This outpouching, known as Rathke’s pouch, extends cranially towards the floor of the diencephalon to later form the adenohypophysis or anterior pituitary gland. Almost all pituitary tumors are benign (not cancer) glandular tumors called pituitary adenomas. Craniopharyngioma is a rare type of noncancerous (benign) brain tumor.
Spread between the mix, one can find cystic cavities which hold an oily proteinaceous fluid along with cholesterol, piloid gliosis, granulomatous inflammation, calcification, and nodules of “wet keratin.”On the other hand, papillary craniopharyngioma is characterized as well-differentiated squamous epithelium lacking surface maturation, with occasional goblet cells and ciliated epithelium. These embryonic cells can proliferate around the extension of the craniopharyngeal duct and develop into a craniopharyngioma.The metaplastic theory is related to the development of papillary craniopharyngiomas, which are believed to be the most common subtype of craniopharyngioma in adult patients. While migrating cranially, its extension forms the craniopharyngeal duct which later involutes. The reservoir then permits instillation of substances into the tumor as well as aspiration of cystic fluid, which can be performed as an outpatient procedure.Radiation therapy includes various modalities: conventional external radiotherapy, proton beam therapy, stereotactic radiotherapy, radiosurgery, and brachytherapy. Therefore, it continues to be an adjuvant modality to neurosurgical intervention.This method consists of instillation of different toxic substances with the endpoint of producing tumor fibrosis and sclerosis, for example, radioactive isotopes, bleomycin, interferon alpha. It may present at any age, even in the prenatal and neonatal periods, but peak incidence rates are childhood-onset at 5–14 years and adult-onset at 50–74 years.
In some cases, surgery to remove the tumor could damage the tissue to which the tumor is attached. Calcification is uncommon or even rare in the papillary subtype, a fact often forgotten Multiple modalities can be implemented in the management of craniopharyngioma, including neurological surgery, radiotherapy, and instillation of sclerosing substances. For this reason, craniopharyngioma is extremely difficult to control, and it is also notorious for its high rates of recurrence Craniopharyngiomas are usually a partly solid and partly fluid-filled cyst.
A second, smaller peak occurs in adults aged over 40 years old, consisting of both papillary and adamantinomatous subtypes 10,11,13,14. Solid components are present, but often form a relatively minor part of the mass and enhance vividly on both CT and MRI. These partial resections can be accompanied by adjuvant methods including radiotherapy and instillation of sclerosing substances. They are usually found as macroadenomas, causing symptoms because of their size as they press on nearby structures.The symptoms of functioning pituitary adenomas depend on the particular hormone the tumor is overproducing.A pituitary tumor that produces too much prolactin may cause:A pituitary tumor that produces too much adrenocorticotropic hormone (ACTH) may cause:A pituitary tumor that produces too much growth hormone may cause:A pituitary tumor that produces too much TSH (through high T4) may cause:Nonfunctioning tumors press on or damage the pituitary and prevent it from secreting enough hormones. In some occasions, involution is not total, and remnants of ectodermal cells can be present. A minority are purely suprasellar (20%), whereas purely intrasellar location is quite uncommon (<5%), and may be associated with the expansion of the pituitary fossa Occasionally, craniopharyngiomas appear as intraventricular, homogeneous, soft-tissue masses without calcification (papillary subtype). If a pituitary adenoma makes too much of a hormone it’s called functional or secretory tumors. Because the symptoms are generally caused by pressure from the growing tumor on the brain, the optic nerves or the pituitary gland, the way to relieve the symptoms is usually to remove or shrink the tumor.In the vast majority of cases, craniopharyngiomas have a large suprasellar component (95%), with most involving both the suprasellar and intrasellar spaces (75%).
There are two major theories of the development of craniopharyngioma: the embryonic theory and the metaplastic theory.
There is very little room for tumors to grow in this part of the skull. Despite being benign, pituitary adenomas can cause major health problems because they are close to the brain, may invade nearby tissues (like the skull or the sinuses).
Craniopharyngiomas are rare benign (noncancerous) tumors that are typically found near the pituitary gland and hypothalamus, which are positioned beneath the center of the brain, behind and between the eyes. As a craniopharyngioma slowly grows, it can affect the function of the pituitary gland and other nearby structures in the brain. It states that adenohypophyseal cells of the pars tuberalis can undergo metaplasia and result in the formation of squamous cell nests.
The types of modalities chosen depend on neurosurgeon judgment and experience.The most common surgical approaches include pterional, subfrontal, and transsphenoidal. It also affects which tests are used for diagnosis, the choice of treatment, and the patient’s outlook.Pituitary adenomas that don’t make excess hormones are called non-functional adenomas or null cell adenomas. The UCLA Pituitary Tumor Program has experts in each of the specialties, working closely together to provide you with the most comprehensive, state-of-the-art surgical and non-surgical treatments.
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