Skip to main content
SpringerLink
Log in

Raumfordernde Prozesse der Sellaregion unter besonderer Berücksichtigung tumorähnlicher Läsionen

  • Übersichten
  • Published:
Der Pathologe Aims and scope Submit manuscript

Zusammenfassung

Die meisten Raumforderungen der Sellarregion werden durch Tumoren hervorgerufen, v. a. durch Hypophysenadenome und Kraniopharyngeome, aber auch Meningeome. In etwa 8% liegt der Raumforderung ein nichtneoplastischer Prozess zugrunde (Entzündungen, Hyperplasien, Zysten u. Ä.). Zysten der Hypophysenregion werden in Rathke-, Arachnoidal-, Kolloid- und Epidermoidzysten klassifiziert und sind abzugrenzen von neoplastischen Zysten, die sich aus Kraniopharyngeomen oder Hypophysenadenomen entwickeln. Die Entzündungen können autochthon (lymphozytäre Hypophysitis, idiopathische granulomatöse Hypophysitis, xanthomatöse und peritumoröse Hypophysitis), oder Teil eines generalisierten Prozesses (Sarkoidose u. Ä.) sein . Hyperplastische Prozesse können zu einer Größenzunahme der Hypophyse auf das Doppelte führen. Prolaktin- und ACTH-Zell-Hyperplasien sind die häufigsten Formen, die diffus oder nodulär auftreten können. Bei nodulärer Architektur können sich Übergangsformen in Adenome ausbilden. Andere Hyperplasien finden sich neben Adenomen oder anderen Tumoren. Auch vaskuläre (Aneurysmen) und knöcherne Prozesse (v. a. die fibröse Dysplasie) können als Raumforderung in der Sellaregion auftreten.

Abstract

Most space occupying lesions of the sellar region are tumors (e.g., pituitary adenomas, craniopharyngiomas, but also meningiomas). In approximately 8% of patients with sellar mass lesions, non-neoplastic disorders (e.g., inflammations, cysts, hyperplasia) are causal. Cystic lesions of the pituitary region are classified as Rathke's cysts, colloid cysts, arachnoidal cysts and epidermoid cysts. These have to be differentiated from cystic craniopharyngeomas or cystic pituitary adenomas. Autochthonous inflammations (lymphocyctic hypophysitis, idiopathic granulomatous hypophysitis, xanthomatous and peritumorous hypophysitis) have to be distinguished from generalized diseases involving the pituitary (e.g., sarcoidosis, tuberculosis). Hyperplasia can result in a doubling of pituitary size. Lactotroph and corticotroph hyperplasia are the most common and may be of a diffuse and nodular type. The nodular form of pituitary hyperplasia may show transition into adenoma. Other hyperplasias may be found adjacent to adenomas or other tumours. Furthermore, vascular (aneurysms) and bony lesions (especially fibrous dysplasia) can appear as space occupying lesions of the sellar region.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1.
Abb. 2.
Abb. 3.
Abb. 4.
Abb. 5.
Abb. 6.

Literatur

  1. Asa SL (1998) Tumors of the pituitary gland. Armed Forces Institute of Pathology, Washington/DC

  2. Harrison MJ, Morgello S, Post KD (1994) Epithelial cystic lesions of the sellar and parasellar region: A continuum of ectodermal derivatives? J Neurosurg 80: 1018–1025

    Google Scholar 

  3. Saeger W (2002) Tumor-like lesions of the pituitary and sellar region. Endocrinologist 12: 300–314

    Google Scholar 

  4. Asa SL, Kovacs K, Bilbao JM, Penz G (1981) Immunohistochemical localization of keratin in craniopharyngiomas and squamous cell nests of the human pituitary. Acta Neuropath (Wien) 54: 257–260

    Google Scholar 

  5. Russell DS, Rubinstein LJ (1989) Pathology of tumours of the nervous system. Edward Arnold, London

  6. Lloyd RV, Douglas BR, Young WF Jr (2002) Pituitary gland. In: de Lellis RA, LiVolsi VA (eds) Endocrine diseases. Armed Forces Institute of Pathology, Washington/DC, pp 1–44

  7. Klonoff DC, Kahn DG, Rosenzweig W, Wilson CB (1990) Hyperprolactinemia in a patient with a pituitary and an ovarian dermoid tumor: case report. Neurosurgery 26: 335–339

    CAS  PubMed  Google Scholar 

  8. Inoue T, Matsushima T, Fukui M, Iwaki T, Takeshita I, Kuromatsu C (1988) Immunohistochemical study of intracranial cysts. Neurosurgery 23: 576–581

    CAS  PubMed  Google Scholar 

  9. Sautner D, Saeger W, Lüdecke DK, Jansen V, Puchner MJA (1995) Hypophysitis in surgical and autoptical specimens. Acta Neuropath (Wien) 90: 637–644

    Google Scholar 

  10. Thodou E, Asa SL, Kontogeorgos G et al. (1995) Clinical case seminar: Lymphocytic hypophysitis: Clinicopathological findings. J Clin Endocrinol Metab 80: 2302–2311

    CAS  PubMed  Google Scholar 

  11. Püschel W, Wernert N, Hinkeldey KKM, Brittner-Flemmer V, Remberger K (1992) Granulomatöse Hypophysitis. Bericht über drei Fälle und Literaturübersicht. Pathologe 13: 100–103

    PubMed  Google Scholar 

  12. Folkerth RD, Price DL, Schwartz M, Black PM, Degirolami U (1998) Xanthomatous hypophysitis. Am J Surg Pathol 22: 736–741

    Article  CAS  PubMed  Google Scholar 

  13. Puchner MJA, Lüdecke DK, Saeger W (1994) The anterior pituitary lobe in patients with cystic craniopharyngiomas: three cases of associated lymphocytic hypophysitis. acta neurochir (Wien) 126: 38–43

    Google Scholar 

  14. Stern BJ, Krumholz A, Johns C, Scott P, Nissim J (1985) Sarcoidosis and its neurological manifestations. Arch Neurol 42: 909–917

    CAS  PubMed  Google Scholar 

  15. Goyal M, Kucharczyk W, Keystone E (2000) Granulomatous hypophysitis due to Wegener's granulomatosis. Am J Neuroradiol 21: 1466–1469

    CAS  PubMed  Google Scholar 

  16. Klatt EC, Nichols L, Noguchi TT (1994) Evolving trends revealed by autopsies of patients with the acquired immunodeficiency syndrome. 565 autopsies in adults with the acquired immunodeficiency syndrome, Los Angeles,Calif, 1992–1993. Arch Pathol Lab Med 118: 884–890

    CAS  PubMed  Google Scholar 

  17. Trouillas J, Guigard MP, Fonlupt P, Souchier C, Girod C (1996) Mapping of corticotropic cells in the normal human pituitary. J Histochem Cytochem 44: 473–479

    CAS  PubMed  Google Scholar 

  18. Young WF Jr, Scheithauer BW, Gharib H, Laws ER Jr, Carpenter PC (1988) Cushing's syndrome due to primary multinodular corticotrope hyperplasia. Mayo Clin Proc 63: 256–262

    PubMed  Google Scholar 

  19. Salgado LR, Mendonca BB, Goldman J et al. (1995) Failure of partial hypophysectomy as definitive treatment in Cushing's disease owing to nodular corticotrope hyperplasia: Report of four cases. Endocr Pathol 6: 57–66

    PubMed  Google Scholar 

  20. Ezzat S, Asa SL, Stefaneanu L et al. (1994) Somatotroph hyperplasia without pituitary adenoma associated with a long standing Growth Hormone-Releasing Hormone-producing bronchial carcinoid. J Clin Endocrinol Metab 78: 555–560

    CAS  PubMed  Google Scholar 

  21. Thorner MO, Perryman RL, Cronin MJ et al. (1982) Somatotroph hyperplasia: successful treatment of acromegaly by removal of a pancreatic islet tumor secreting a growth hormone-releasing factor. J Clin Invest 70: 965–977

    CAS  PubMed  Google Scholar 

  22. Saeger W, Lüdecke DK, Losa M (1997) Kombinierte neuronale und endokrine Tumoren der Sellaregion. Pathologe 18: 419–424

    Article  CAS  PubMed  Google Scholar 

  23. Fechner RE, Mills SE (1992) Tumors of the bones and joints. Armed Forces Institute of Pathology, Washington/DC

  24. Chanson P, Dib A, Visot A, Derome PJ (1994) McCune-Albright syndrome and acromegaly: clinical studies and responses to treatment in five cases. Eur J Endocrinol 131: 229–234

    CAS  PubMed  Google Scholar 

  25. Solcia E, Klöppel G, Sobin LH et al. (2000) Histological typing of endocrine tumours. Springer, Berlin Heidelberg New York Tokio

  26. Saeger W, Schröder S, Klöppel G (2001) Pathologie wichtiger Erkrankrungen endokriner Organe (Schilddrüse ausgenommen). Pathologe 22: 296–309

    Article  CAS  PubMed  Google Scholar 

  27. Lübke D, Saeger W (1995) Carcinomas of the pituitary: definition and review of the literature. Gen Diagn Pathol 141: 81–92

    PubMed  Google Scholar 

  28. McKeever PE, Blaivas M, Gebarski SS (2001) Sellar tumors other than adenomas. In: Thapar K, Kovacs K, Scheithauer BW, Lloyd RV (eds) Diagnosis and management pituitary tumors. Humana, Totowa/NJ, pp 387–448

  29. Kurosaki M, Saeger W, Lüdecke DK (2001) Immunohistochemical localization of cytokeratins in craniopharyngioma. Acta Neurochir (Wien) 143: 147–151

    Google Scholar 

  30. Janzer RC, Burger PC, Giangaspero F et al. (2000) Tumours of the sellar region. In: Kleihues P, Cavenee WK (eds) Pathology and genetics: Tumours of the nervous system. International Agency for Research and Cancer (IARC), Lyon, pp 243–248

  31. Louis DN, Scheithauer BW, Budka H et al. (2000) Meningeal tumours. In: Kleihues P, Cavenee WK (eds) Pathology and genetics: Tumours of the nervous system. International Agency for Research and Cancer (IARC), Lyon, pp 175–196

  32. Finkelstein SD, Hirose T, van den Berg SR et al. (2000) Peripheral neuroblastic tumours. In: Kleihues P, Cavenee WK (eds) Pathology and genetics: Tumours of the nervous system. International Agency for Research and Cancer (IARC), Lyon, pp 149–162

  33. Cavenee WK, Furnari FB, Nagane M et al. (2000) Astrocytic tumours. In: Kleihues P, Cavenee WK (eds) Pathology and genetics: Tumours of the nervous system. International Agency for Research and Cancer (IARC), Lyon, pp 9–54

  34. Reifenberger G, Kros JM, Burger PC, Louis DN, Collins VP (2000) Oligodendroglial tumours and mixed gliomas. In: Kleihues P, Cavenee WK (eds) Pathology and genetics: Tumours of the nervous system. International Agency for Research and Cancer (IARC), Lyon, pp 55–70

  35. Woodruff JM, Kourea HP, Louis DN, Scheithauer BW, Giannini C (2000) Tumours of the cranial and peripheral nerves. In: Kleihues P, Cavenee WK (eds) Pathology and genetics: Tumours of the nervous system. International Agency for Research and Cancer (IARC), Lyon, pp 163–174

  36. Nelson JS, Bruner JM, Wiestler OD et al. (2000) Neuronal and mixed neuronal-glial tumours. In: Kleihues P, Cavenee WK (eds) Pathology and genetics: Tumours of the nervous system. International Agency for Research and Cancer (IARC), Lyon, pp 95–114

  37. Rosenblum MK, Matsutani M, van Meir EG (2000) Germ cell tumours. In: Kleihues P, Cavenee WK (eds) Pathology and genetics: Tumours of the nervous system. International Agency for Research and Cancer (IARC), Lyon, pp 207–214

  38. Saeger W, Riedel M, Schröder H (1985) Metastasen in der Hypophyse und der Sella. Pathologe 6: 308–312

    CAS  PubMed  Google Scholar 

  39. Ernestus R-I (2002) Operative Behandlung von Hypophysentumoren. In: Jockenhövel F (ed) Erkrankungen von Hypophyse und Hypothalamus. Uni-Med, Bremen, pp 196–211

  40. Scheithauer BW (1998) The hypothalamus and neurohypophysis. In: Kovacs K, Asa SL (eds) Functional endocrine pathology. Blackwell Science, Malden, pp 171–246

Download references

Author information

Authors and Affiliations

  1. Institut für Pathologie des Marienkrankenhauses, Alfredstraße 9, 22087 , Hamburg

    W. Saeger

  2. Institut für Pathologie des Marienkrankenhauses, Hamburg

    W. Saeger

Authors
  1. W. Saeger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Saeger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saeger, W. Raumfordernde Prozesse der Sellaregion unter besonderer Berücksichtigung tumorähnlicher Läsionen. Pathologe 24, 247–254 (2003). https://doi.org/10.1007/s00292-003-0626-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00292-003-0626-9

Schlüsselwörter

Keywords

Search

Navigation