{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T15:46:07Z","timestamp":1793375167777,"version":"4.5.0"},"reference-count":52,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Pituitary tumors account for over 90% of all sellar region masses. However, a spectrum of rare neoplastic, inflammatory, infectious, and vascular lesions\u2014benign and malignant\u2014can arise in the intra- and parasellar compartments and clinically and radiologically mimic PitNETs. We report a cohort of 47 such rare and cystic midline intracranial lesions, emphasizing their distinctive morphological, clinical, and imaging features and the personalized treatment strategies applied. Methods: In this retrospective single-center study, we reviewed all patients treated for suspected PitNETs via transsphenoidal approach between 2015 and 2024. Of 529 surgical cases, we excluded confirmed PitNETs, meningiomas, and classical intradural craniopharyngiomas. Collected data encompassed patient demographics, tumor characteristics, presenting symptoms, extent of resection or medical therapy, endocrine outcomes, and follow-up information. Results: Among all 529 patients who underwent surgical treatment for sellar lesions from 2015 to 2024, 47 cases (8.9%) were identified as rare or cystic masses. Forty-six underwent transsphenoidal resection; one patient with hypophysitis received corticosteroid therapy alone. Presenting symptoms included headache (n = 16), dizziness (n = 5), oculomotor disturbances (n = 2), and visual impairment (n = 17). Endocrine dysfunction was found in 30 patients, 27 of whom required hydrocortisone replacement. Histopathological diagnoses were led by colloid cysts (n = 14) and Rathke\u2019s cleft cysts (n = 11). The remaining 22 cases comprised plasmacytoma, germinoma, lymphoma, pituicytoma, inverted papilloma, metastatic carcinoma, chordoma, nasopharyngeal carcinoma, chloroma, and other rare entities. Preoperative imaging diagnosis proved incorrect in 38% (18\/47) of cases, with several lesions initially misidentified as PitNETs. Conclusions: Nearly 9% of presumed PitNETs were rare, often benign or inflammatory lesions requiring distinct management. Most could be safely resected and demonstrated excellent long-term outcomes. Yet, despite advanced imaging techniques, accurate preoperative differentiation remains challenging, with over one-third misdiagnosed. Clinical red flags\u2014such as early hormone deficits, rapid progression or atypical imaging findings\u2014should prompt early interdisciplinary evaluation and, when indicated, image-guided biopsy to avoid unnecessary surgery and ensure tailored therapy.<\/jats:p>","DOI":"10.3390\/cancers17152568","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T11:54:51Z","timestamp":1754308491000},"page":"2568","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Distinctive Characteristics of Rare Sellar Lesions Mimicking Pituitary Adenomas: A Collection of Unusual Neoplasms"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6653-701X","authenticated-orcid":false,"given":"Andrej","family":"Pala","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Ulm, Lindenallee 2, 89312 G\u00fcnzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadja","family":"Gr\u00fcbel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Ulm, Lindenallee 2, 89312 G\u00fcnzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Knoll","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Ulm, Lindenallee 2, 89312 G\u00fcnzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9018-2458","authenticated-orcid":false,"given":"Gregor","family":"Durner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Ulm, Lindenallee 2, 89312 G\u00fcnzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1929-5414","authenticated-orcid":false,"given":"Gwendolin","family":"Etzrodt-Walter","sequence":"additional","affiliation":[{"name":"Endokrinologiezentrum Ulm, Weinbergweg 41, 89075 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9037-5660","authenticated-orcid":false,"given":"Johannes","family":"Ro\u00dfkopf","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, University of Ulm, Lindenallee 2, 89312 G\u00fcnzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Jankovic","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, F.D. Roosevelt University Hospital with Policlinic Banska Bystrica, Namestie Ludvika Svobodu 1, 97517 Banska Bystrica, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Osterloh","sequence":"additional","affiliation":[{"name":"Department of Neuropathology, University of Ulm, Lindenallee 2, 89312 G\u00fcnzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Scheithauer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Ulm, Frauensteige 12, 89075 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8358-1813","authenticated-orcid":false,"given":"Christian Rainer","family":"Wirtz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Ulm, Lindenallee 2, 89312 G\u00fcnzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4977-7588","authenticated-orcid":false,"given":"Michal","family":"Hlav\u00e1\u010d","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Ulm, Lindenallee 2, 89312 G\u00fcnzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s11102-010-0253-4","article-title":"Demographic differences in incidence for pituitary adenoma","volume":"14","author":"McDowell","year":"2010","journal-title":"Pituitary"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0889-8529(05)70058-X","article-title":"Differential diagnosis of sellar masses","volume":"28","author":"Freda","year":"1999","journal-title":"Endocrinol. 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