15 March 2025
: Case report 
Incidental High-Grade Sellar Solitary Fibrous Tumor Mimicking Non-Functioning Pituitary Adenoma: A Case Report and Literature Review
Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Michele Persico
ABCDEF 1*, Brent D. Weinberg BDE 2, Stewart G. Neill BDE 3, Hui-Kuo Shu E 4, Jim Zhong EG 4
DOI: 10.12659/AJCR.946592
Am J Case Rep 2025; 26:e946592
Table 2. High-grade sellar and/or suprasellar solitary fibrous tumors (SFT) reported cases between 1983 and 2024. In this table, the terminology of the described and historical SFT cases reflects the one before the 2021 World Health Organization (WHO) Classification, as these cases were reported under older classification schemes.
| Author | Age* & Sex | Time sxs started | Sxs* | Pituitary function (Symptoms or labs)* | MRI findings* |
|---|---|---|---|---|---|
| Current case, 2024 | 66 F | n/a | No | – Unremarkable endocrine workup | – T1: isointense– T2: central hyperintensity |
| Rivera et al, 2024 []16 | 73 F | weeks | VD, HA | – IGF-1, FSH, LH↓– cortisol, fT4, TSH, PRL WNL | n/a |
| Ebrahimzadeh et al, 2024 []17 | 54 M | 1 year | VD, HA | – Polydipsia, polyuria, loss of libido | – T1: isointense– T2: hyperintense– Post-con: enhancement |
| Wang et al, 2021 []18 | 45 M | 1 year | VD | – ↑PRL,– ↓T4, fT4, GH, ACTH, cort, FSH, LH, Test, PG, E2– fT3, T3, TSH WNL– Sexual dysfunction | – Post-con: homogeneous enhancement |
| Thapa et al, 2021 []19 | 87 F | 1.5 yy | VD, HA | – ↑PRL (slightly)– ↓fT4, cortisol | – T1: isointense– T2: iso-hyperintense– Post-con: heterogeneous enhancement |
| Ghanchi et al, 2020 []20 | 12 M | 2 mm | VD, polydipsia | – Unremarkable endocrine workup | – Post-con: homogeneous enhancement |
| Gibson et al, 2017 []21 | 34 M | VD | – Panhypopituitarism following prior resection | – Post-con: enhancing | |
| Nesaratnam et al, 2017 []22 | 73 F | 3 wks | VD, HA | – 7 mm prior: N&V, ↓ cortisol also s/p synacthen, FSH & LH WNLNote: PMH hypothyroidism | – Post-con: enhancing |
| Esquenazi et al, 2014 []23 | 51 M | 2 mm | VD, HA, N&V | – PRL, ACTH, FSH, LH, TSH, Ttot, cortisol, fT4 WNL | n/a |
| Sanchez et al, 2013 []24 | 72 F | 1 month | VD | n/a | n/a |
| Das et al, 2010 []25 | 47 M | 1 month | VD, HA | – ↓TSH, T4, T3, GH, PRL,– Cort WNL | – T1: hypointense– T2: hyperintense– Post-con: dense and homogeneously enhancing |
| Jalali et al, 2008 []26 | 35 M | 1 year | VD, HA | n/a | – T1: heterogeneous iso and hypointense– T2: hyperintense– Post-con: patchy enhancing |
| Juco et al, 2007 []27 | 18 F | 3 mm | VD | – PRL WNL | n/a |
| Han et al, 2007 []28 | 44 M | 2 mm | VD, HA | – Hypopituitarism (labs) | – T1: heterogeneous hypo to isointense– Post-con T1: diffuse homogeneous– T2: inhomogenous |
| Ksira et al, 2006 []29 | 59 | n/a | VD, HA | – ↑PRL– ↓TSH, fT4– ↓ACTH, cort– GH WNL | – T1: isointense– T2: isointense– Post-con: dense and homogenously enhancing |
| Safavi et al, 2005 []30 | 56 F | 3 mm | VD | n/a | n/a |
| Asano et al, 2002 []31 | 23 F | n/a | VD | n/a | n/a |
| Gharbi et al, 2001 []32 | 44 M | 1 month | VD, HA | n/a | – T1: isointense– T2: hyperintense (slightly)– Post-con: intense and homogenously enhancing |
| Kanda et al, 2001 []33 | 60 F | n/a | VD | – ↑PRL– ↓LH, FSH, cort– GH, ACTH WNL | – T1: iso-intense– T2: iso-intense, partial high-intensity– Post-con: enhancing |
| Morrison et al, 1997 []34 | 35 F | 1 week | VD, HA | – ↑PRL– T4, T3, LH, FSH, E2, cort WNL | – Post-con: enhancing |
| Kumar et al, 1986 [,]35 | M | n/a | VD | n/a | CT |
| Yokota et al, 1985 []37 | F | 1.5 mm | VD | – ↑GH, ACTH– PRL, TSH WNL– ↓LH, FSH (slightly)– Amenorrhea, acromegaly | CT |
| Mangiardi et al, 1983 []38 | F | 2 mm | VD, HA | n/a | CT: – Post-con: enhancing |
| # Abstract; ## original article in Japanese, English version unavailable, except for the abstract; ### original article in French, English version unavailable, except for the abstract; * at presentation; ** HPC is now termed SFT; *** RT after surgery, as adjuvant treatment; **** total resection deferred due to uncontrollable bleeding; ***** interrupted for excessive bleeding. PMH – past medical history; Sxs – symptoms; n/a – not available; mm – months; yy – years; RT – radiotherapy; VFD – Visual Disturbances; HA – headache; HPC – hemangiopericytoma; N&V – nausea and vomiting; G – growth; BCNU – 1.3-bis(2-chloroethyl)-1-nitrosourea; PRL – Prolactin; FSH – follicle-stimulating hormone; LH – luteinizing hormone; E2 – estradiol; fT3 – free triiodothyronine; T3 – triiodothyronine; fT4 – free thyroxine; T4 – thyroxine; TSH – thyroid-stimulating hormone; ACTH – adrenocorticotropic hormone; cort – cortisol; GH – growth hormone; T – testosterone; PG – progesterone; ICA – internal carotid artery; SFT – solitary fibrous tumor; WHO – World Health Organization. | |||||
| Author | Structures compressed/displaced/invaded/encased | Working diagnosis (pre-biopsy) | Definitive diagnosis (post-biopsy)** | Treatment*** | Outcome**** |
| Current case, 2024 | – Optic chiasm | Pituitary adenoma | HPC, WHO grade III | – Partial resection + proton therapy (59.4 Gy in 33 fractions) | Shrinkage after 3 years |
| Rivera et al, 2024 [] | – Optic chiasm– Anterior cerebral arteries | n/a | HPC | Partial resection + RT | Residual tumor stable in size |
| Ebrahimzadeh et al, 2024 []17 | – Optic chiasm | Pituitary adenoma | HPC | Total resection | n/a |
| Wang et al, 2021 []18 | – Pituitary gland– Left cavernous sinus | Germ-cell tumor | HPC, WHO grade II | Total resection + RT (unspecified RT regimen) | Absent recurrence after 29 mm |
| Thapa et al, 2021 []19 | – Left CN II– Pituitary gland | Unspecified tumor | SFT/HPC, WHO grade II | – Partial resection– Radiosurgery on recurrence (30 Gy in 5 fractions); no surgery | – G 2 mm s/p 1 surgery– Shrinkage after 3 and 15 mm after radiosurgery |
| Ghanchi et al, 2020 []20 | – Optic chiasm | Broad differential | SFT/HPC, WHO grade II | – Partial resection– Total resection on recurrence | – G 3mm after 1 surgery |
| Gibson et al, 2017 []21 | – Optic chiasm, optic tracts, optic nerves, and bilateral gyrus recti | n/a | Anaplastic HPC, WHO grade III | – 3 partial resection– Radiosurgery s/p 3 resection (unspecified radiosurgery regimen) | – Residual tumor 2 and 4 mm– Died of PE at 7 mm s/p initial presentation |
| Nesaratnam et al, 2017 []22 | – Optic chiasm– Sphenoid sinus, cavernous sinus– Carotid arteries | Pituitary adenoma | Anaplastic HPC, WHO grade III | Total resection + RT (54–60 Gy) | n/a |
| Esquenazi et al, 2014 []23 | – Optic chiasm– Suprasellar cistern, cavernous sinus | Pituitary adenoma | Lipomatous HPC, WHO grade II | – Partial resection– Total resection after 2 mm follow-up | – Residual tumor 2 mm after 1 surgery |
| Sanchez et al, 2013 []24 | n/a | n/a | HPC | – Total resection– Total resection on 1 recurrence + RT (50.4 Gy in 28 fractions)– Partial resection on 2 recurrence– Radiosurgery after 3 surgery (27 Gy in 5 fractions) | – Recurrence after 1 year 1 surgery– Recurrence after 3 yy 2 surgery– Recurrence after 3 surgery– Shrinkage 14 mm after radiosurgery |
| Das et al, 2010 []25 | – Optic chiasm– Sphenoid sinus | n/a | HPC, malignant | Partial resection + RT (60 Gy in 30 fractions) | Absent recurrence (unspecified follow-up timing) |
| Jalali et al, 2008 []26 | – Optic chiasm | Pituitary adenoma | HPC | – Total resection (refused RT)– Partial resection + RT (55 Gy in 33 fractions) | – Recurrence after 6 mm– Residual tumor after RT |
| Juco et al, 2007 []27 | – Pituitary gland | n/a | HPC, WHO grade III | Total resection + RT (unspecified RT regimen) | Absent recurrence after 27 mm |
| Han et al, 2007 []28 | – Optic chiasm– ICA (cavernous portion) | Pituitary adenoma | HPC | – Partial resection + RT (52 Gy in 30 fractions)– Partial resection on recurrence– Radiosurgery after 2 resection (planned but unspecified if executed) | – Recurrence after 9 yy |
| Ksira et al, 2006 []29 | – Optic chiasm– Left cavernous sinus– Floor 3 ventricle | Pituitary adenoma | HPC | – Partial resection– Total resection + RT (54 Gy) | – Residual tumor 2 mm s/p 1 surgery– Absent recurrence 6 mm after 2 surgery + RT |
| Safavi et al, 2005 []30 | – Sphenoid sinus, clivus, and petrous apex,– Right optic nerve– Right posteroinferior cavernous sinus– Right IICA | Pituitary adenoma | HPC | – Attempted surgery– Partial resection– Radiosurgery after 2 surgery (unspecified radiosurgery regimen) | – Residual tumor after 2 surgery– Shrinkage 3.5 yy after RS |
| Asano et al, 2002 []31 | – Sphenoidal sinus, cavernous sinus | Cystic pituitary tumor or meningioma | HPC | – Total resection + RT (unspecified RT regimen | n/a |
| Gharbi et al, 2001 []32 | – Optic chiasm– Floor 3 ventricle– Left cavernous sinus | Pituitary adenoma | HPC | n/a | Spontaneous total tumor necrosis after 6 mm |
| Kanda et al, 2001 []33 | – Optic nerve | Pituitary adenoma | HPC | – Attempted surgery– Partial resection + radiosurgery (8 Gy in 3 fractions) | – Absent recurrence 20 mm after radiosurgery |
| Morrison et al, 1997 []34 | – Optic chiasm– Cavernous sinus | Pituitary adenoma | HPC | Partial resection+ RT (50 Gy in 30 doses) | – Residual tumor after 1 year |
| Kumar et al, 1986 [,]35 | n/a | n/a | HPC | – Partial resection + RT (50 Gy in 25 fractions)– 3 partial resection (spaced 3 mm between each other) + BCNU s/p 3 surgery– Interstitial RT (100 Gy via a 12 mCi 125I seed) | – Recurrence 3 yy after 1 surgery + RT– Recurrence 3 mm after 3 surgery + BCNU– Absent recurrence after 18 mm interstitial RT |
| Yokota et al, 1985 []37 | – 3 ventricle, ACA | Pituitary adenoma | HPC | Total resection | n/a |
| Mangiardi et al, 1983 []38 | n/a | Pituitary adenoma | HPC | Total resection + RT (50 Gy) | Absent recurrence after 6 mm |
| # Abstract; ## original article in Japanese, English version unavailable, except for the abstract; ### original article in French, English version unavailable, except for the abstract; * at presentation; ** HPC is now termed SFT; *** RT after surgery, as adjuvant treatment; **** total resection deferred due to uncontrollable bleeding; ***** interrupted for excessive bleeding. PMH – past medical history; Sxs – symptoms; n/a – not available; mm – months; yy – years; RT – radiotherapy; VFD – Visual Disturbances; HA – headache; HPC – hemangiopericytoma; N&V – nausea and vomiting; G – growth; BCNU – 1.3-bis(2-chloroethyl)-1-nitrosourea; PRL – Prolactin; FSH – follicle-stimulating hormone; LH – luteinizing hormone; E2 – estradiol; fT3 – free triiodothyronine; T3 – triiodothyronine; fT4 – free thyroxine; T4 – thyroxine; TSH – thyroid-stimulating hormone; ACTH – adrenocorticotropic hormone; cort – cortisol; GH – growth hormone; T – testosterone; PG – progesterone; ICA – internal carotid artery; SFT – solitary fibrous tumor; WHO – World Health Organization. | |||||