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Citation: Mechergui H, Bouali S, Slimane A, Farhat S, Abderrahman Kh, Kallel J. Xanthogranuloma of the sellar region in a female patient presenting

with pituitary dysfunction: A case report and review of literature. Jr. med. res. 2025; 7(1):9-11. Mechergui et al © All rights are reserved.

https://doi.org/10.32512/jmr.7.1.2025/9.11 Submit your manuscript:www.jmedicalresearch.com

Case Report

Mechergui Haifa

1,2*

, Bouali Sofiene

1,2

, Slimane Abdelhafidh

1,2

, Farhat Siwar

1,2

, Abderrahman Khansa

1,2

, Kallel Jalel

1,2

Xanthogranuloma of the sellar region in a female patient presenting with

pituitary dysfunction: A case report and review of literature.

1: National Institute of Neurology Tunis,

Tunisia.

2: College of Medicine, Tunis, Tunisia

* Corresponding author

Correspondence to:

mecherguihaifa@gmail.com

Publication Data:

Submitted: December 27,2024

Accepted: February12,2025

Online: April 30,2025

This article was subject to full peer-

review.

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Xanthogranuloma of the sellar region is an extremely rare lesion. It represents

approximately 1.9% of all sellar and parasellar region tumors with only eighty-

four reported cases in the literature. The preoperative diagnosis is difficult due to

the lack of clinical and radiological specificities. We herein report A new case of

sellar Xanthogranuloma described in a young Tunisian patient.

Keywords

Craniopharyngioma; Magnetic Resonance Imaging; surgery; Xanthogranuloma.

Introduction

Xanthogranuloma of the sellar region is an extremely rare brain tumor. This lesion

arises frequently in the middle ear, petrous apex, paranasal sinuses, choroid

plexus and mostly located in the trigone of the lateral ventricle [1]. It represents

about 1.9% of all tumors of the sellar region with only less than ninety previously

described cases. These tumors were underdiagnosed and usually confused with

xanthogranulomatous reaction of Craniopharyngioma or Rathke’s cleft cyst [2].

Diagnosis is challenging because of the absence of typical clinical and radiological

features for these tumors. Our aim was to report Xanthogranuloma management

specificities according to the SCARE 2020 criteria.

Observation

We report the case of a 28-year-old female with a history of delayed puberty and

pituitary insufficiency for seven years. the patient complained of gradual decrease

in visual acuity of the right eye. Neurological examination showed no neurological

deficits. Ophthalmological examination reveals visual acuity of 1/10 on the right

side and 10/10 on the left side without any disturbance of the visual fields.

Fundus examination showed optic atrophy on the right and papillary pallor on the

left. Endocrinological tests were normal. Brain MRI showed well-defined

40X35X20 mm sellar and supra sellar tumoral lesion with mixed solid and cystic

components. This lesion was of ovoid shape, presenting hyperintense signal on

both T1- and T2-weighted sequences and displacing the optic chiasm (figure 1).

Brain CT scan reveals the presence of calcifications located around the periphery

of the lesion. Surgery was indicated. A complete resection was performed using a

fronto-pterional approach. The histopathological examination, based on the

presence of fibrous tissue with abundant cholesterol clefts, foamy macrophages,

and hemosiderin deposits confirmed the diagnosis of Xanthogranuloma (figure2).

Postoperative course was uneventful. The MRI follow up at 3 months did not

show any tumor recurrence.

Abstract

Xanthogranuloma of the sellar region in a female patient presenting with pituitary dysfunction: A case report and review of literature

Citation: Mechergui H, Bouali S, Slimane A, Farhat S, Abderrahman Kh, Kallel J. Xanthogranuloma of the sellar region in a female patient presenting

with pituitary dysfunction: A case report and review of literature. Jr. med. res. 2025; 7(1):9-11. Mechergui et al © All rights are reserved.

Submit your manuscript: www.jmedicalresearch.com.

Figure 1: Preoperative sagittal T1-weighted magnetic resonance showing a an ovoid sellar and supra sellar tumor measuring 40*35*20 mm in diameter with solid and cystic components. The lesion presents a

hyperintense signal on both T1- and T2-weighted sequences. The tumor compressed the pituitary gland and the optic chiasma upward.

Figure 2: histopathological exam showed cholesterol cleft, chronic inflammatory cells, and collagenous fibrous tissue.

Xanthogranuloma of the sellar region in a female patient presenting with pituitary dysfunction: A case report and review of literature

Citation: Mechergui H, Bouali S, Slimane A, Farhat S, Abderrahman Kh, Kallel J. Xanthogranuloma of the sellar region in a female patient presenting

Submit your manuscript: www.jmedicalresearch.com.

Conflict of Interest: None

References

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sellar region : A systematic review. Hormones (Athens). 2023 Jun ;22(2) :199-210.

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[3] Alharbi A, Alkhaibary A, Alaglan A, Khairy S, Alkhunaizi Z, AlSufiani F, Alassiri AH, Alkhani A. Sellar xanthogranuloma: A diagnostic challenge. Surg Neurol Int. 2022 Mar 4; 13:76.

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[7] Kobayashi M, Yagasaki H, Kobayashi K, Ogiwara M, Kinouchi H, Sugita K. Xanthogranuloma of the sellar region accompanied by growth hormone deficiency: case report and

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Discussion

Xanthogranuloma of the sellar region is a rare entity that mostly presents in children, adolescents, and young adults [3]. Annual

incidence approximates 0.05 per million inhabitants. Tumors occur in the choroid plexus of the lateral ventricles, and rarely in

the sellar and parasellar region [4]. Xanthogranulomas were distinguished from craniopharyngiomas first in 1999 [5]. Sellar

Xanthogranulomas are characterized by the presence of cholesterol crystals, hemosiderin deposits, lymphocytic infiltrates,

macrophage accumulation, fibrous proliferation, and sparse clusters of epithelial cells [6]. However, they are still frequently

misdiagnosed as craniopharyngiomas due to their macroscopic intraoperative features and the occasional presence of epithelial

components. Clinical symptoms are of wide range and remain nonspecific. Xanthogranulomas may be responsible of several

neurological and endocrine disorders such as visual impairment due to optic chiasm compression, panhypopituitarism, diabetes

insipidus of central origin, and obstructive hydrocephalus [7]. Magnetic resonance imaging (MRI) is crucial step in the

management of this entity. However, features are rarely specific. Cholesterol crystals are observed hyperintense on T1 weighted

image and hypointense on T2. Hemosiderin cysts are iso or hyperintense on T1 sequence and hyperintense on T2. Fibrosis is

hypointense on T1 and T2 images. After gadolinium administration, enhancement is usually heterogeneous [8].

Surgical resection is necessary and reduce mass effect neurological consequences. The evolution of the hormonal deficiency is

variable. In our case, the patient’s hormonal deficits did not improve, and she resumed her endocrine replacement therapy. The

histopathological examination of the excised specimen confirms the Xanthogranuloma diagnosis in most of the cases.