Fluid-fluid level in pituitary tumors: analysis of management of 106 cases

Clinical article

Atul Goel M.Ch. 1 , Abhidha Shah M.S., M.Ch 1 , Sukhdeep Singh Jhawar M.S., M.Ch. 1 , and Naina K. Goel M.D. 2
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  • 1 Departments of Neurosurgery and
  • 2 Neuropathology, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India
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Object

The management issues of 106 cases of pituitary tumors with a fluid level within the fluid content of the cystic part of the tumor (a “fluid-fluid” level) were reviewed.

Methods

Between 2000 and March 2009, 1660 pituitary tumors were treated neurosurgically at K.E.M. Hospital. Investigations of 106 of these cases revealed a fluid-fluid level within the tumor. All patients underwent surgery via a transsphenoidal route. The mean follow-up duration was 46 months.

Results

The tumors varied in size: 31 were between 1 and 3 cm, and 75 were larger than 3 cm in maximum dimension (mean maximum dimension 3.4 cm). Fifty-two tumors had 1 fluid level, 11 had 2, and 43 had multiple fluid levels (≥ 3). The onset of symptoms was acute in 8 cases and insidious in 98 cases. In 16 cases, there was evidence of acute exacerbation of symptoms during the course of symptom progression. The symptoms were progressive in all cases. Ninety-seven percent of patients had visual deficits at the time of presentation. The solid portion of the tumor was relatively friable and vascular in most cases, and the fluid varied in color and in consistency, from a thin yellow to dark red liquid. Visual outcome was extremely gratifying in the majority of cases; of those presenting with visual dysfunction, 94% reported visual recovery in the immediate postoperative period. During the follow-up period, there was tumor recurrence in 21 cases; in 12 of these cases, the authors documented a fluid-fluid level. The histological features did not indicate malignancy in any case.

Conclusions

A fluid level within a fluid cavity in pituitary tumors is rarely reported but is not uncommon in large/giant tumors. The presence of such a feature suggests that surgery in these cases can be relatively straightforward despite the lesion's large size, and the visual outcome is gratifying. However, recurrence rates are relatively higher in such cases than in other pituitary tumors.

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Contributor Notes

Address correspondence to: Atul Goel, M.Ch., Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai 400012, India. email: atulgoel62@hotmail.com.

Please include this information when citing this paper: published online December 4, 2009; DOI: 10.3171/2009.11.JNS091083.

  • 1

    Catalano P, , Fang-Hui E, & Som PM: Fluid-fluid levels in benign neurogenic tumors. AJNR Am J Neuroradiol 18:385387, 1997

  • 2

    Goel A, , Nadkarni T, , Muzumdar D, , Desai K, , Phalke U, & Sharma P: Giant pituitary tumors: a study based on surgical treatment of 118 cases. Surg Neurol 61:436446, 2004

    • Search Google Scholar
    • Export Citation
  • 3

    Lenthall RK, , Dean JR, , Bartlett JR, & Jeffree MA: Intrapituitary fluid levels following haemorrhage: MRI appearances in 13 cases. Neuroradiology 41:167170, 1999

    • Search Google Scholar
    • Export Citation
  • 4

    Menon RK, , Muzumdar D, , Shah A, & Goel A: Blood-fluid level in cortical venous thrombosis—a rare diagnostic entity. Surg Neurol 71:111114, 2009

    • Search Google Scholar
    • Export Citation
  • 5

    Patankar T, , Prasad S, , Pardiwala D, , Gupta S, & Goel A: Fluidfluid levels in benign neurogenic tumours. Report of two cases and review of literature. Rivista di Neuroradiologia 11:893896, 1998

    • Search Google Scholar
    • Export Citation
  • 6

    Prasad S, , Gupta S, , Patankar T, & Goel A: Fluid-fluid levels in intracranial schwannomas. Australas Radiol 43:529531, 1999

  • 7

    Soyer P, , Bluemke DA, , Fishman EK, & Rymer R: Fluid-fluid levels within focal hepatic lesions: imaging appearance and etiology. Abdom Imaging 23:161165, 1998

    • Search Google Scholar
    • Export Citation
  • 8

    Tsai JC, , Dalinka MK, , Fallon MD, , Zlatkin MB, & Kressel HY: Fluid-fluid level: a nonspecific finding in tumors of bone and soft tissue. Radiology 175:779782, 1990

    • Search Google Scholar
    • Export Citation
  • 9

    Wakai S, , Fukushima T, , Teramoto A, & Sano K: Pituitary apoplexy: its incidence and clinical significance. J Neurosurg 55:187193, 1981

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