopharyngioma |
Endoscopic transsphenoidal excision (primary tumor) Bifrontal interhemispheric transcallosal approach (residual tumor) |
Postoperative CSF leak |
de Vries et al[23] |
75 |
F |
Depression, fatigue, unintended weight loss |
Nonfunctioning PA |
Meningothelial meningioma |
Extended endoscopic transplanum excision |
Improvement of symptoms |
Bteich et al[24] |
35 |
M |
Headache, progressive visual disturbance |
Nonfunctioning PA |
Papillary craniopharyngioma |
Endoscopic transsphenoidal excision |
N/A |
Median = 60 (33–78) |
3 F 2 M |
Progressive visual field loss and/or headache |
PA |
Rathke's cleft cyst |
Endoscopic transsphenoidal excision |
N/A |
|
Gezer et al[26] |
34 |
F |
Menstrual irregularities, proximal muscle weakness, and rapid weight gain |
Corticotropic PA |
Meningioma |
Endoscopic transsphenoidal excision |
Postoperative resolution of weight gain, menstrual irregularities, and proximal muscle weakness |
Shareef et al[27] |
60 |
M |
Prior history of PA with resection, nonremitting bitemporal visual deficit |
PA |
Adamantinomatous craniopharyngioma |
Endoscopic transsphenoidal excision |
Transient postoperative diabetes insipidus |
62 56 |
F F |
Progressive visual loss in left eye Headache with progressive bilateral visual loss |
Nonfunctioning PA Nonfunctioning PA |
Meningioma Meningioma |
Endoscopic transsphenoidal excision Transmaxillary-transpterygoid approach |
Improvement in visual acuity postoperatively |
|
Ren et al[29] |
41 |
M |
Intermittent headache |
Lactotroph PA |
DLBCL |
Endoscopic transsphenoidal excision (PA) Chemotherapy (DLBCL) |
No tumor recurrence |
Mean = 53.8 ± 18.5 |
N/A |
N/A |
Double PitNET (n = 38) Triple PitNET (n = 2) PitNET (n = 34) PitNET (n = 6) PitNET (n = 5) PitNET (n = 12) |
Gangliocytoma Meningioma Posterior lobe tumor Metastasis |
N/A |
N/A |
|
Lu et al[30] |
61 |
F |
Progressive decline of binocular vision |
PA |
Meningioma |
Endoscopic transsphenoidal excision |
Stable visual acuity without tumor recurrence |
Abbreviations: ACTH, adrenocorticotropic hormone; DLBCL, diffuse large B-cell lymphoma; F, female; FSH, follicle stimulating hormone; GH, growth hormone; M, male; PA, pituitary adenoma; PitNET, pituitary neuroendocrine tumor.
a Case series
Study |
Patient age (y) |
Sex |
Clinical presentation |
Tumor location |
Surgical approach |
Additional comment |
---|---|---|---|---|---|---|
Miranda et al[31] |
10 |
F |
Neck pain, progressive right-sided hemiparesis, gait instability, somnolence, bilateral nystagmus, voice changes, lower cranial nerve dysfunction, left tongue/uvula deviation, (+) Hoffman's sign, and extensor plantar reflex |
Craniocervical junction |
Posterior fossa craniotomy, C1–C2 laminectomy with gross total resection |
Complete recovery without signs of residual tumor |
Ko et al[32] |
34 |
F |
Leg/hip pain with voiding difficulties |
Cauda equina (L2–L3) |
L1–L3 laminectomy with gross total resection |
No evidence of tumor recurrence at 2 y |
Yin et al[33] |
55 |
M |
Intermittent pulsatile headache, right eye vision loss + diplopia |
Sella |
Transsphenoidal approach with gross total resection |
Local tumor recurrence at 4-mo follow-up requiring stereotactic radiosurgery |
Gupta et al[34] |
19 |
M |
Back pain radiating to bilateral leg with diminished knee and ankle reflexes bilaterally |
Lumbosacral spine (L5–S2) |
L4–S2 laminectomy with gross total resection |
Complete recovery without signs of residual tumor |
Tsuchiya et al[35] |
10 |
M |
Worsening low back and bilateral lower extremity pain |
Lumbar spine (L3) |
L3 laminectomy with gross total resection |
Complete recovery without signs of residual tumor |
Zhang et al[36] |
45 |
F |
Episodic low back and bilateral upper leg pain |
Lumbar spine (L3) |
L3 laminectomy with gross total resection |
Complete recovery without signs of residual tumor |
Maamri et al[37] |
58 |
F |
Low back pain with bilateral sciatica |
Lumbar spine (L3) |
L2–L3 laminectomy with gross total resection |
Complete recovery |
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Discussion
Collision tumors affecting the sellar and suprasellar regions are rare. Due to indistinguishable radiographical characteristics, the preoperative diagnosis of a sellar collision tumor is difficult to differentiate from an isolated tumor type and is often preemptively diagnosed as a pituitary adenoma. Dual PitNETS are the most frequent type of sellar collision tumor, some of which are separate and some of which are contiguous.[1] [38] However, the second most common combination of tumor types varies significantly. Secondary tumors that have been described as co-occurring with pituitary adenomas include gangliocytomas, pilocytic astrocytomas, craniopharyngiomas, spindle cell astrocytomas, pituicytomas, granular cell tumors, and Rathke's cleft cysts.[19] [20] [21] [25] Collision tumors consisting of a pituitary adenoma and parasellar meningioma are exceedingly rare. There are several case reports and series describing the coexistence of a pituitary adenoma and sellar/suprasellar meningioma, although none have reported a specific diagnosis of clear cell meningioma.[1] [2] [4] [11] [12] [14] [17] [18] [23] [26] [28] [30] Therefore, this case report represents the first description of a collision tumor consisting of a gonadotroph adenoma with a coexisting clear cell meningioma without a dural tail, the latter of which represented a significant diagnostic challenge.
Sellar or suprasellar meningiomas can closely mimic pituitary adenomas on neuroimaging.[39] Therefore, a definitive preoperative diagnosis of a pituitary adenoma and parasellar meningioma is not often possible on MRI. In considering our patient's preoperative MRI, in retrospect it may have been possible to appreciate a small layer of hyperintense signal on T1 postcontrast sequences between the intrasellar and suprasellar tumor components, which may have delineated the distinct border of both the adenoma and meningioma. However, this layer, representing the diaphragma sella, was not found to be completely contiguous on the sagittal MRI, and was therefore considered an unreliable measure for confirming the radiographical appearance of a collision tumor.
Definitive diagnosis of a collision tumor requires histologic evaluation of the resected tumor specimen by the pathologist, as was the case for our patient. While a diagnosis of a PitNET in the context of a sellar/suprasellar collision tumor in itself is relatively unsurprising, a concomitant diagnosis of clear cell meningioma represents a unique entity. Clear cell meningiomas have a proclivity for the cerebellopontine angle and spine, particularly in the cauda equina region, and tends to affect children and young adults, neither of which were the case in our patient (47-year-old, sellar region).[40] Clear cell meningiomas are unique in that both germline and somatic SMARCE1 mutations are present, unlike other meningioma types. While the histopathologic diagnosis can be supported by a loss of nuclear SMARCE1 expression by IHC, it is not required in the cases with archetypal histological features such as dense bands of collagen, glycogen-rich cytoplasm, and clear cell morphology, as in our case.[41] Importantly, clear cell meningiomas tend to exhibit more aggressive behavior, with higher rates of recurrence and occasional seeding of cerebrospinal fluid in comparison to other meningioma subtypes. As such, clear cell meningiomas have been designated a CNS WHO grade 2, thus warranting careful surveillance of our patient.
Few reports have described the diagnosis of a parasellar clear cell meningioma, all of which occurred as a single tumor.[33] [42] [43] [44] [45] [46] Although more common in young adults and children, sellar region clear cell meningioma was diagnosed in 11- to 79-year-old patients.[33] [42] [43] [44] [45] [46] Additionally, in all but one case, a dural attachment was seen,[42] [43] [44] [45] [46] while a single case described the occurrence of an intrasellar clear cell meningioma without a dural attachment.[33] Therefore, given the rarity of clear cell meningioma arising as a single-region tumor, this further emphasizes the diagnostic conundrum seen in our case where a gonadotropic adenoma was simultaneously diagnosed with a suprasellar clear cell meningioma without the classic dural attachment.
The association between pituitary adenomas and intracranial meningiomas has been widely described and are thought to arise as a delayed complication following radiotherapy for pituitary lesions.[47] However, collision tumors composed of simultaneously occurring pituitary adenoma and meningioma are difficult to explain, as the underlying etiology is not understood. One theory suggests that in patients with a growth hormone (GH) secreting macroadenoma, GH excess can induce meningioma growth resulting in collision tumor formation, although this has never been confirmed.[48] [49] Nonetheless, the co-occurrence of a pituitary adenoma and parasellar meningioma is likely an incidental finding of two common lesions within the sellar region.
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Conclusion
We describe the diagnosis and treatment of a collision tumor composed of a pituitary adenoma and sellar region meningioma in a 47-year-old-man. Collision tumors arising in the sellar/suprasellar region of the brain are exceedingly rare entities, currently with unclear etiologies. In the absence of reliable radiographic measures to diagnose collision tumors using neuroimaging, histological evaluation remains the gold standard. A multidisciplinary approach between neurosurgeons and neuropathologists is critical for the management of these patients.
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Conflict of Interest
None declared.
Informed Consent
Informed consent was deemed unnecessary for this work by the Colorado Multiple Institutional Review Board.
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References
- 1 Schöning JV, Flitsch J, Lüdecke DK. et al. Multiple tumorous lesions of the pituitary gland. Hormones (Athens) 2022; 21 (04) 653-663
- 2 Yamada K, Hatayama T, Ohta M, Sakoda K, Uozumi T. Coincidental pituitary adenoma and parasellar meningioma: case report. Neurosurgery 1986; 19 (02) 267-270
- 3 Tajika Y, Kubo O, Takeshita M, Tajika T, Shimizu T, Kitamura K. An intracranial collision tumor composed of intrasellar gangliocytoma and pituitary adenoma. No Shinkei Geka 1989; 17 (12) 1181-1186
- 4 Prevedello DM, Thomas A, Gardner P, Snyderman CH, Carrau RL, Kassam AB. Endoscopic endonasal resection of a synchronous pituitary adenoma and a tuberculum sellae meningioma: technical case report. Neurosurgery 2007; 60 (4, Suppl 2): E401 , discussion E401
- 5 Karavitaki N, Scheithauer BW, Watt J. et al. Collision lesions of the sella: co-existence of craniopharyngioma with gonadotroph adenoma and of Rathke's cleft cyst with corticotroph adenoma. Pituitary 2008; 11 (03) 317-323
- 6 Moshkin O, Scheithauer BW, Syro LV, Velasquez A, Horvath E, Kovacs K. Collision tumors of the sella: craniopharyngioma and silent pituitary adenoma subtype 3: case report. Endocr Pathol 2009; 20 (01) 50-55
- 7 Koutourousiou M, Kontogeorgos G, Wesseling P, Grotenhuis AJ, Seretis A. Collision sellar lesions: experience with eight cases and review of the literature. Pituitary 2010; 13 (01) 8-17
- 8 Rivera J, Alves S, Bianchi CC, Al-Mutawa N, Guiot MC, Zeitouni A. An unusual collision tumor comprising a prolactinoma and a plasmocytoma originating from the sellar region. Pituitary 2010; 13 (02) 189-193
- 9 Sahli R, Christ E, Kuhlen D, Giger O, Vajtai I. Sellar collision tumor involving pituitary gonadotroph adenoma and chondroma: a potential clinical diagnosis. Pituitary 2011; 14 (04) 405-408
- 10 Jin G, Hao S, Xie J, Mi R, Liu F. Collision tumors of the sella: coexistence of pituitary adenoma and craniopharyngioma in the sellar region. World J Surg Oncol 2013; 11: 178
- 11 Mahvash M, Igressa A, Pechlivanis I, Weber F, Charalampaki P. Endoscopic endonasal transsphenoidal approach for resection of a coexistent pituitary macroadenoma and a tuberculum sellae meningioma. Asian J Neurosurg 2014; 9 (04) 236
- 12 Karsy M, Sonnen J, Couldwell WT. Coincident pituitary adenoma and sellar meningioma. Acta Neurochir (Wien) 2015; 157 (02) 231-233
- 13 Matyja E, Maksymowicz M, Grajkowska W. et al. Ganglion cell tumours in the sella turcica in close morphological connection with pituitary adenomas. Folia Neuropathol 2015; 53 (03) 203-218
- 14 Lim KZ, Goldschlager T, Chandra RV, Hall J, Uren B, Pullar M. Co-occurrence of pituitary adenoma with suprasellar and olfactory groove meningiomas. Basic Clin Neurosci 2016; 7 (04) 361-365
- 15 Ban VS, Chaudhary BR, Allinson K, Santarius T, Kirollos RW. Concomitant primary CNS lymphoma and FSH-pituitary adenoma arising within the sella. entirely coincidental?. Neurosurgery 2017; 80 (01) E170-E175
- 16 Heng LJ, Jia D, Gong L, Zhang W, Ma J, Qu Y. Endoscopic endonasal resection of a mixed lesion of gangliocytoma and nonfunctioning pituitary adenoma. World Neurosurg 2017; 106: 1050.e1-1050.e6
- 17 Zhao Y, Zhang H, Lian W. et al. Collision tumors composed of meningioma and growth hormone-secreting pituitary adenoma in the sellar region: case reports and a literature review. Medicine (Baltimore) 2017; 96 (50) e9139
- 18 Amirjamshidi A, Mortazavi SA, Shirani M, Saeedinia S, Hanif H. Coexisting pituitary adenoma and suprasellar meningioma-a coincidence or causation effect: report of two cases and review of the literature. J Surg Case Rep 2017; 2017 (05) rjx039
- 19 Levitus CF, Charitou MMAN. An incidental collision tumor of the sella turcica. AACE Clin Case Rep 2019; 5 (04) e247-e249
- 20 Malli A, Melissaris S, Dimitriadi A, Choreftaki T, Georgakoulias N. A coexisting pilocytic astrocytoma and a prolactinoma: a case report of collision tumors and literature review. Cureus 2019; 11 (06) e4911
- 21 Miyazaki T, Kowari K, Eda H, Kambara M, Maruyama R, Akiyama Y. Ten-year follow-up of collision tumors composed of craniopharyngioma and pituitary adenoma: a case report and literature review. Case Rep Med 2019; 2019: 8080163
- 22 Snyder R, Fayed I, Dowlati E, Seager A, Mason RB. Pituitary adenoma and craniopharyngioma collision tumor: diagnostic, treatment considerations, and review of the literature. World Neurosurg 2019; 121: 211-216
- 23 de Vries F, Lobatto DJ, Zamanipoor Najafabadi AH. et al. Unexpected concomitant pituitary adenoma and suprasellar meningioma: a case report and review of the literature. Br J Neurosurg 2023; 37 (04) 677-681
- 24 Bteich F, El Khoury L, Nohra G, Trak V, Yazbek S, Akiki M. Pituitary adenoma and papillary craniopharyngioma: a rare case of collision tumor and review of the literature. World Neurosurg 2020; 139: 63-69
- 25 de Almeida Verdolin A, Lamback EB, Ventura N. et al. Collision sellar lesions: coexistence of pituitary adenoma and Rathke cleft cyst-a single-center experience. Endocrine 2020; 68 (01) 174-181
- 26 Gezer E, Cantürk Z, Selek A. et al. Cushing's disease due to a pituitary adenoma as a component of collision tumor: a case report and review of the literature. J Med Case Rep 2020; 14 (01) 59
- 27 Shareef Z, Kerndt C, Nessel T, Mistry D, Figueroa B. Collision tumor in the pituitary, concurrent pituitary adenoma, and craniopharyngioma. Case Rep Otolaryngol 2020; 2020: 9584090
- 28 Bao YY, Wu X, Ding H, Hong T. Endoscopic endonasal resection of coexisting pituitary adenoma and meningioma: two cases' report and literature review. Neurochirurgie 2021; 67 (06) 611-617
- 29 Ren S, Lu Q, Xiao Y. et al. Coexistence of pituitary adenoma and primary pituitary lymphoma: a case report and review of the literature. Front Surg 2022; 9: 842830
- 30 Lu W, Shengkai Y, Yu W, Aimin L, Shiwei Y, Kang X. Case report: clinical report of co-occurrence of pituitary adenoma and meningioma in the sellar region after meningioma treatment. Front Neurol 2022; 13: 1042106
- 31 Miranda P, Simal JA, Vila M, Hernández M, Menor F, Alvarez-Garijo JA. Posterior fossa clear cell meningioma without dural attachment in a child. Childs Nerv Syst 2009; 25 (03) 389-392
- 32 Ko JK, Choi BK, Cho WH, Choi CH. Non-dura based intaspinal clear cell meningioma. J Korean Neurosurg Soc 2011; 49 (01) 71-74
- 33 Yin S, Zhou P, Li Q, Jiang S. Intrasellar clear cell meningioma mimicking invasive pituitary adenoma: a case report and review of the literature. Turk Neurosurg 2015; 25 (06) 976-979
- 34 Gupta SK, Nayak N, Gandhoke CS. et al. A giant nondural-based lumbosacral clear cell meningioma mimicking schwannoma: a case report and review of the literature. Asian J Neurosurg 2021; 16 (01) 44-50
- 35 Tsuchiya T, Ikeda S, Isoo A. et al. Intraoperative anatomical findings in pediatric clear cell meningioma of the lumbar spine: case report and literature review. NMC Case Rep J 2021; 8 (01) 519-527
- 36 Zhang X, Zhang P, Wang JJ. et al. Intraspinal clear cell meningioma without dural attachment: a case report and literature review. Medicine (Baltimore) 2021; 100 (11) e25167
- 37 Maamri K, Hadj Taieb MA, Trifa A, Elkahla G, Njima M, Darmoul M. Spinal clear cell meningioma without dural attachment: a case report and literature review. Radiol Case Rep 2022; 17 (05) 1760-1764
- 38 Vasquez CA, Downes A, Kleinschmidt-DeMasters BK, Youssef AS. Functioning pituitary adenoma with xanthogranulomatous features: review of literature and case report. J Neurol Surg B Skull Base 2019; 80 (05) 449-457
- 39 Spallone A. Meningioma as a sequel of radiotherapy for pituitary adenoma. Neurochirurgia (Stuttg) 1982; 25 (02) 68-72
- 40 Zhang H, Ma L, Shu C, Dong LQ, Ma YQ, Zhou Y. Spinal clear cell meningiomas: clinical features and factors predicting recurrence. World Neurosurg 2020; 134: e1062-e1076
- 41 Gerkes EH, Fock JM, den Dunnen WF. et al. A heritable form of SMARCE1-related meningiomas with important implications for follow-up and family screening. Neurogenetics 2016; 17 (02) 83-89
- 42 Baxter DS, Smith P, Stewart K, Murphy M. Clear cell meningioma presenting as rapidly deteriorating visual field and acuity during pregnancy. J Clin Neurosci 2009; 16 (11) 1502-1504
- 43 Chen H, Li XM, Chen YC. et al. Intracranial clear cell meningioma: a clinicopathologic study of 15 cases. Acta Neurochir (Wien) 2011; 153 (09) 1769-1780
- 44 Jain D, Sharma MC, Sarkar C. et al. Clear cell meningioma, an uncommon variant of meningioma: a clinicopathologic study of nine cases. J Neurooncol 2007; 81 (03) 315-321
- 45 Ohba S, Sasaki H, Kimura T, Ikeda E, Kawase T. Clear cell meningiomas: three case reports with genetic characterization and review of the literature. Neurosurgery 2010; 67 (03) E870-E871 , discussion E871
- 46 Prayson RA, Chamberlain WA, Angelov L. Clear cell meningioma: a clinicopathologic study of 18 tumors and examination of the use of CD10, CA9, and RCC antibodies to distinguish between clear cell meningioma and metastatic clear cell renal cell carcinoma. Appl Immunohistochem Mol Morphol 2010; 18 (05) 422-428
- 47 Abs R, Parizel PM, Willems PJ. et al. The association of meningioma and pituitary adenoma: report of seven cases and review of the literature. Eur Neurol 1993; 33 (06) 416-422
- 48 Furtado SV, Dadlani R, Ghosal N, Mahadevan A, Shankar SK, Hegde AS. Co-existing thyrotropin secreting pituitary adenoma and low grade glioma: clinical considerations and literature review. J Neurosurg Sci 2009; 53 (02) 71-75
- 49 Black PM, Carroll R, Glowacka D, Riley K, Dashner K. Platelet-derived growth factor expression and stimulation in human meningiomas. J Neurosurg 1994; 81 (03) 388-393
Address for correspondence
Publication History
Received: 28 August 2023
Accepted: 05 November 2023
Article published online:
09 January 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Schöning JV, Flitsch J, Lüdecke DK. et al. Multiple tumorous lesions of the pituitary gland. Hormones (Athens) 2022; 21 (04) 653-663
- 2 Yamada K, Hatayama T, Ohta M, Sakoda K, Uozumi T. Coincidental pituitary adenoma and parasellar meningioma: case report. Neurosurgery 1986; 19 (02) 267-270
- 3 Tajika Y, Kubo O, Takeshita M, Tajika T, Shimizu T, Kitamura K. An intracranial collision tumor composed of intrasellar gangliocytoma and pituitary adenoma. No Shinkei Geka 1989; 17 (12) 1181-1186
- 4 Prevedello DM, Thomas A, Gardner P, Snyderman CH, Carrau RL, Kassam AB. Endoscopic endonasal resection of a synchronous pituitary adenoma and a tuberculum sellae meningioma: technical case report. Neurosurgery 2007; 60 (4, Suppl 2): E401 , discussion E401
- 5 Karavitaki N, Scheithauer BW, Watt J. et al. Collision lesions of the sella: co-existence of craniopharyngioma with gonadotroph adenoma and of Rathke's cleft cyst with corticotroph adenoma. Pituitary 2008; 11 (03) 317-323
- 6 Moshkin O, Scheithauer BW, Syro LV, Velasquez A, Horvath E, Kovacs K. Collision tumors of the sella: craniopharyngioma and silent pituitary adenoma subtype 3: case report. Endocr Pathol 2009; 20 (01) 50-55
- 7 Koutourousiou M, Kontogeorgos G, Wesseling P, Grotenhuis AJ, Seretis A. Collision sellar lesions: experience with eight cases and review of the literature. Pituitary 2010; 13 (01) 8-17
- 8 Rivera J, Alves S, Bianchi CC, Al-Mutawa N, Guiot MC, Zeitouni A. An unusual collision tumor comprising a prolactinoma and a plasmocytoma originating from the sellar region. Pituitary 2010; 13 (02) 189-193
- 9 Sahli R, Christ E, Kuhlen D, Giger O, Vajtai I. Sellar collision tumor involving pituitary gonadotroph adenoma and chondroma: a potential clinical diagnosis. Pituitary 2011; 14 (04) 405-408
- 10 Jin G, Hao S, Xie J, Mi R, Liu F. Collision tumors of the sella: coexistence of pituitary adenoma and craniopharyngioma in the sellar region. World J Surg Oncol 2013; 11: 178
- 11 Mahvash M, Igressa A, Pechlivanis I, Weber F, Charalampaki P. Endoscopic endonasal transsphenoidal approach for resection of a coexistent pituitary macroadenoma and a tuberculum sellae meningioma. Asian J Neurosurg 2014; 9 (04) 236
- 12 Karsy M, Sonnen J, Couldwell WT. Coincident pituitary adenoma and sellar meningioma. Acta Neurochir (Wien) 2015; 157 (02) 231-233
- 13 Matyja E, Maksymowicz M, Grajkowska W. et al. Ganglion cell tumours in the sella turcica in close morphological connection with pituitary adenomas. Folia Neuropathol 2015; 53 (03) 203-218
- 14 Lim KZ, Goldschlager T, Chandra RV, Hall J, Uren B, Pullar M. Co-occurrence of pituitary adenoma with suprasellar and olfactory groove meningiomas. Basic Clin Neurosci 2016; 7 (04) 361-365
- 15 Ban VS, Chaudhary BR, Allinson K, Santarius T, Kirollos RW. Concomitant primary CNS lymphoma and FSH-pituitary adenoma arising within the sella. entirely coincidental?. Neurosurgery 2017; 80 (01) E170-E175
- 16 Heng LJ, Jia D, Gong L, Zhang W, Ma J, Qu Y. Endoscopic endonasal resection of a mixed lesion of gangliocytoma and nonfunctioning pituitary adenoma. World Neurosurg 2017; 106: 1050.e1-1050.e6
- 17 Zhao Y, Zhang H, Lian W. et al. Collision tumors composed of meningioma and growth hormone-secreting pituitary adenoma in the sellar region: case reports and a literature review. Medicine (Baltimore) 2017; 96 (50) e9139
- 18 Amirjamshidi A, Mortazavi SA, Shirani M, Saeedinia S, Hanif H. Coexisting pituitary adenoma and suprasellar meningioma-a coincidence or causation effect: report of two cases and review of the literature. J Surg Case Rep 2017; 2017 (05) rjx039
- 19 Levitus CF, Charitou MMAN. An incidental collision tumor of the sella turcica. AACE Clin Case Rep 2019; 5 (04) e247-e249
- 20 Malli A, Melissaris S, Dimitriadi A, Choreftaki T, Georgakoulias N. A coexisting pilocytic astrocytoma and a prolactinoma: a case report of collision tumors and literature review. Cureus 2019; 11 (06) e4911
- 21 Miyazaki T, Kowari K, Eda H, Kambara M, Maruyama R, Akiyama Y. Ten-year follow-up of collision tumors composed of craniopharyngioma and pituitary adenoma: a case report and literature review. Case Rep Med 2019; 2019: 8080163
- 22 Snyder R, Fayed I, Dowlati E, Seager A, Mason RB. Pituitary adenoma and craniopharyngioma collision tumor: diagnostic, treatment considerations, and review of the literature. World Neurosurg 2019; 121: 211-216
- 23 de Vries F, Lobatto DJ, Zamanipoor Najafabadi AH. et al. Unexpected concomitant pituitary adenoma and suprasellar meningioma: a case report and review of the literature. Br J Neurosurg 2023; 37 (04) 677-681
- 24 Bteich F, El Khoury L, Nohra G, Trak V, Yazbek S, Akiki M. Pituitary adenoma and papillary craniopharyngioma: a rare case of collision tumor and review of the literature. World Neurosurg 2020; 139: 63-69
- 25 de Almeida Verdolin A, Lamback EB, Ventura N. et al. Collision sellar lesions: coexistence of pituitary adenoma and Rathke cleft cyst-a single-center experience. Endocrine 2020; 68 (01) 174-181
- 26 Gezer E, Cantürk Z, Selek A. et al. Cushing's disease due to a pituitary adenoma as a component of collision tumor: a case report and review of the literature. J Med Case Rep 2020; 14 (01) 59
- 27 Shareef Z, Kerndt C, Nessel T, Mistry D, Figueroa B. Collision tumor in the pituitary, concurrent pituitary adenoma, and craniopharyngioma. Case Rep Otolaryngol 2020; 2020: 9584090
- 28 Bao YY, Wu X, Ding H, Hong T. Endoscopic endonasal resection of coexisting pituitary adenoma and meningioma: two cases' report and literature review. Neurochirurgie 2021; 67 (06) 611-617
- 29 Ren S, Lu Q, Xiao Y. et al. Coexistence of pituitary adenoma and primary pituitary lymphoma: a case report and review of the literature. Front Surg 2022; 9: 842830
- 30 Lu W, Shengkai Y, Yu W, Aimin L, Shiwei Y, Kang X. Case report: clinical report of co-occurrence of pituitary adenoma and meningioma in the sellar region after meningioma treatment. Front Neurol 2022; 13: 1042106
- 31 Miranda P, Simal JA, Vila M, Hernández M, Menor F, Alvarez-Garijo JA. Posterior fossa clear cell meningioma without dural attachment in a child. Childs Nerv Syst 2009; 25 (03) 389-392
- 32 Ko JK, Choi BK, Cho WH, Choi CH. Non-dura based intaspinal clear cell meningioma. J Korean Neurosurg Soc 2011; 49 (01) 71-74
- 33 Yin S, Zhou P, Li Q, Jiang S. Intrasellar clear cell meningioma mimicking invasive pituitary adenoma: a case report and review of the literature. Turk Neurosurg 2015; 25 (06) 976-979
- 34 Gupta SK, Nayak N, Gandhoke CS. et al. A giant nondural-based lumbosacral clear cell meningioma mimicking schwannoma: a case report and review of the literature. Asian J Neurosurg 2021; 16 (01) 44-50
- 35 Tsuchiya T, Ikeda S, Isoo A. et al. Intraoperative anatomical findings in pediatric clear cell meningioma of the lumbar spine: case report and literature review. NMC Case Rep J 2021; 8 (01) 519-527
- 36 Zhang X, Zhang P, Wang JJ. et al. Intraspinal clear cell meningioma without dural attachment: a case report and literature review. Medicine (Baltimore) 2021; 100 (11) e25167
- 37 Maamri K, Hadj Taieb MA, Trifa A, Elkahla G, Njima M, Darmoul M. Spinal clear cell meningioma without dural attachment: a case report and literature review. Radiol Case Rep 2022; 17 (05) 1760-1764
- 38 Vasquez CA, Downes A, Kleinschmidt-DeMasters BK, Youssef AS. Functioning pituitary adenoma with xanthogranulomatous features: review of literature and case report. J Neurol Surg B Skull Base 2019; 80 (05) 449-457
- 39 Spallone A. Meningioma as a sequel of radiotherapy for pituitary adenoma. Neurochirurgia (Stuttg) 1982; 25 (02) 68-72
- 40 Zhang H, Ma L, Shu C, Dong LQ, Ma YQ, Zhou Y. Spinal clear cell meningiomas: clinical features and factors predicting recurrence. World Neurosurg 2020; 134: e1062-e1076
- 41 Gerkes EH, Fock JM, den Dunnen WF. et al. A heritable form of SMARCE1-related meningiomas with important implications for follow-up and family screening. Neurogenetics 2016; 17 (02) 83-89
- 42 Baxter DS, Smith P, Stewart K, Murphy M. Clear cell meningioma presenting as rapidly deteriorating visual field and acuity during pregnancy. J Clin Neurosci 2009; 16 (11) 1502-1504
- 43 Chen H, Li XM, Chen YC. et al. Intracranial clear cell meningioma: a clinicopathologic study of 15 cases. Acta Neurochir (Wien) 2011; 153 (09) 1769-1780
- 44 Jain D, Sharma MC, Sarkar C. et al. Clear cell meningioma, an uncommon variant of meningioma: a clinicopathologic study of nine cases. J Neurooncol 2007; 81 (03) 315-321
- 45 Ohba S, Sasaki H, Kimura T, Ikeda E, Kawase T. Clear cell meningiomas: three case reports with genetic characterization and review of the literature. Neurosurgery 2010; 67 (03) E870-E871 , discussion E871
- 46 Prayson RA, Chamberlain WA, Angelov L. Clear cell meningioma: a clinicopathologic study of 18 tumors and examination of the use of CD10, CA9, and RCC antibodies to distinguish between clear cell meningioma and metastatic clear cell renal cell carcinoma. Appl Immunohistochem Mol Morphol 2010; 18 (05) 422-428
- 47 Abs R, Parizel PM, Willems PJ. et al. The association of meningioma and pituitary adenoma: report of seven cases and review of the literature. Eur Neurol 1993; 33 (06) 416-422
- 48 Furtado SV, Dadlani R, Ghosal N, Mahadevan A, Shankar SK, Hegde AS. Co-existing thyrotropin secreting pituitary adenoma and low grade glioma: clinical considerations and literature review. J Neurosurg Sci 2009; 53 (02) 71-75
- 49 Black PM, Carroll R, Glowacka D, Riley K, Dashner K. Platelet-derived growth factor expression and stimulation in human meningiomas. J Neurosurg 1994; 81 (03) 388-393