Apoplectic Silent Crooke Cell Adenoma with Adjacent Pseudoaneurysms: Causation or Bystander?
ACTH-Secreting Pituitary Adenoma
/ complications
Aneurysm, False
/ complications
Carotid Artery Diseases
/ complications
Carotid Artery, Internal
/ pathology
Humans
Intracranial Aneurysm
/ complications
Magnetic Resonance Imaging
/ methods
Male
Middle Aged
Pituitary Gland
/ pathology
Pituitary Neoplasms
/ diagnosis
Aneurysms
Apoplexy
Crooke cell adenoma
Pituitary gland
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
29
06
2018
revised:
29
10
2018
accepted:
31
10
2018
pubmed:
23
11
2018
medline:
21
3
2019
entrez:
23
11
2018
Statut:
ppublish
Résumé
Crooke cell adenomas (CCAs) are rare and potentially aggressive pituitary tumors that often invade the cavernous sinuses. Although clinical presentations of pituitary tumors may include the development of accompanying intracranial aneurysms, there are no documented cases of coexistent intracranial aneurysms and CCAs to date. Herein we describe an apoplectic silent CCA that presented with adjacent cavernous internal carotid artery (ICA) aneurysms. A 45-year old male patient presented for evaluation of headaches and diplopia. Subsequent imaging series revealed a hemorrhagic pituitary macroadenoma that had invaded the left cavernous sinus and circumferentially involved the ICA. Two pseudoaneurysms were visualized along regions of the ICA directly attached to the tumor. A transnasal transsphenoidal endoscopic approach was used for resection of the tumor, which was identified histologically as a CCA. Endocrine evaluations characterized the tumor as nonfunctional. The patient experienced an excellent recovery with resolution of related symptoms. A pseudoaneurysm was treated with a Pipeline embolization device; however, it persisted at last follow-up. CCAs are a poorly characterized and rare pituitary tumor type. In this case, an apoplectic silent CCA invaded the left cavernous sinus and presented with pseudoaneurysms along its involvement of the ICA. Accordingly, the authors speculated that the invasive qualities of this silent corticotroph adenoma may have directly contributed to the development of these aneurysms.
Sections du résumé
BACKGROUND
BACKGROUND
Crooke cell adenomas (CCAs) are rare and potentially aggressive pituitary tumors that often invade the cavernous sinuses. Although clinical presentations of pituitary tumors may include the development of accompanying intracranial aneurysms, there are no documented cases of coexistent intracranial aneurysms and CCAs to date. Herein we describe an apoplectic silent CCA that presented with adjacent cavernous internal carotid artery (ICA) aneurysms.
CASE DESCRIPTION
METHODS
A 45-year old male patient presented for evaluation of headaches and diplopia. Subsequent imaging series revealed a hemorrhagic pituitary macroadenoma that had invaded the left cavernous sinus and circumferentially involved the ICA. Two pseudoaneurysms were visualized along regions of the ICA directly attached to the tumor. A transnasal transsphenoidal endoscopic approach was used for resection of the tumor, which was identified histologically as a CCA. Endocrine evaluations characterized the tumor as nonfunctional. The patient experienced an excellent recovery with resolution of related symptoms. A pseudoaneurysm was treated with a Pipeline embolization device; however, it persisted at last follow-up.
CONCLUSIONS
CONCLUSIONS
CCAs are a poorly characterized and rare pituitary tumor type. In this case, an apoplectic silent CCA invaded the left cavernous sinus and presented with pseudoaneurysms along its involvement of the ICA. Accordingly, the authors speculated that the invasive qualities of this silent corticotroph adenoma may have directly contributed to the development of these aneurysms.
Identifiants
pubmed: 30465959
pii: S1878-8750(18)32539-7
doi: 10.1016/j.wneu.2018.10.232
pii:
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
480-484Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.