Case report
Intraosseous lipoma of the body of the sphenoid bone

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Summary

A case of intraosseous lipoma arising from the body of the sphenoid bone with intrasellar and suprasellar components is reported. This is the first report of this uncommon tumour occurring in an atypical intracranial site, producing the locally invasive and pressure effects of visual failure and hypopituitarism. The diagnosis was based on computed tomographic (CT) and magnetic resonance (MR) imaging with histological confirmation following frontal craniotomy.

Section snippets

INTRODUCTION

Intracranial lipomas are rare tumours, representing 0.34–0.46% of all brain tumours.[1], [2] Pathologically, they are frequently reported to contain connective tissue elements including bone,[2], [3], [4] a feature that distinguishes intracranial from extracranial lipomas. Intraosseous lipomas are among the most uncommon of bone tumours5 and occur most frequently in the appendicular skeleton.6 Although there are case reports of intraosseous lipomas arising from the skull bones,[7], [8], [9],

CASE REPORT

A 59-year-old woman was referred with a six month history of deteriorating vision. Visual acuity was normal but visual fields to confrontation with an 8 mm red pin showed an asymmetrical and incomplete bitemporal hemianopia, more marked in the left eye and a minimal peripheral inferior nasal field constriction more marked in the right eye. These findings were confirmed by automated Humphrey’s Systems charting (Fig. 1). There was mild bilateral optic atrophy.

The patient’s past history was

OPERATION

Thyroxine was commenced and glucocorticoid replacement was continued preoperatively, with supraphysiological doses given perioperatively. A right frontal craniotomy was performed under general anaesthesia. The suprasellar region was exposed via a subfrontal approach and microsurgical techniques used to display the intrasellar and suprasellar components of the mass which had caused marked distortion and flattening of the optic nerves and chiasm. The suprasellar component of the tumour was

PATHOLOGY

Histological examination of the lesion showed a mass of mature fatty tissue surrounded by a broad zone of gliotic cerebral tissue that included fragments of neurohypophysis and adenohypophysis. The fatty tissue comprised mature adipocytes containing blood vessels as well as a moderate amount of lamellar bone trabeculae. There was no evidence of malignancy.

POSTOPERATIVE COURSE

Postoperatively glucocorticoid therapy was reduced to physiological levels and the patient made an uneventful recovery with no diabetes insipidus. The visual acuity and fields were initially unchanged in the early postoperative period but six months later there was a slight improvement in both eyes – to confrontation with an 8 mm red pin and also on Humphrey’s charting with less extensive loss in the peripheral temporal field in the left eye and normal temporal fields in the right eye (Fig. 4).

DISCUSSION

Intraosseous lipomas are essentially a proliferation of mature lipocytes within the marrow of normal trabecular bone. They are uncommon tumours, representing 0.08% of all primary bone tumours and are usually asymptomatic and the diagnosis made incidentally.5 The natural history includes a tendency to spontaneous involution through a process of infarction, calcification, and cyst formation.15 Although intraosseous lipomas are generally considered benign bone neoplasms, malignant transformation

CONCLUSION

Intraosseous lipomas are a distinct pathologic entity and their intramedullary location causes them to behave quite differently from intracranial lipomas. The natural history of intraosseous lipoma in the appendicular skeleton is generally one of involution. The intraosseous lipoma of the body of the sphenoid bone in this patient however presented as an expanding mass lesion in an unusual location. The resultant hypopituitarism and progressive visual failure necessitated neurosurgical debulking

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