Sharma M C, Arora R, Mahapatra A K, Sarat-Chandra P, Gaikwad S B, Sarkar C
Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Clin Neurol Neurosurg. 2000 Jun;102(2):72-7. doi: 10.1016/s0303-8467(00)00063-9.
Intrasellar tuberculomas are rare and only few case reports have been described in the literature. We report a series of 18 cases of histologically proven intrasellar tuberculomas, which, to the best of our knowledge, is the largest series in the English literature.
A total of 1143 pituitary lesions, between 1984 and June 1999, were operated for various reasons in our institute. Of these, 18 cases were histopathologically proven intrasellar tuberculomas. The clinical profile was reviewed in detail. Radiological data and histopathological slides were also reviewed.
The age ranged from 8 to 43 years (average 23.6 years) with a female preponderance. The duration of symptoms varied from 15 days to 2 years (average 4 months), the most common symptoms being headache followed by decrease or loss of vision. Five patients had features of pan-hypopituitarism whereas three had raised prolactin (PRL) levels. In six patients, both sella as well as sphenoid sinus were involved. In one patient the lesion was extending from the sella over the clivus. Clinically as well as radiologically, these lesions were mistaken for pituitary adenomas except for one case where tuberculoma was suspected on imaging. In three patients, there was past history of pulmonary tuberculosis, in one patient of tuberculous meningitis, and in one patient, of spondilytis of the spine. In one patient there was cervical lymphadenopathy along with features of acromegaly (also proved by high levels of serum growth hormone) and radiology revealed a pituitary pathology. Microscopic examination of the excised lesion revealed a composite lesion consisting of a pituitary adenoma and tuberculoma, which has not been documented in literature to date. One patient died during the hospital stay. All the other patients were put on antitubercular chemotherapy following surgery and had good outcomes.
Intrasellar tuberculomas are rare. These may be suspected in female patients especially if radiological imaging shows involvement of paranasal sinuses and pituitary fossa along with thickening of pituitary stalk. Simultaneous involvement of clivus may also be an additional feature. The incidence of pituitary tuberculosis is likely to increase with a rise in the incidence of AIDS.
鞍内结核瘤罕见，文献中仅有少数病例报告。我们报告了一系列18例经组织学证实的鞍内结核瘤病例，据我们所知，这是英文文献中最大的病例系列。
1984年至1999年6月期间，我院因各种原因对1143例垂体病变进行了手术。其中，18例经组织病理学证实为鞍内结核瘤。详细回顾了临床资料。还回顾了放射学数据和组织病理学切片。
年龄范围为8至43岁（平均23.6岁），女性居多。症状持续时间从15天到2年不等（平均4个月），最常见的症状是头痛，其次是视力下降或丧失。5例有全垂体功能减退的表现，3例催乳素（PRL）水平升高。6例患者蝶鞍和蝶窦均受累。1例患者病变从蝶鞍延伸至斜坡。除1例影像学怀疑为结核瘤外，这些病变在临床和放射学上均被误诊为垂体腺瘤。3例患者有肺结核病史，1例有结核性脑膜炎病史，1例有脊柱脊柱炎病史。1例患者有颈部淋巴结肿大并伴有肢端肥大症特征（血清生长激素水平升高也证实了这一点），放射学显示垂体病变。对切除病变的显微镜检查发现了一个由垂体腺瘤和结核瘤组成的复合病变，迄今为止文献中尚未有记载。1例患者在住院期间死亡。所有其他患者术后接受抗结核化疗，效果良好。
鞍内结核瘤罕见。女性患者可能怀疑患有此病，尤其是放射学影像显示鼻窦和垂体窝受累以及垂体柄增粗时。斜坡同时受累也可能是一个附加特征。随着艾滋病发病率的上升，垂体结核的发病率可能会增加。
