Nishioka H, Ito H, Haraoka J, Akada K
Department of Neurosurgery, Tokyo Medical University, Japan.
Neurosurgery. 1999 Mar;44(3):644-7; discussion 647-8. doi: 10.1097/00006123-199903000-00115.
Recently, it has been suggested that the primary site of suprasellar germinomas is the neurohypophysis, but nongerminomatous germ cell tumors originating from the pituitary gland have been rarely reported.
A 27-year-old man presented with panhypopituitarism, bitemporal hemianopsia, and mild right oculomotor nerve paralysis. Diabetes insipidus was not observed. The tumor was shown by magnetic resonance imaging to extend and invade bilateral cavernous sinuses, sellar and clival dura mater, and the sphenoid sinus mucosa.
Transsphenoidal removal yielded a diagnosis of immature teratoma. Serum alpha-fetoprotein was prominently elevated. Magnetic resonance imaging and surgical findings of the superiorly displaced residual pituitary gland strongly suggest the pituitary origin of this rare tumor.
In contrast to the neurohypophyseal germinomas, nongerminomatous malignant germ cell tumors originating from the pituitary gland tend not to be associated with diabetes insipidus and thus mimic adenomas. Evaluation of the tumor markers is necessary in young patients with cavernous sinus syndrome and invasive pituitary tumors with heterogeneous intensity revealed by magnetic resonance imaging.
最近，有人提出鞍上生殖细胞瘤的原发部位是神经垂体，但起源于垂体的非生殖细胞性生殖细胞肿瘤鲜有报道。
一名27岁男性患者出现全垂体功能减退、双颞侧偏盲及轻度右侧动眼神经麻痹。未观察到尿崩症。磁共振成像显示肿瘤延伸并侵犯双侧海绵窦、鞍区及斜坡硬脑膜和蝶窦黏膜。
经蝶窦切除术后诊断为未成熟畸胎瘤。血清甲胎蛋白显著升高。磁共振成像及手术发现残余垂体向上移位，强烈提示此罕见肿瘤起源于垂体。
与神经垂体生殖细胞瘤不同，起源于垂体的非生殖细胞性恶性生殖细胞肿瘤往往不伴有尿崩症，因此类似腺瘤。对于患有海绵窦综合征的年轻患者以及磁共振成像显示强度不均一的侵袭性垂体肿瘤患者，评估肿瘤标志物很有必要。
