Ishii K, Isono M, Hori S, Kinba Y, Mori T
Department of Neurosurgery, Oita Medical University, Japan.
No Shinkei Geka. 1999 Jan;27(1):73-7.
A patient of craniopharyngioma associated with intratumoral bleeding was reported. A 44-year-old female was admitted to our department with sudden onset of headache suggesting pituitary apoplexy. On admission, she complained of mild bifrontalgia and neurological examination revealed no abnormality except bitemporal hemianopsia. Hormonal examination indicated hypopituitarism with masked diabetes insipidus and chronic thyroiditis. MRI showed a cystic 12 x 10 x 10 mm tumor with an enhanced rim at the intra- and suprasellar region. The MRI findings of the cyst suggested intratumoral bleeding with various stages. CT and plain tomography revealed plane calcification adjusting or aligning itself to the floor of the sellar. This calcification was difficult to distinguish from the sellar floor on MRI. Under the diagnosis of craniopharyngioma, almost all of the tumor was removed, using the transsphenoidal approach. The cyst consisted of old hematoma and cholesterin. The histological examination revealed a stratified squamous epithelia with numerous immature blood vessels. Such findings are unusual in cases of craniopharyngioma. Craniopharyngioma is rarely associated with intratumoral hemorrhage. The mechanism of this hemorrhage was discussed with reference to the literature on this subject.
报告了1例颅咽管瘤合并瘤内出血的患者。一名44岁女性因突发头痛提示垂体卒中入院。入院时，她主诉轻度双侧额部疼痛，神经系统检查除双颞侧偏盲外无异常。激素检查显示垂体功能减退，隐匿性尿崩症和慢性甲状腺炎。MRI显示鞍内和鞍上区域有一个12×1|0×10mm的囊性肿瘤，边缘强化。囊肿的MRI表现提示不同阶段的瘤内出血。CT和平片显示蝶鞍底部有平面钙化，钙化与蝶鞍底部难以在MRI上区分。在颅咽管瘤的诊断下，采用经蝶窦入路几乎切除了所有肿瘤。囊肿由陈旧性血肿和胆固醇组成。组织学检查显示为分层鳞状上皮，有许多不成熟的血管。这些发现在颅咽管瘤病例中并不常见。颅咽管瘤很少与瘤内出血相关。参考该主题的文献讨论了这种出血的机制。
