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Table of Contents    
LETTER TO EDITOR
Year : 2018  |  Volume : 66  |  Issue : 4  |  Page : 1193-1195

Pleomorphic xanthoastrocytoma arising from the pituitary stalk


1 Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
2 Department of Neurosurgery, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
3 Department of Neurosurgery, Liao Ning Tie Fa Coal Group Hospital, Zhen Xing Road, Diao Bing Shan City, Tie Ling City, Liao Ning, China

Date of Web Publication18-Jul-2018

Correspondence Address:
Dr. Ji Zhang
Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng East Road, Guangzhou - 510060
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.236957

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How to cite this article:
Chen ZJ, Zhang J, Rao YH, Sun JC, Sun SX, Sai K. Pleomorphic xanthoastrocytoma arising from the pituitary stalk. Neurol India 2018;66:1193-5

How to cite this URL:
Chen ZJ, Zhang J, Rao YH, Sun JC, Sun SX, Sai K. Pleomorphic xanthoastrocytoma arising from the pituitary stalk. Neurol India [serial online] 2018 [cited 2018 Nov 18];66:1193-5. Available from: http://www.neurologyindia.com/text.asp?2018/66/4/1193/236957




Sir,

A 39-year old woman presented with a history of progressive visual disturbance for 11 days, accompanied by headache and dizziness. Her family history was not remarkable. Neurological examination revealed subnormal visual acuity and bitemporal visual field defects, most pronounced in the left eye. The pituitary function was within the normal range. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a well-circumscribed rounded mass, which was more obvious after contrast enhancement in the suprasellar region. The lesion was approximately 2.6 × 2.0 × 1.5 cm in size and none of the contrast-enhancing cystic areas could be seen inside the lesion [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d,[Figure 1]e,[Figure 1]f. The patient underwent surgery to completely resect the tumor, which originated from the pituitary stalk. He did not undergo any further adjuvant therapy in the form of radiotherapy or chemotherapy. The surgical specimen was consistent with the diagnosis of a pleomorphic xanthoastrocytoma (PXA) [Figure 2]. Post-operative visual field and visual acuity of the patient showed an obvious improvement. The regular MRI at follow-up showed no evidence of tumor relapse [Figure 1]g,[Figure 1]h,[Figure 1]i.
Figure 1: Pre-operative CT (a-c) and MRI (d-f) showing a well-circumscribed mass in the form of an approximately 2.6 × 2.0 × 1.5 cm cystic and solid tumor situated within the suprasellar region causing a displacement of the pituitary stalk and upliftment of the superior border of the pituitary gland (a-f); post-operative MR showed no evidence of tumor relapse (g-i)

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Figure 2: Immunohistochemical and specific staining of the neoplasm. Hematoxylin and eosin stained section of the tumor demonstrating pleomorphic tumor cells (a) [×400]. Partially positive immune-staining for cluster of differentiation (CD) 68 (b), weakly positive for Syn (d), positive for glial fibrillary acid protein (e), and negative for isocitrate dehydrogenase 1 (c). Silver impregnation staining revealed abundant reticulin fibers (f) (×100)

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PXA is an rare astrocytic neoplasm and has a histology corresponding to World Health Organization grade II tumor.[1] PXA has been reported in unusual sites, such as the posterior fossa, cerebellum, spinal cord, pineal region, sella, and retina. PXA arising from the suprasellar region is very rare, and only six such patients have been documented until now [Table 1].[2],[3],[4],[5],[6] The diagnosis of PXA located within the pituitary stalk is definitely challenging due to non-specific clinical and radiographic features. The radiological differential diagnosis includes a craniopharyngioma, high-grade glioma, Langerhan cell granulomatosis, and meningioma. To our best knowledge, this tumor residing in the pituitary stalk is extremely rare and no published reports of any previous cases in this location were available in the literature. Due to the superficial cerebral location of the lesion, many patients present with a fairly long history of seizures. The role of adjuvant chemotherapy, radiotherapy, or both, after maximum surgical resection, especially in patients with a more aggressive clinical course, is not clearly established.[7],[8] During surgery, the neoplasm appeared well-encapsulated and could be completely excised from the pituitary stalk. The post-operative sequential studies of MRI showed no residual lesion and recurrence. The patient recovered well and no further treatment was needed. Complete removal is the primary goal of surgical treatment of PXA, which is regarded as being critically significant to the post-operative outcome.[9] The role of adjunctive radiation therapy, chemotherapy, or both, requires to be further established.[10]
Table 1: Reported cases of pleomorphic xanthoastrocytoma arising from the suprasellar region

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kepes JJ, Rubinstein LJ, Eng LF. Pleomorphic xanthoastrocytoma: A distinctive meningocerebral glioma of young subjects with relatively favorable prognosis—A study of 12 cases. Cancer 1979;44:1839-52.  Back to cited text no. 1
    
2.
Arita K, Kurisu K, Tominaga A, Sugiyama K, Sumida M, Hirose T. Intrasellar pleomorphic xanthoastrocytoma: Case report. Neurosurgery 2002;51:1079-82.  Back to cited text no. 2
    
3.
Yeh DJ, Hessler RB, Stevens EA, Lee MR. Composite pleomorphic xanthoastrocytoma-ganglioglioma presenting as a suprasellar mass: Case report. Neurosurgery 2003;52:1465-8.  Back to cited text no. 3
    
4.
Krossnes BK, Mella O, Wester K, Mork SJ. Pigmented astrocytoma with suprasellar location: Case report and literature review. Acta Neuropathol 2004;108:461-6.  Back to cited text no. 4
    
5.
Vizcaíno MA, Caccamo DV, Fox E, Rodriguez FJ. Pleomorphic xanthoastrocytoma: Report of two cases with unconventional clinical presentations. Clin Neuropathol 2014;33:380-7.  Back to cited text no. 5
    
6.
Jiang GY, Yu JH, Zhang XY, Qi XL, Sun YS. Pleomorphic xanthoastrocytoma arising from the suprasellar region: A report of two cases. J Clin Neurosci 2016;33:228-31.  Back to cited text no. 6
    
7.
Fouladi M, Jenkins J, Burger P, Langston J, Merchant T, Heideman R,et al. Pleomorphic xanthoastrocytoma: Favorable outcome after complete surgical resection. Neuro Oncol 2001;3:184-92.  Back to cited text no. 7
    
8.
Pahapill PA, Ramsay DA, Del Maestro RF. Pleomorphic xanthoastrocytoma: Case report and analysis of the literature concerning the efficacy of resection and the significance of necrosis. Neurosurgery 1996;38:822-8.  Back to cited text no. 8
    
9.
Fouladi M, Jenkins J, Burger P, Langston J, Merchant T, Heideman R,et al. Pleomorphic xanthoastrocytoma: Favorable outcome after complete surgical resection. Neuro-Oncol 2001;3:184-92.  Back to cited text no. 9
    
10.
Van Roost D, Kristof R, Zentner J, Wolf HK, Schramm J. Clinical, radiological, and therapeutic features of pleomorphic xanthoastrocytoma: Report of three patients and review of the literature. J Neurol Neurosurg Psychiatry 1996;60:690-2.  Back to cited text no. 10
    


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