International journal of surgery case reports · 2025
Sellar and parasellar paraganglioma mimicking pituitary macroadenoma in a young female: A rare case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Zico Isma Azam, Anam Jahinul, Khalil Ibrahim, Al Noman Abdullah
Аннотация
INTRODUCTION AND IMPORTANCE: Sellar and parasellar paragangliomas are exceptionally rare neuroendocrine tumors, often mistaken for pituitary adenomas or meningiomas due to their anatomical location and radiological similarities. This report presents a rare case of sellar-parasellar paraganglioma, highlighting diagnostic challenges and management strategies.
PRESENTATION OF CASE: A 25-year-old female presented with progressive visual disturbances, headache, and lactational amenorrhea. Clinical examination revealed bitemporal hemianopia and diplopia. Imaging showed a 6.0 cm lobulated sellar-suprasellar mass with left temporal fossa extension, hypointense on T1, hyperintense on T2, with a classic "salt and pepper" appearance and strong contrast enhancement. Initial endonasal transsphenoidal surgery was aborted due to uncontrollable bleeding. Subsequent transcranial surgery achieved near-total resection, with histopathological confirmation of paraganglioma.
CLINICAL DISCUSSION: The highly vascular tumor necessitated a transcranial approach for maximal resection. Post-operatively, the patient's visual symptoms partially improved, but she developed left-sided ptosis. Stereotactic radiotherapy was planned for residual tumor. Histopathology showed round to oval cells in nests, positive for chromogranin A, with minimal atypia.
CONCLUSION: Sellar-parasellar paragangliomas pose significant diagnostic and therapeutic challenges due to their rarity, radiological mimicry, and hypervascularity. Accurate preoperative diagnosis requires high suspicion, advanced imaging, and histopathological confirmation. A multidisciplinary approach combining microsurgery and adjuvant radiotherapy is essential for optimal management.
PRESENTATION OF CASE: A 25-year-old female presented with progressive visual disturbances, headache, and lactational amenorrhea. Clinical examination revealed bitemporal hemianopia and diplopia. Imaging showed a 6.0 cm lobulated sellar-suprasellar mass with left temporal fossa extension, hypointense on T1, hyperintense on T2, with a classic "salt and pepper" appearance and strong contrast enhancement. Initial endonasal transsphenoidal surgery was aborted due to uncontrollable bleeding. Subsequent transcranial surgery achieved near-total resection, with histopathological confirmation of paraganglioma.
CLINICAL DISCUSSION: The highly vascular tumor necessitated a transcranial approach for maximal resection. Post-operatively, the patient's visual symptoms partially improved, but she developed left-sided ptosis. Stereotactic radiotherapy was planned for residual tumor. Histopathology showed round to oval cells in nests, positive for chromogranin A, with minimal atypia.
CONCLUSION: Sellar-parasellar paragangliomas pose significant diagnostic and therapeutic challenges due to their rarity, radiological mimicry, and hypervascularity. Accurate preoperative diagnosis requires high suspicion, advanced imaging, and histopathological confirmation. A multidisciplinary approach combining microsurgery and adjuvant radiotherapy is essential for optimal management.