Endo T, Kumabe T, Ikeda H, Shirane R, Yoshimoto T
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Acta Neurochir (Wien). 2002 Nov;144(11):1233-7. doi: 10.1007/s00701-002-1027-1.
We report a case of neurohypophyseal germinoma appearing as predominantly granulomatous reaction in the first histological examination. A 12-year-old boy presented with diabetes insipidus, panhypopituitarism, and bitemporal hemianopsia. Transsphenoidal exploration for the intrasellar mass lesion extending to the suprasellar region was performed in May 1999. Histological examination revealed granulomatous hypophysitis and corticosteroid therapy was initiated. Six months later, the lesion relapsed despite corticosteroid therapy. Subtotal removal of the lesion was performed via an anterior interhemispheric approach in December 1999. Histological examination revealed typical germinoma. Subsequently, the patient underwent irradiation of 20 Gy to the tumour site and 24 Gy to the whole brain. Magnetic resonance imaging confirmed tumour remission. We must consider the possibility of neurohypophyseal germinoma in patients with granulomatous hypophysitis which does not respond to corticosteroid therapy, and perform re-exploration for more specimens to achieve the correct diagnosis.
我们报告一例神经垂体生殖细胞瘤，在首次组织学检查中主要表现为肉芽肿反应。一名12岁男孩出现尿崩症、全垂体功能减退和双颞侧偏盲。1999年5月对延伸至鞍上区域的鞍内肿块病变进行了经蝶窦探查。组织学检查显示为肉芽肿性垂体炎，并开始使用皮质类固醇治疗。六个月后，尽管进行了皮质类固醇治疗，病变仍复发。1999年12月通过前纵裂入路对病变进行了次全切除。组织学检查显示为典型的生殖细胞瘤。随后，患者接受了肿瘤部位20 Gy和全脑24 Gy的放疗。磁共振成像证实肿瘤缓解。对于对皮质类固醇治疗无反应的肉芽肿性垂体炎患者，我们必须考虑神经垂体生殖细胞瘤的可能性，并进行再次探查以获取更多标本以实现正确诊断。
