Xanthogranuloma of the sellar region: a clinicopathological entity different from adamantinomatous craniopharyngioma

Xanthogranulomatous change of craniopharyngioma, consisting of cholesterol clefts, macrophages, chronic inflammatory infiltrates, necrotic debris and hemosiderin deposits, has been traditionally considered a hallmark of the a damantinomatous variant, even in the absence of epithelium. Based on a seri es of 110 craniopharyngioma patients undergoing primary surgery, we found 3 7 specimens with a predominating xanthogranulomatous component. Only 3 of t hese cases (8%) exhibited additional histological features of adamantinomat ous craniopharyngioma, while 13 cases (35%) contained non-adamantinomatous epithelium composed of squamous or ciliated cuboidal cells. Subsequent clin ical analysis revealed that these 37 xanthogranulomatous lesions differed f rom 59 classical adamantinomatous craniopharyngiomas with respect to prefer ential occurrence in adolescents and young adults (mean age 27 years), pred ominant intrasellar location, smaller tumor size, more severe endocrinologi cal deficits, longer preoperative history, lower frequency of calcification and visual disturbances, better resectability, and a more favorable outcom e. On the other hand, xanthogranulomatous and adamantinomatous lesions did not differ with respect to sex, amount of cystic components, or the intraop erative aspect, considered by the neurosurgeon as being typical for craniop haryngioma in all cases. We suggest that xanthogranuloma (cholesterol granu loma) of the sellar region is clinically and pathologically distinct from t he classical adamantinomatous craniopharyngioma.