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Sellar xanthogranuloma: A diagnostic challenge.

Ahoud Alharbi1,2,3, Ali Alkhaibary1,2,3, Abeer Alaglan1,2,3

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Summary

Sellar xanthogranulomas are rare sellar lesions. This case highlights their diagnostic challenges, clinical presentation, and favorable prognosis after surgical removal.

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Area of Science:

  • Neuropathology
  • Endocrinology
  • Neurosurgery

Background:

  • Sellar xanthogranulomas are rare intracranial lesions, accounting for less than 1% of all sellar lesions.
  • First described as a distinct entity by the World Health Organization in 2000, their origin and clinical course remain unclear.
  • Paucity of reported cases makes them a diagnostic challenge.

Observation:

  • A 43-year-old female with diabetes, hypothyroidism, and PCOS presented with facial deviation, periorbital pain, headache, and visual field defects.
  • Imaging revealed a sellar lesion with mixed density on CT and high signals on T1/T2 MRI.
  • Histopathology confirmed xanthogranuloma with chronic inflammation and cholesterol clefts.

Findings:

  • Sellar xanthogranulomas present with hypopituitarism and visual dysfunction.
  • Radiological features are not characteristic, necessitating histopathological confirmation.
  • Diagnosis is confirmed by identifying fibrous connective tissue, chronic inflammatory cells, and cholesterol clefts.

Implications:

  • Sellar xanthogranulomas, though rare, require a high index of suspicion for diagnosis.
  • Prompt histopathological diagnosis is crucial for appropriate management.
  • Prognosis is generally favorable following surgical excision.