Endocrine Abstracts

Introduction: Sellar and supra-sellar hemangioma is a very rare, benign tumor, presenting a differential diagnostic difficulty with pituitary adenomas, especially as its imaging aspects are non-specific. We report an unusual case of an intrasellar and suprasellar cavernous hemangioma that was initially thought to be an invasive pituitary macroadenoma.

Case report: A 65-year-old female patient presented with headaches and visual disturbances that had been evolving for 10 years, in a context of preserved general condition. The evolution of the symptoms had been marked by a worsening for the last 3 months. Clinical examination was unremarkable. Work-up: hypothalamic-pituitary MRI visualized a voluminous expansive sellar and supra-sellar lesion measuring 68×57×44 mm, consistent with an invasive macroadenoma. Cortisolaemia: 5.3 mg/dl Prolactinaemia: 10.7 ng/ml, T4l: 8 pmol/l. The patient was started on hydrocortisone and L-thyroxine replacement therapy. She underwent an initial biopsy, the anatomopathological study concluded to a vascular tumor proliferation in favor of a cavernous hemangioma with no sign of malignancy. The patient was scheduled for trans-sphenoidal tumor resection.

Discussion and conclusion: Hemangioma is a benign vascular tumor, arising preferentially in the liver and skin. Cerebral localization is rare (0.5%), and sellar and supra-sellar involvement is extremely rare, with a slight female predominance. The clinical and radiological presentation is not characteristic enough to differentiate cavernous hemangiomas from other pathologies more frequently encountered in the sellar and supra-sellar region, such as pituitary adenomas, meningioma, optic glioma, craniopharyngioma, germinoma\.. It is important to differentiate sellar cavernous hemangioma from pituitary tumors because of the risk of severe hemorrhage during operation, as these tumors are vascular lesions and postulated to be dural based, and the possible complications in the postoperative period Diagnosis of certainty remains the prerogative of anatomopathological examination. Given the high risk of bleeding, subtotal tumor resection with decompression of surrounding tissue, followed by radiotherapy, may be considered the safest and most effective strategy.