Downloaded from www.ajronline.org by 187.94.223.230 on 11/14/15 from IP address 187.94.223.230. Copyright ARRS. For personal use only; all rights reserved
140
Primary
Sellar-Parasellar
Mohammad
Sarwar1
Olfactory
esthesioneuroblastomas
ognized
neoplasms
with
scnibed [1 -9]. Still neunologic symptoms logic
Esthesioneuroblastoma
symptoms
rarer [9].
have
are
oven
relatively
1 00 cases
having
is their initial In the reported
been
produced
nec-
After
de-
continued
manifestation cases, the
with neuro-
contiguous
intra-
by
cranial spread of the tumor, usually If the three types of esthesioneunoma lioma, esthesioneunocytoma, and
well
been
out
involvement
of the
olfactory
cause of its unique location. radiographic features of this
apparatus
P.,
a 31-year-old
complaint
of
neurologic second
and reflex
Plain
third
lesion
extension
was normal.
the
parts
of each
stain
arteries, basal were elevated.
At surgery was located laterally left
on
veins
the
side
resection region this
case
assay
done
received Received
of the
part
of the
been
optic
published
nerve in the
[1 4].
of
1 B),
cerebral
cerebral
veins
and
carotid
A
also
artery.
partial
sellan
and
left
was within
parasellan
revealed
microscopy
Urinary
limits.
es-
findings
vanillylmandelic
normal
The
intracapsulan
examination
of acid
The patient
nad postoperatively. 6, 1 978:
accepted
of Radiology, Division Galveston, TX 77550
after
revision
of Neuroradiology,
March
29,
University
plain
seen
that
last,
of the
skull
the
5 months
However,
she
films,
tumor
had
later,
had
hen
developed
intracenebral
age
of the
younger
and
from
patient
from
of
this
1 0 years
the
sellan-
established
findings
neuroblastomas
than
arose
at surgery.
mitigates
origin
cerebral
case
to be convincingly against
the
neoplasm, have
possibility
since
occurred
[1 5]. Similarly,
from Further-
all
the
in individ-
age
group,
lack
of an extracranial neunoblastoma, and absence levels of vanillylmandelic acid would exclude the that this lesion could be an intracranial metas-
tasis. is
no
universally
agreed
upon
consensus
on
the
of olfactory esthesioneunoblastoma. One of the considenations is the ganglion of Locy [1 3]. This ganglion grows
blush (fig.
the
an
There
stretching
middle
estimation
indicate
(fig.
to determine
origin
supraclinoid
phase
more,
possibility
a
tumor was found. The tumor nerves and had extended
histologic
AJR 133:140-141, July 1979 1 979 American Roentgen Ray Society 0361-803X/79/1331-0140 $00.00
©
internal
involved.
tumor The
venous
Proximal
and
was
the surgery
November
Department Medical Branch,
the
When
in this
seems
studies
of
of evidence of elevated
region
homogenous
However,
to
region
difficult
angiograms,
unchanged.
neoplasm
radiologic
uals
slight
olfactory and
An almost
The light and electron
after
4,000
left
The
with
was
a multilobulan,
parasellar
it was
the
seem
in size.
region
reported
hemianop-
demonstrated
encapsulated the two optic
accomplished. have
1 A).
the
On
demonstrated
not
each
patient
tnismus.
left
diminution
region
cavernous
into
of Rosenthal,
also
thesioneuroblastoma.
the
artery.
persisted
nerve
of the was
(fig.
of a meningoma.
a vascular, between
oculomotor
panasellan
angiography
carotid
and
bitemporal
interim.
from
status
That
the chief of the
in the
neurologic
panasellar
6 weeks.
the skull
of
of
about
also
each
with
distribution nerve
was
sinus
carotid
phase
tnigeminal
and
sphenoid
for
in the
tomognams
sellar
internal
the
cheek
There
displacement
arterial
mimicking
was admitted
left
of the and
Bilateral
inferolateral
the
detected.
in the
into
and
the
divisions
were
woman,
hypesthesia
nadiographs
calcified
in
of
numbness
examination,
corneal sia.
black
tumor did
the
of hen disease
demonstrated and
determined scan
therapy,
progression
scan available,
increased
and
Report
0.
CT
in the sellar was
noticeably
the
Case
CT
without
Discussion
be-
A brief review of the origin neoplasm is presented.
the
ptosis. CT scan
prior
as
radiation
5 years
lesion
of the
size
bilateral
with-
is reported
no
growth
tumor and
postoperative for
right
calcified
Since
the
under the frontal lobes. (esthesioneunoepitheesthesioneunoblastoma)
to three [9, 1 2, 13]. esthesioneunoblastoma
had
partially 2).
and
to do well
she
until
are combined, then six such cases have been reported where the initial manifestation was intracranial tumor [91 3]. However, if only esthesioneuroblastoma itself is considered, then the list is reduced A case of a sellan-parasellan
surgery
1979.
of Texas
between the olfactory fossa and the telencephalic vesicle. The cells of this ganglion can be seen in the nasal septum, lamina cnibrosa, and cnista galli. Some of the nerve fibers can be traced to the hypothalamus. It is then quite possible that the part of the ganglion of Locy that is traceable to the hypothalamus can be the starting point of the origin of an ethesioneuroblastoma. If this is the case, the sellan-paraselIan location
of the
Alternatively neoplasm neural
crest
If these
neoplasm
reported
here
and more simplistically, one to have grown from derivatives
may
be explained.
may regard this of the cranial
[14].
are to be correctly diagnosed preoperabe considered in the initial differential diagnosis of calcified sellar-panasellar lesions. A correct preoperative diagnosis of this neoplasm was understandably not considered in this case. The calcification in the tumor requires consideration of chondroma and meningioma in the tively,
they
differential
dludes seen
tumors
must
diagnosis.
likelihood in
meningioma.
The
homogenous
of a chondroma Tumor
blush
reliably
ex-
[1 6] and is similar to that vasculanity and early draining
Downloaded from www.ajronline.org by 187.94.223.230 on 11/14/15 from IP address 187.94.223.230. Copyright ARRS. For personal use only; all rights reserved
AJR:133,
July
CASE
1979
Fig. 1 -A, Lateral tomogram of sellar region. Intrais normal. B, Left carotid arteniogram, lateral subtraction seen in right carotid angiogram.
REPORTS
and suprasellan calcification film of late arterial phase.
141
Part
(arrowhead). Homogeneous
3.
4.
of floor of sella turcica of tumor (arrowheads)
stain
Obert
GJ,
mas.
Cancer
Devine
Fitz-Hugh
GS,
Allen
Lewis
origin. EM,
Review Arch
CT scans at sellar bilaterally into medial
region. aspect
Partially of each
10.
M,
been
have
secondarily
described
esthesioneunoblastomas
in
invaded
the
intracranial
that
cavity
[9,
11
These apy. an
tumors
are
radiosensitive
to be surgical The
radiosensitivity
unnecessary
plasms
they
are
at
close
the
followed this
of
attempt
when
and
resection
neoplasm
total
to the
ideal should
resection
of
1 2.
treatment
by radiation
neo-
hypothalamus.
WB:
Olfactory
esthesioneuro-epitheliomas.
1 5.
Radiology
1951
Aldave
A,
Report
of a case
43-46,
Dastur
DK,
Gallagen
1959
HS: and
Olfactory
review
of the
esthesioneuroepithelioma. literature.
Arch
Pathol
67:
JH:
1 6.
types HO:
Polle
GJ:
Primary
Otolarynintracranial
J Neuro-
neunoblastoma).
Presse
Micheau
B: Tumeun dite de Ia a development
Med
C:
VS:
Pathological
lesions
in 1 000
and
unusual
68
: 1 981
-1
Microscopical
984,
1960
diagnosis
and report
analysis cases
cases
Neuroblastoma
25:99-108,
Schochet
of
including
intracranial children.
J Neurol
of glioma.
of
of five
II.
Sci
8:
Rubinstein
of the
olfactory
nerve.
Acta Neu-
1971
55,
Peters
B, O’NeaI
A light
(Berl) U:
tral
neuroepithelial
26,
1972
mas.
Ann
1969
Jakumeit
Sarwar
of two cases.
Esthesioneunoblastoma.
Hetpertuiset
et nasal.
Lalitha
Neuropathol
57:541-546,
U,
R, Berd
R,
oneurobiastoma.
REFERENCES
2.
Genard-Manchant
rochir 14.
1 . Seaman
neuroepithelioma.
(esthesioneuroepithelioma),
cerebral
143-170, 1 3.
of
1973
Messimy
Incidence,
preclude
tumors
1965
1966
(olfactory
space-occupying
then-
these
LT: Olfactory
olfactory esthesioneuromas: journal review cases. J Cancer Inst 35 : 75-82, 1965
10,
13].
seems
.
74,
and presentation
5, Webster
Rubinstein
olfactive
simultane have
FW: Nasal
: 1 69-1
81
FS, Tenta
38:548-556,
David
Otolaryngol
1970
AE,
placode veins
Massani
79:547-550,
surg
R, Foote
Otolaryngol
esthesioneuroblastoma
calcified, multilobular middle fossa.
PM: Olfactory
Arch
AJR 1 05 : 7- 1 3, 1960 MH: Neurogenous nasal neoplasms.
Hamilton
9, Fig. 2.-Plain lesion extends
neuroblasto-
of 7 cases.
McGavnan gol
Olfactory
TN, Sprinkle
RVP, Tollefsen Arch
L, De La Pava
A report 8.
Rucker
of the world literature Otolaryngol 84 : 644-653,
Castro
7.
MS,
JR:
1960
1965
JS, Hutten
Skolnik
6.
5,
(esthesioneuroepithelioma).
81 :161-168, olfactory
McDonald
1 3 : 205-21
neuroblastoma 5,
KD,
is eroded. Cnibiform plate region in sellar region. Similar stain was
J, et al:
electron
31 : 1 81 -1 89,
Cytogenesis
M, Swischuk AJR 127:973-977,
and
tumors.
and
esthesistudy.
Acta
1975 differentiation
J Neuropatho/
LE, Schechter 1976
Intracranial
microscopic
of primitive
Exp
Neurol
MM: Intracranial
cen31 :7-
chondro-
140
Primary
Sellar-Parasellar
Mohammad
Sarwar1
Olfactory
esthesioneuroblastomas
ognized
neoplasms
with
scnibed [1 -9]. Still neunologic symptoms logic
Esthesioneuroblastoma
symptoms
rarer [9].
have
are
oven
relatively
1 00 cases
having
is their initial In the reported
been
produced
nec-
After
de-
continued
manifestation cases, the
with neuro-
contiguous
intra-
by
cranial spread of the tumor, usually If the three types of esthesioneunoma lioma, esthesioneunocytoma, and
well
been
out
involvement
of the
olfactory
cause of its unique location. radiographic features of this
apparatus
P.,
a 31-year-old
complaint
of
neurologic second
and reflex
Plain
third
lesion
extension
was normal.
the
parts
of each
stain
arteries, basal were elevated.
At surgery was located laterally left
on
veins
the
side
resection region this
case
assay
done
received Received
of the
part
of the
been
optic
published
nerve in the
[1 4].
of
1 B),
cerebral
cerebral
veins
and
carotid
A
also
artery.
partial
sellan
and
left
was within
parasellan
revealed
microscopy
Urinary
limits.
es-
findings
vanillylmandelic
normal
The
intracapsulan
examination
of acid
The patient
nad postoperatively. 6, 1 978:
accepted
of Radiology, Division Galveston, TX 77550
after
revision
of Neuroradiology,
March
29,
University
plain
seen
that
last,
of the
skull
the
5 months
However,
she
films,
tumor
had
later,
had
hen
developed
intracenebral
age
of the
younger
and
from
patient
from
of
this
1 0 years
the
sellan-
established
findings
neuroblastomas
than
arose
at surgery.
mitigates
origin
cerebral
case
to be convincingly against
the
neoplasm, have
possibility
since
occurred
[1 5]. Similarly,
from Further-
all
the
in individ-
age
group,
lack
of an extracranial neunoblastoma, and absence levels of vanillylmandelic acid would exclude the that this lesion could be an intracranial metas-
tasis. is
no
universally
agreed
upon
consensus
on
the
of olfactory esthesioneunoblastoma. One of the considenations is the ganglion of Locy [1 3]. This ganglion grows
blush (fig.
the
an
There
stretching
middle
estimation
indicate
(fig.
to determine
origin
supraclinoid
phase
more,
possibility
a
tumor was found. The tumor nerves and had extended
histologic
AJR 133:140-141, July 1979 1 979 American Roentgen Ray Society 0361-803X/79/1331-0140 $00.00
©
internal
involved.
tumor The
venous
Proximal
and
was
the surgery
November
Department Medical Branch,
the
When
in this
seems
studies
of
of evidence of elevated
region
homogenous
However,
to
region
difficult
angiograms,
unchanged.
neoplasm
radiologic
uals
slight
olfactory and
An almost
The light and electron
after
4,000
left
The
with
was
a multilobulan,
parasellar
it was
the
seem
in size.
region
reported
hemianop-
demonstrated
encapsulated the two optic
accomplished. have
1 A).
the
On
demonstrated
not
each
patient
tnismus.
left
diminution
region
cavernous
into
of Rosenthal,
also
thesioneuroblastoma.
the
artery.
persisted
nerve
of the was
(fig.
of a meningoma.
a vascular, between
oculomotor
panasellan
angiography
carotid
and
bitemporal
interim.
from
status
That
the chief of the
in the
neurologic
panasellar
6 weeks.
the skull
of
of
about
also
each
with
distribution nerve
was
sinus
carotid
phase
tnigeminal
and
sphenoid
for
in the
tomognams
sellar
internal
the
cheek
There
displacement
arterial
mimicking
was admitted
left
of the and
Bilateral
inferolateral
the
detected.
in the
into
and
the
divisions
were
woman,
hypesthesia
nadiographs
calcified
in
of
numbness
examination,
corneal sia.
black
tumor did
the
of hen disease
demonstrated and
determined scan
therapy,
progression
scan available,
increased
and
Report
0.
CT
in the sellar was
noticeably
the
Case
CT
without
Discussion
be-
A brief review of the origin neoplasm is presented.
the
ptosis. CT scan
prior
as
radiation
5 years
lesion
of the
size
bilateral
with-
is reported
no
growth
tumor and
postoperative for
right
calcified
Since
the
under the frontal lobes. (esthesioneunoepitheesthesioneunoblastoma)
to three [9, 1 2, 13]. esthesioneunoblastoma
had
partially 2).
and
to do well
she
until
are combined, then six such cases have been reported where the initial manifestation was intracranial tumor [91 3]. However, if only esthesioneuroblastoma itself is considered, then the list is reduced A case of a sellan-parasellan
surgery
1979.
of Texas
between the olfactory fossa and the telencephalic vesicle. The cells of this ganglion can be seen in the nasal septum, lamina cnibrosa, and cnista galli. Some of the nerve fibers can be traced to the hypothalamus. It is then quite possible that the part of the ganglion of Locy that is traceable to the hypothalamus can be the starting point of the origin of an ethesioneuroblastoma. If this is the case, the sellan-paraselIan location
of the
Alternatively neoplasm neural
crest
If these
neoplasm
reported
here
and more simplistically, one to have grown from derivatives
may
be explained.
may regard this of the cranial
[14].
are to be correctly diagnosed preoperabe considered in the initial differential diagnosis of calcified sellar-panasellar lesions. A correct preoperative diagnosis of this neoplasm was understandably not considered in this case. The calcification in the tumor requires consideration of chondroma and meningioma in the tively,
they
differential
dludes seen
tumors
must
diagnosis.
likelihood in
meningioma.
The
homogenous
of a chondroma Tumor
blush
reliably
ex-
[1 6] and is similar to that vasculanity and early draining
Downloaded from www.ajronline.org by 187.94.223.230 on 11/14/15 from IP address 187.94.223.230. Copyright ARRS. For personal use only; all rights reserved
AJR:133,
July
CASE
1979
Fig. 1 -A, Lateral tomogram of sellar region. Intrais normal. B, Left carotid arteniogram, lateral subtraction seen in right carotid angiogram.
REPORTS
and suprasellan calcification film of late arterial phase.
141
Part
(arrowhead). Homogeneous
3.
4.
of floor of sella turcica of tumor (arrowheads)
stain
Obert
GJ,
mas.
Cancer
Devine
Fitz-Hugh
GS,
Allen
Lewis
origin. EM,
Review Arch
CT scans at sellar bilaterally into medial
region. aspect
Partially of each
10.
M,
been
have
secondarily
described
esthesioneunoblastomas
in
invaded
the
intracranial
that
cavity
[9,
11
These apy. an
tumors
are
radiosensitive
to be surgical The
radiosensitivity
unnecessary
plasms
they
are
at
close
the
followed this
of
attempt
when
and
resection
neoplasm
total
to the
ideal should
resection
of
1 2.
treatment
by radiation
neo-
hypothalamus.
WB:
Olfactory
esthesioneuro-epitheliomas.
1 5.
Radiology
1951
Aldave
A,
Report
of a case
43-46,
Dastur
DK,
Gallagen
1959
HS: and
Olfactory
review
of the
esthesioneuroepithelioma. literature.
Arch
Pathol
67:
JH:
1 6.
types HO:
Polle
GJ:
Primary
Otolarynintracranial
J Neuro-
neunoblastoma).
Presse
Micheau
B: Tumeun dite de Ia a development
Med
C:
VS:
Pathological
lesions
in 1 000
and
unusual
68
: 1 981
-1
Microscopical
984,
1960
diagnosis
and report
analysis cases
cases
Neuroblastoma
25:99-108,
Schochet
of
including
intracranial children.
J Neurol
of glioma.
of
of five
II.
Sci
8:
Rubinstein
of the
olfactory
nerve.
Acta Neu-
1971
55,
Peters
B, O’NeaI
A light
(Berl) U:
tral
neuroepithelial
26,
1972
mas.
Ann
1969
Jakumeit
Sarwar
of two cases.
Esthesioneunoblastoma.
Hetpertuiset
et nasal.
Lalitha
Neuropathol
57:541-546,
U,
R, Berd
R,
oneurobiastoma.
REFERENCES
2.
Genard-Manchant
rochir 14.
1 . Seaman
neuroepithelioma.
(esthesioneuroepithelioma),
cerebral
143-170, 1 3.
of
1973
Messimy
Incidence,
preclude
tumors
1965
1966
(olfactory
space-occupying
then-
these
LT: Olfactory
olfactory esthesioneuromas: journal review cases. J Cancer Inst 35 : 75-82, 1965
10,
13].
seems
.
74,
and presentation
5, Webster
Rubinstein
olfactive
simultane have
FW: Nasal
: 1 69-1
81
FS, Tenta
38:548-556,
David
Otolaryngol
1970
AE,
placode veins
Massani
79:547-550,
surg
R, Foote
Otolaryngol
esthesioneuroblastoma
calcified, multilobular middle fossa.
PM: Olfactory
Arch
AJR 1 05 : 7- 1 3, 1960 MH: Neurogenous nasal neoplasms.
Hamilton
9, Fig. 2.-Plain lesion extends
neuroblasto-
of 7 cases.
McGavnan gol
Olfactory
TN, Sprinkle
RVP, Tollefsen Arch
L, De La Pava
A report 8.
Rucker
of the world literature Otolaryngol 84 : 644-653,
Castro
7.
MS,
JR:
1960
1965
JS, Hutten
Skolnik
6.
5,
(esthesioneuroepithelioma).
81 :161-168, olfactory
McDonald
1 3 : 205-21
neuroblastoma 5,
KD,
is eroded. Cnibiform plate region in sellar region. Similar stain was
J, et al:
electron
31 : 1 81 -1 89,
Cytogenesis
M, Swischuk AJR 127:973-977,
and
tumors.
and
esthesistudy.
Acta
1975 differentiation
J Neuropatho/
LE, Schechter 1976
Intracranial
microscopic
of primitive
Exp
Neurol
MM: Intracranial
cen31 :7-
chondro-
