Osaka Y, Horikawa Y, Nakahara Y, Sakakibara T, Yoshino E
Department of Neurosurgery, Kyoto Prefectural Yosanoumi Hospital, Japan.
No Shinkei Geka. 2001 Aug;29(8):741-5.
We report three cases of pituitary abscess. Three patients, all females, had suffered headache and complained of general fatigue. In each case magnetic resonance imaging (MRI) revealed a sellar mass with suprasellar extension. T1-weighted images revealed an isointense or slightly hypointense lesion with thin ring-enhancement following gadolinium injection. No inflammatory signs were found in two cases. In one case, a gradual change in clinical symptoms and MRI findings was noted: the hypophyseal hemorrhagic lesion detected on MRI changed into a cystic lesion with thin ring-enhancement. Transsphenoidal surgery was performed in all three cases. In each case, however, no organism was cultured and no tumor component was found. It is difficult to diagnose pituitary abscess prior to surgery if no inflammatory signs are present. Diagnosis of this condition requires careful radiological evaluation. Findings of a suprasellar round cystic mass with thin ring-enhancement on MRI associated with thickened stalk, hyperprolactinemia, and diabetes insipidus may be suggestive of a pituitary abscess.
我们报告三例垂体脓肿病例。三名患者均为女性,均有头痛症状并主诉全身乏力。每例患者的磁共振成像(MRI)均显示鞍区肿块并向上延伸至鞍上区域。T1加权图像显示等密度或略低密度病变,注射钆剂后呈薄环状强化。其中两例未发现炎症迹象。在一例中,观察到临床症状和MRI表现的逐渐变化:MRI上检测到的垂体出血性病变转变为有薄环状强化的囊性病变。三例均行经蝶窦手术。然而,每例均未培养出病原体,也未发现肿瘤成分。如果没有炎症迹象,术前很难诊断垂体脓肿。这种疾病的诊断需要仔细的影像学评估。MRI上显示鞍上圆形囊性肿块伴薄环状强化,同时伴有垂体柄增粗、高催乳素血症和尿崩症,可能提示垂体脓肿。