open access

Vol 69, No 2 (2018)
Review paper
Published online: 2018-03-29
Submitted: 2017-07-02
Accepted: 2017-08-03
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Cystic lesions of the sellar-suprasellar region — diagnosis and treatment

Elżbieta Andrysiak-Mamos, Karol Sagan, Leszek Sagan, Elżbieta Sowińska-Przepiera, Anhelli Syrenicz
DOI: 10.5603/EP.2018.0023
·
Pubmed: 29952427
·
Endokrynologia Polska 2018;69(2):212-228.

open access

Vol 69, No 2 (2018)
REVIEWS — Postgraduate Education
Published online: 2018-03-29
Submitted: 2017-07-02
Accepted: 2017-08-03

Abstract

The differentiation of cystic lesions located in the sellar-suprasellar region is a significant problem in clinical practice because of the similarities in their clinical, radiological, and even histopathological picture. Arriving at the right diagnosis is vital for taking appropriate therapeutic decisions.

The most frequent clinical manifestation of lesions located in the sellar-suprasellar region is headache. It often co-exists with symptoms of anterior pituitary gland insufficiency or hyperprolactinaemia caused by compression of the pituitary stalk. Diabetes insipidus, obe­sity, mental disorders, and circadian rhythm disorders may be associated with lesions penetrating the suprasellar space. It is extremely important to rule out the possible coexistence of pituitary microadenoma and Rathke’s cleft cyst, which became possible with the use of 11C-methionine positron emission tomography/computed tomography (C-MET PET/CT). Reports from literature indicate that pituitary microadenoma may coexist with Rathke’s cleft cyst in 10% of patients. Cystic lesions of the sellar-suprasellar region should also be differentiated from a cystic pituitary adenoma or abscess.

The first-choice therapy in symptomatic cystic lesions of the sellar-suprasellar region is neurosurgery, which usually relieves headache and improves vision impairment, while less frequently restores normal pituitary function. In suprasellar lesions, neurosurgery may trig­ger or aggravate pre-existing symptoms of damage to the hypothalamus. Patients undergoing neurosurgery for cystic lesions located in the sellar-suprasellar region should be monitored for a few years due to their high recurrence rate, potential malignant transformation of these lesions, and possible adenoma development through metaplasia. The advent of targeted therapy of the BRAF/MEK pathway is associated with new therapeutic opportunities for patients with craniopharyngiomas.

Abstract

The differentiation of cystic lesions located in the sellar-suprasellar region is a significant problem in clinical practice because of the similarities in their clinical, radiological, and even histopathological picture. Arriving at the right diagnosis is vital for taking appropriate therapeutic decisions.

The most frequent clinical manifestation of lesions located in the sellar-suprasellar region is headache. It often co-exists with symptoms of anterior pituitary gland insufficiency or hyperprolactinaemia caused by compression of the pituitary stalk. Diabetes insipidus, obe­sity, mental disorders, and circadian rhythm disorders may be associated with lesions penetrating the suprasellar space. It is extremely important to rule out the possible coexistence of pituitary microadenoma and Rathke’s cleft cyst, which became possible with the use of 11C-methionine positron emission tomography/computed tomography (C-MET PET/CT). Reports from literature indicate that pituitary microadenoma may coexist with Rathke’s cleft cyst in 10% of patients. Cystic lesions of the sellar-suprasellar region should also be differentiated from a cystic pituitary adenoma or abscess.

The first-choice therapy in symptomatic cystic lesions of the sellar-suprasellar region is neurosurgery, which usually relieves headache and improves vision impairment, while less frequently restores normal pituitary function. In suprasellar lesions, neurosurgery may trig­ger or aggravate pre-existing symptoms of damage to the hypothalamus. Patients undergoing neurosurgery for cystic lesions located in the sellar-suprasellar region should be monitored for a few years due to their high recurrence rate, potential malignant transformation of these lesions, and possible adenoma development through metaplasia. The advent of targeted therapy of the BRAF/MEK pathway is associated with new therapeutic opportunities for patients with craniopharyngiomas.

Get Citation

Keywords

cystic lesion, sellar-suprasellar region, diagnosis, treatment

About this article
Title

Cystic lesions of the sellar-suprasellar region — diagnosis and treatment

Journal

Endokrynologia Polska

Issue

Vol 69, No 2 (2018)

Article type

Review paper

Pages

212-228

Published online

2018-03-29

DOI

10.5603/EP.2018.0023

Pubmed

29952427

Bibliographic record

Endokrynologia Polska 2018;69(2):212-228.

Keywords

cystic lesion
sellar-suprasellar region
diagnosis
treatment

Authors

Elżbieta Andrysiak-Mamos
Karol Sagan
Leszek Sagan
Elżbieta Sowińska-Przepiera
Anhelli Syrenicz

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