Suprasellar Teratoma in a Young Adult: A Case Report
Yair Antonio Ugalde-Hernandez
Department of Neurosurgery, Hospital General Leon, Institute of Public Health from Guanajuato State, León, México.
Ana Cristina Salgado-Sauz
Research Unit, Head of Teaching and Research, Hospital General León, Institute of Public Health from Guanajuato State, León, México.
Diana Aguirre-Rojas
Department of Neurosurgery, Hospital General Leon, Institute of Public Health from Guanajuato State, León, México.
María Guadalupe López- Aguilar
Department of Neurosurgery, Hospital General Leon, Institute of Public Health from Guanajuato State, León, México.
Mauricio Franco-González
Department of Neurosurgery, Hospital General Leon, Institute of Public Health from Guanajuato State, León, México.
Leticia Casimiro-Guzman
Department of Pathology, Hospital General León, Institute of Public Health from Guanajuato State, León, México.
Nicolas Padilla-Raygoza *
Department of Research and Technological Development, Directorate of Teaching and Research, Institute of Public Health from Guanajuato State, Guanajuato, México.
*Author to whom correspondence should be addressed.
Abstract
Background: Intracranial germ cell tumours are uncommon neoplasms that often arise along midline structures, including the pineal and suprasellar regions. Teratomas are non-germinomatous germ cell tumours and may produce visual, neurological and endocrine manifestations when located in the suprasellar region.
Case Presentation: A 20-year-old male with medically managed hypothyroidism and hypogonadism was evaluated after cranial magnetic resonance imaging demonstrated a sellar lesion with suprasellar extension. He had experienced progressive right-sided visual loss and severe holocranial headache for six months. Examination showed phenotypic features of hypogonadism and a relative afferent pupillary defect in the right eye, while motor, sensory, language, memory, praxis and gnosis functions were preserved. Magnetic resonance imaging revealed a large heterogeneous solid-cystic sellar lesion with suprasellar extension, measuring approximately 3.5 × 4.2 × 4 cm, with distortion of adjacent ventricular structures. The patient underwent frontal craniotomy using a microsurgical interhemispheric approach. The tumour was extra-axial, thick-capsulated and adherent to major neurovascular structures. Approximately 80% subtotal resection was achieved to preserve adjacent anatomy. Histopathological examination confirmed teratoma with mature tissue elements, including fibrous wall, bone, adipose tissue, microcalcifications and cholesterol clefts in this patient.
Conclusion: This case supports careful clinicoradiological and histopathological correlation when evaluating suprasellar lesions associated with visual and endocrine manifestations.
Keywords: Suprasellar teratoma, intracranial germ cell tumour, non-germinomatous germ cell tumour, sellar region, young adult, visual loss, hypogonadism, hypothyroidism, magnetic resonance imaging, subtotal resection, histopathology