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### Rathke cleft cyst |
Rathke cleft cyst (RCC) is a benign lesion located within or above the pituitary gland, arising from remnants of the fetal Rathke pouch [69]. These lesions vary in size from a few millimeters up to 40 mm, with the majority measuring between 10 and 20 mm in diameter. Most RCCs are asymptomatic, and the majority discover... |
CT is useful for diagnosis, showing a well-demarcated round or ovoid intrasellar-suprasellar mass located at the midline between the anterior and posterior pituitary lobes. RCCs usually appear homogeneously hypodense (75% of the cases), less frequently mixed hypo-isodense (20%) and hyperdense (10%), without calcificati... |
On histology, RCC shows small fragments of fibrovascular stroma, partially lined from pseudostratified columnar epithelium, resembling that of respiratory tract, with intermingled goblet cells. |
Main differential diagnoses include CPs and PAs. CPs often show enhancing solid components and calcifications, not present in RCCs. On the other hand, intracystic nodule, midline location within the gland, no fluid-fluid level, and no septation may help differentiate RCCs from PAs. |
RCCs are usually stable “leave me alone” lesions with a good prognosis. Surgical treatment may be required in case of symptomatic lesions or diagnostic doubts. |
### Arachnoid cyst |
Arachnoid cysts (ACs) represent the most common off-midline extra-axial cysts and are usually located within the subarachnoid spaces, including the suprasellar cistern. |
Also known as meningeal cysts, they are CSF filled lesions lined by a layer of flattened arachnoid cells. ACs are sometimes in communication with subarachnoid cisterns. |
Most ACs are primary and due to meningeal development anomalies (embryonic endomeninges fail to merge and remain separated). On the other hand, inflammation, tumor, trauma, or hemorrhage may give rise to secondary ACs [73]. |
Although ACs are generally asymptomatic, some patients may experience a wide variety of symptoms related to the location and size of the lesion. Nevertheless, the most frequent clinical presentation is headache. Subdural hematoma may represent a rare complication of ACs after minor trauma [74]. |
On CT, uncomplicated ACs show CSF density and do not enhance. Intrathecal instillation of contrast agent (CT cisternography) may be helpful in documenting communication with the subarachnoid space. ACs also follow CSF signal on all MRI sequences (Fig. 15). They do not present diffusion restriction nor contrast enhancem... |
Histological examination show a delicate fibrous tissue forming cyst wall (arachnoid laminar connective tissue) lined by an attenuated meningothelium. Stroma is edematous with lymphocytic infiltrate. |
The main differential diagnosis is the epidermoid cyst which however shows higher signal than CSF on FLAIR sequence and diffusion restriction. |
Asymptomatic ACs do not require treatment (“leave me alone” lesions). When treatment is required, surgical options include fenestration, endoscopic resection, marsupialization, or cysto-peritoneal shunting with a programmable valve. |
### Hypophysitis |
Hypophysitis is a rare inflammatory disease of the pituitary gland and its stalk that can be classified based on the anatomical extension (adenohypophysitis, infundibuloneurohypophysitis, panhypophysitis), its etiology (primary or secondary, when associated with sellar lesions or systemic inflammatory diseases), and hi... |
Histological examination shows fragment of fibrotic tissue with lymphoplasmacytic infiltrate and a hemorrhagic background with pigmented macrophages. |
Differential diagnoses include NFPAs, CPs, metastases, RCC, IGCTs, lymphoma and, in the post-partum period, Sheehan’s syndrome. The management of hypophysitis consists of high-dose glucocorticoid administration and hormone replacement therapy [83]. Moreover, during the acute phase of hypophysitis, immunosuppressive the... |
### Pituitary abscess |
Pituitary abscess represents a rare but life-threatening condition, with immunosuppression, surgery, and infections that are known predisposing factors [84]. The clinical presentation includes fever, meningism, and symptoms due to mass effect, such as headache, visual change, and hypopituitarism [85]. On MRI, a cystic ... |
### Sellar region lymphoma |
Lymphoma of the sellar region is a rare entity that may origin from the infundibulum, pituitary gland, or the hypothalamus, with a diffusely infiltrative growth and a propensity for perineural spread. Diffuse large B cell lymphoma represents the most common type (90%), and usually occurs in immunodepressed patients wit... |
On hematoxylin-eosin staining, these tumors are composed of medium to large-sized cells, arranged in a discohesive pattern, and show an immunohistochemical profile consistent with a high-grade B cell lymphoma. |
Differential diagnoses include infections, metastases, and PAs. The role of surgery is generally restricted to stereotactic biopsy. The management of lymphomas is based on multimodal treatment, which includes high-dose methotrexate, other chemotherapeutic agents and radiotherapy [91]. Unfortunately, disease recurrence ... |
### Meningioma |
Meningioma is the second most common tumor of the sellar region in adults, with an incidence peak between the sixth and the seventh decade of life and female predominance. Meningiomas of this region may arise from the tuberculum sellae, clinoid processes, or cavernous sinus walls. Clinical presentation is related to co... |
On histological examination, atypical meningiomas show loss of lobular architecture (“sheeting”) and hypercellularity. In some field, cells with high nuclear/cytoplasmatic ratio (“small cell change”) can be visible, along with nodular areas composed of clear cells. Immunolabeling with Ki67 shows a proliferative index n... |
Differential diagnoses of sellar/parasellar meningiomas include metastasis, lymphoma, PA, and cavernous sinus venous malformation. Surgery is the therapy of choice in symptomatic or growing lesions. However, the proximity of these tumors to the optic nerve, cavernous sinus, and internal carotid artery often precludes s... |
### Cavernous venous malformations |
Cavernous hemangiomas of cavernous sinus are not true neoplasms and are better described as venous malformations (VMs) according to the International Society for the Study of Vascular Anomalies (ISSVA) 2018 classification. VM is a rare congenital vascular anomaly containing endothelial-lined sinusoidal spaces filled wi... |
On microscopy, VMs show different sized, ectasic, vascular channels, often back-to-back arranged, densely packed. Vessels are lined by flattened, benign-appearing endothelium. The immunostaining for CD31 is typical. |
Differential diagnoses include PA, meningioma, and schwannoma. Total removal of these highly vascular lesions is often very difficult due to the risk of severe intraoperative bleeding and the presence of critical neurovascular structures within the cavernous sinus. Stereotactic radiosurgery has been shown to be a succe... |
### Pituitary metastasis |
Pituitary metastases are rare (about 1% of all surgically treated pituitary lesions) [98]. Lung and breast are the most common primary sites of origin, with a predilection for the posterior pituitary, given its direct connection with systemic circulation [99]. The onset of diabetes insipidus in an oncologic patient is ... |
The histologic findings vary according to the histotype of the primary tumor. |
Differential diagnoses include LHy, lymphoma, Langerhans cell histiocytosis, and neurosarcoidosis. Treatment and prognosis depend on the primary tumor. Surgical decompression and radiotherapy can be considered in symptomatic patients. |
### Optic pathway glioma |
Optic pathway gliomas (OPGs) are rare low-grade gliomas (WHO grade 1) that arise from the optic pathway (optic nerve, optic chiasma, optic tract, lateral geniculate body) or hypothalamus, most frequently in children with a mean age of 4–5 years. The main histological subtypes are pilocytic astrocytoma and pilomyxoid as... |
On histopathology, pilocytic astrocytomas show round to spindled nuclei and dendrite-like cytoplasmic processes, often paired with Rosenthal fibers. |
The main differential diagnosis is optic nerve meningioma, that is frequently calcific. OPGs in patients with NF1 sometimes show a spontaneous regression [103]. Management strategies include surgery, chemotherapy, and radiotherapy. Surgery is rarely curative and is reserved to tumors causing severe symptoms related to ... |
### Anterior communicating artery aneurysm |
Aneurysms arising from anterior communicating arteries (ACoA) can mimic a suprasellar or parasellar mass. Saccular aneurysms are the most common type. Peak presentation is between 40 and 60 years of age, with a female predominance. Typical manifestations are related to mass effect and include visual impairment due to o... |
## Conclusions |
Differential diagnosis of neoplasms and tumor-like lesions of the sellar region may not always be easy because of the plethora of entities possibly involving this anatomical region, some of which presenting with similar findings on MRI. The radiologist must be aware of the presence of this wide range of differential di... |
399e61ad1db5531ca2509472eb809bc4a589e98c7ea9eebf21059e7ee2db434c pmc10033642.txt |
PMCID: PMC10309016 |
TITLE: DOG-1 as a Myoepithelial Marker in Discriminating Invasive Breast Carcinomas From Non-Invasive Breast Lesions |
LICENSE: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
ABSTRACT: AbstractIntroductionThe most common cancer in women is, by far, breast cancer. The incidence and mortality of breast cancer must be reduced by a multidisciplinary strategy that includes education campaigns, preventive measures, screening programmes for early diagnosis, and the availability of treatment facili... |
## Introduction |
Breast cancer is by far the most frequent cancer among women with an estimated 2 million new cancer cases diagnosed in 2018 (23% of all cancers), and ranks second overall (10.9% of all cancers) [1]. Breast cancer has ranked number one cancer among Indian females with age adjusted rate as high as 25.8 per 100,000 women ... |
## Materials and methods |
This prospective cross-sectional study was done in the Department of Pathology at Osmania General Hospital, Hyderabad on 60 cases from June 2017 to June 2019. Female patients with different breast lesions including benign proliferating lesions, ductal carcinoma in-situ (DCIS) and invasive carcinoma breast cases were in... |
DOG-1 is a cytoplasmic and membranous stain and p63 is a nuclear stain. Immunoreactivity for each antibody was assessed separately. Immunoreactivity for each antibody was assessed separately and the intensity of DOG1 and p63 was classified as follows: weak or no staining received a score of 1, moderate staining receive... |
## Results |
The mean age of the study population was 33.67 ± 8.48 in the benign and non-invasive breast lesions group and 54.43 ± 12.84 in the invasive lesions group. Fifty percent (15) of the patients with benign lesions belonged to the age group 20-30 years, whereas 26.7% (8) of the patients with malignant lesions belonged to th... |
Histopathological diagnosis of benign breast diseases and non-invasive breast lesions is shown in Table 1. |
[TABLE] Histopathological diagnosis of the benign and non-invasive breast disease cases.DCIS: Ductal carcinoma in-situ |
Diagnosis | Number of cases |
Ductal hyperplasia | 3 |
DCIS | 3 |
Fibrocystic disease | 4 |
Phyllodes | 4 |
Adenosis | 2 |
Fibroadenoma | 14 |
A comparison of histopathological diagnosis with the intensity of DOG1 expression is shown in Table 2. |
[TABLE] Comparison of histopathological diagnosis with the intensity of DOG1 expressionDCIS: Ductal carcinoma in-situ |
Nature of disease | Histopathological diagnosis | DOG-1 Expression Intensity | Total |
Negative | Weak Positive | Strong Positive | |
Benign and non-invasive disease | Fibroadenoma | 0 | 3 | 11 | 14 |
Adenosis | 0 | 1 | 1 | 2 |
Phyllodes | 2 | 0 | 2 | 4 |
Fibrocystic disease | 1 | 1 | 2 | 4 |
DCIS | 1 | 0 | 2 | 3 |
Ductal hyperplasia | 0 | 1 | 2 | 3 |
Invasive disease | Invasive Carcinoma | 28 | 2 | 0 | 30 |
Total | 32 | 8 | 20 | 60 |
Fischer exact = 55.61, p < 0.0001 |
A comparison of histopathological diagnosis with the intensity of P63 expression is shown in Table 3. |
[TABLE] Comparison of histopathological diagnosis with the intensity of P63 expressionDCIS: Ductal carcinoma in-situ |
Nature of disease | Histopathological diagnosis | P63 Expression Intensity | Total |
Negative | Weak Positive | Strong Positive | |
Benign and non-invasive disease | Fibroadenoma | 0 | 3 | 11 | 14 |
Adenosis | 0 | 0 | 2 | 2 |
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