Sellar colloid cyst: Peculiar radiological characteristics of a common lesion at an uncommon location
- Department of Neurosurgery, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
Bhanu Pratap Singh Chauhan, Department of Neurosurgery, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
DOI:10.25259/SNI_571_2023Copyright: © 2023 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Bhanu Pratap Singh Chauhan, Binita Dholakia, Chirag Hirani, Wajid Nazir, Daljit Singh, Hukum Singh. Sellar colloid cyst: Peculiar radiological characteristics of a common lesion at an uncommon location. 15-Sep-2023;14:327
How to cite this URL: Bhanu Pratap Singh Chauhan, Binita Dholakia, Chirag Hirani, Wajid Nazir, Daljit Singh, Hukum Singh. Sellar colloid cyst: Peculiar radiological characteristics of a common lesion at an uncommon location. 15-Sep-2023;14:327. Available from: https://surgicalneurologyint.com/surgicalint-articles/12560/
Background: Colloid cysts, common benign lesions of the third ventricle, have rarely been reported in uncommon extraventricular locations such as the pituitary fossa. Even in the sellar region, it is usually seen between the anterior and posterior pituitary lobes (pars intermedia).
Case Description: Here, we report a case of a female patient, who was incidentally diagnosed with a sellar colloid cyst, while being evaluated for nonspecific holocranial headache. On imaging, there was a lesion located in the anterior sellar region, compressing the whole pituitary gland posteriorly (first reported case to the best of our knowledge), that was found to be a colloid cyst intraoperatively during microsurgical excision through transnasal transsphenoidal route.
Conclusion: This rare entity should be kept in mind while considering lesions of the pituitary region, as evident by typical radiological features, in spite of being located in a less likely site.
Keywords: Anterior sellar colloid cyst, Incidental finding, Transnasal transsphenoidal excision
Colloid cysts are common benign lesions of the third ventricle, with a reported incidence of 0.2–2%, usually arising from the roof.[
A 45-year-old previously healthy female presented to us with nonspecific holocranial headache for 2 years. After the failure of initial management with analgesics, and ruling out other nonorganic causes of headache, she was evaluated with magnetic resonance imaging (MRI) brain and was found to have sinusitis [
(a) Magnetic resonance imaging brain sagittal T2 sequence showing hyperintense signal along the wall of the sphenoid and partially along the ethmoid sinus, suggestive of sinusitis, and a hypodense lesion in the sellar region (orange arrow) with dense central hypodensity (dot sign) (green arrow), compressing the normal pituitary gland inferoposteriorly (blue arrow). (b) Interval magnetic resonance imaging brain sagittal T1 sequence showing hyperintense sellar lesion (orange arrow), coronal T2 sequence showing resolved sinusitis and hypointense sellar lesion with central nodule (green arrow), and a sagittal post-contrast sequence showing nonenhancing lesion (black arrow) and mildly enhancing nodule (red arrow) with normal enhancing pituitary gland (yellow arrow). (c) Contrast-enhanced computed tomography brain showing a hyperdense lesion in sella (orange arrow) in sagittal and axial sections.
(a) Intraoperative microscopic image showing viscous white mucoid content (blue arrow) oozing out. (b) Intraoperative microscopic image showing thin translucent capsule (marked in blue oval) and a firm yellow nodule (arrow). (c) Postoperative contrast-enhanced magnetic resonance imaging brain sagittal section showed no residual lesion and a normal enhancing pituitary gland (orange arrow), which has expanded after the excision of the lesion.
Colloid cysts are usually found within the ventricular system, particularly the roof of third ventricle.[
Here, in spite of radiological characteristics suggestive of a typical colloid cyst, we did not consider it in our differential diagnosis initially, as the location was an anterior sellar region, which is highly unlikely for a colloid cyst. The diagnosis was made intraoperatively.
Colloid cyst of the pituitary gland is a very rare pathology, with a wide range of presentation from being asymptomatic to profound neurological deficits and hormonal disturbances. They need to be kept in mind while considering the differential diagnosis of sellar suprasellar lesions, especially when the lesion appears hypointense on T2 without contrast enhancement and a dot sign, that is central low signal intensity on T2 as compared to the periphery of the lesion. MRI characteristics of such lesions are highly specific, irrespective of the location, and in spite of these being found in uncommon locations. These can be safely managed by minimally invasive transnasal transsphenoidal routes, either microscopic or endoscopic.
Patient’s consent not required as patients identity is not disclosed or compromised.
Publication of this article was made possible by the James I. and Carolyn R. Ausman Educational Foundation.
There are no conflicts of interest.
The author(s) confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
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