Pathology of sellar tumors: A contemporary diagnostic approach

Abstract

The sellar region is a complex area situated in the middle of the cranial base, with the pituitary gland in central position and anatomically close to the crossroads of vital structures, which makes the basis for the development of numerous endocrinological and neurological conditions caused by the expansion or secretory activity of the tumor tissue. In this article, we will summarize the literature enclosing histopathological and immunohistochemical aspects of sellar tumors, together with clinical characteristics, being the key elements in making a proper diagnosis. A histopathological diagnostic algorithm will be presented for the most frequent tumors of this region, pituitary neuroendocrine tumors, as well as tumors of the posterior pituitary, meningiomas, craniopharyngiomas, chordomas, germ cell tumors hematological malignancies, Rathke cleft cyst and metastases. Contemporary histopathological diagnostic approach to sellar tumors strongly depends on the routine use of immunohistochemistry for a broad spectrum of antibodies, as well as a detailed correlation with endocrinological, neurological, neurosurgical and neuroradiological aspects, which are mandatory for establishing an accurate diagnosis, reducing dilemmas, and offering the best options for further treatment of patients with sellar tumors.