Primary Sellar Leiomyomas: A Report of Two Cases and Review of the Literature of a Rare Entity

Leiomyomas are benign smooth muscle tumors that are commonly found in the genitourinary or gastrointestinal tracts. Rarely, they present as primary intracranial brain tumors. A majority of these lesions have been described in immunocompromised patients. In exceedingly rare cases, these tumors have been found sporadically in the immunocompetent patient.

We present two cases of sporadic sellar leiomyomas. The first patient is a 25-year-old woman who presented with a 2-year history of amenorrhea and a heterogeneous lesion. The second is a 53-year-old man who presented with headaches and progressive panhypopituitarism, and a large cystic lesion expanding the sella. In both cases, endoscopic transnasal transsphenoidal surgery was performed for resection of the tumor. We review the intraoperative findings, neuropathology, immunohistochemistry, and the clinical follow-up.

To the best of our knowledge, with an online literature search, only two prior cases have been reported. Review of relevant literature on these rare tumors and these two cases may allow us to conclude that the natural history differs depending on the immune status of the patient and on the fact that sellar leiomyomas may cause pituitary dysfunction through infiltration of the gland, mass effect and compression, or as a byproduct of prolactin secretion intrinsic to the tumor itself.