Endoscopic Endonasal Resection of a Mixed Lesion of Gangliocytoma and Nonfunctioning Pituitary Adenoma

BACKGROUND: The coexistence of a gangliocytoma and a pituitary adenoma is a rare event that has been reported in only case reports. The knowledge of its diagnosis and treatment is extremely limited. CASE DESCRIPTION: We present a rare case of intrasellar-suprasellar gangliocytoma and nonfunctioning pituitary adenoma. The lesion was diagnosed preoperatively as a pituitary adenoma, and it was resected using the extended endoscopic endonasal approach. We could clearly observe 2 different textures inside the tumor. The main body of the tumor tissue was tough and fibrous with distinct lobular nodules distributed within it. To our knowledge, this is the first report of distinct compartments with heterogeneous consistencies in a mixed sellar gangliocytoma-adenoma. CONCLUSIONS: Our finding of the heterogeneous texture in the lesion of gangliocytoma associated with pituitary adenoma may help to uncover the pathogenesis of this rare disorder. This finding also supports the examination of intraoperative frozen sections to aid in diagnosis. We recommend maximized safe resection as a surgical strategy for the coexistent lesion of gangliocytoma and pituitary adenoma.