Sinha S, Singh A K, Tatke M, Singh D
Department of Neurosurgery, G.B. Pant Hospital and Maulana Azad Medical College, New Delhi, India.
Neurosurgery. 2000 Mar;46(3):735-8; discussion 738-9. doi: 10.1097/00006123-200003000-00041.
Hypophyseal tuberculomas are extremely rare lesions. The recognition of hypophyseal tuberculomas in the differential diagnosis of pituitary tumors is important, even with no evidence of systemic tuberculosis.
A 27-year-old female patient presented with continuous, dull, generalized headaches and amenorrhea, with no history of visual diminution, galactorrhea, or endocrinological abnormalities and no evidence of systemic tuberculosis. The patient exhibited a normal water balance, without polyuria or polydipsia. A gynecological examination, including an endometrial biopsy for amenorrhea, did not reveal any abnormalities. Perimetric and endocrinological examination results were normal. Contrast magnetic resonance imaging revealed a dense enhancing intrasellar mass, with thickening of the pituitary stalk.
Sublabial rhinoseptal transsphenoidal decompression of the lesion was performed. The histopathological features were consistent with a diagnosis of tuberculoma, and acid-fast bacilli were demonstrated in the surgically removed tissue with Ziehl-Neelsen staining. As soon as the histopathological features were known, the patient underwent a lumbar puncture for cerebrospinal fluid analysis, which indicated normal findings. An intradermal tuberculin test yielded negative results. The patient was treated with medical therapy for 18 months, and complete resolution of the lesion was observed in follow-up examinations.
Hypophyseal tuberculomas are often mistaken for pituitary adenomas. The finding of a thickened pituitary stalk in contrast magnetic resonance imaging scans may be useful for the differentiation of these lesions from pituitary adenomas. Direct radiosurgery is not an appropriate primary treatment method for pituitary adenomas and is principally restricted to elderly, medically unfit patients with microadenomas and patients with residual or recurrent tumors after microsurgery. It is contraindicated for patients who exhibit a thickened pituitary stalk in contrast magnetic resonance imaging scans.
垂体结核瘤是极为罕见的病变。即便没有系统性结核病的证据，在垂体肿瘤的鉴别诊断中识别垂体结核瘤也很重要。
一名27岁女性患者出现持续性钝性全头痛及闭经，无视力减退、溢乳或内分泌异常病史，也无系统性结核病证据。患者水平衡正常，无多尿或烦渴。包括针对闭经的子宫内膜活检在内的妇科检查未发现任何异常。视野和内分泌检查结果正常。增强磁共振成像显示鞍内有一强化明显的肿块，垂体柄增粗。
对该病变进行了经唇下鼻中隔经蝶窦减压术。组织病理学特征符合结核瘤诊断，经齐-尼氏染色在手术切除组织中发现抗酸杆菌。一旦得知组织病理学特征，患者即接受腰椎穿刺进行脑脊液分析，结果正常。皮内结核菌素试验结果为阴性。患者接受了18个月的药物治疗，随访检查中病变完全消退。
垂体结核瘤常被误诊为垂体腺瘤。增强磁共振成像扫描中垂体柄增粗这一表现可能有助于将这些病变与垂体腺瘤相鉴别。直接放射外科手术并非垂体腺瘤合适的初始治疗方法，主要限于老年、身体状况不适宜手术的微腺瘤患者以及显微手术后有残留或复发肿瘤的患者。对于增强磁共振成像扫描显示垂体柄增粗的患者，该方法为禁忌。
