LAUSR

BACKGROUND Xanthogranuloma is a chronic inflammatory mass characterized by cholesterol crystal deposition, which is rarely seen in the sellar region. The objective of this study is to know the clinical features and etiology of sellar xanthogranulomas. METHODS We retrospectively analyzed manifestation, radiographic, and endocrinologic presentation in 9 patients (7 women; 2 men) we had previously treated. RESULTS The patients were between 26-73 years of age (median: 56 years). The chief complains were visual symptoms in 3, polyuria in 3, headache in 4, and tiredness in 4 patients. Perimetry found visual field deficit in 6 patients. Anterior pituitary provocation tests disclosed impairment of at least one hormone in all: growth hormone in 8 and adrenocorticotropic hormone-cortisol axis in 8 patients. The lesions were located in the suprasellar in 2, intrasellar in 2, and intra-suprasellar region in 5 patients. Three of the lesions were solid and 6 were single- to multi-cystic. Very low intensity area on T2-weighted magnetic resonance imaging was observed in 4 lesions. Post-contrast study performed in 7 lesions revealed enhancement in solid parts or cyst walls. Surgical decompression improved visual disturbance in half of the patients but rarely improved hormonal deficits. Follow-up (median: 47 months) found no recurrence of the lesion. In addition to these 9 cases, we found 2 xanthogranulomatous lesions pathologically associated with ciliated epithelia, which also presented severe hypopituitarism. CONCLUSIONS Xanthogranuloma appears to be the last stage of the chronic inflammation affecting Rathke's cleft cyst or craniopharyngioma presenting with severe anterior pituitary insufficiency.