Kaku Shougo, Tanaka Toshihide, Sawauchi Satoshi, Dobashi Hisashi, Ohtsuka Toshihiro, Numoto Robert Tomohiko, Murakami Shigeyuki, Komine Kazumasa, Abe Toshiaki
Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan.
No Shinkei Geka. 2005 Aug;33(8):797-803.
A very rare case of non-functional pituitary adenoma associated with Rathke's cleft cyst is reported. A 42-year-old male suffering from visual disturbance and headache was admitted. Visual acuity was 1.2 on the right and 0.5 on the left, and visual field examination showed bitemporal hemianopsia. Endocrinological study disclosed that the basal serum level of prolactin was elevated slightly to 52.6 ng/ml, whereas those of other hormones were within normal limits. MRI showed a dumbbell-shaped cystic sellar mass extending to the suprasellar region beyond the diaphragm sellae, which consisted of two isolated components around the sellar turcica. At the middle of May, the tumor was partially removed by bifrontal craniotomy. The suprasellar tumor tightly adhered to the frontal lobe and the optic nerve, the tumor was grayish cyst and cyst fluid from the suprasellar mass had the appearance of motor oil and the intrasellar tumor contained old hematoma. Histological findings revealed that the suprasellar mass was Rathke's cleft cyst and the intrasellar mass was diagnosed as pituitary adenoma (non-functional). Visual acuity was improved following surgical operation. So far twenty-three cases of pituitary adenoma associated with Rathke's cleft cysts have been reported in the literature, but there was only one case reported of a non-functional pituitary adenoma associated with a Rathke's cleft cyst. Etiology and pathogenesis of the coexistence of non-functional pituitary adenoma and Rathke's cleft cyst in the present case were not elucidated.
报告了一例非常罕见的非功能性垂体腺瘤合并拉克氏裂囊肿的病例。一名42岁男性因视力障碍和头痛入院。右眼视力为1.2,左眼视力为0.5,视野检查显示双颞侧偏盲。内分泌学研究表明,基础血清催乳素水平略有升高至52.6 ng/ml,而其他激素水平均在正常范围内。磁共振成像(MRI)显示一个哑铃形囊性鞍区肿块延伸至鞍膈上方的鞍上区域,该肿块由蝶鞍周围两个孤立的部分组成。5月中旬,通过双额开颅术部分切除肿瘤。鞍上肿瘤与额叶和视神经紧密粘连,肿瘤为灰白色囊肿,鞍上肿块的囊液呈机油样外观,鞍内肿瘤含有陈旧性血肿。组织学检查结果显示,鞍上肿块为拉克氏裂囊肿,鞍内肿块诊断为垂体腺瘤(非功能性)。手术后视力有所改善。迄今为止,文献中已报道23例垂体腺瘤合并拉克氏裂囊肿的病例,但仅有1例非功能性垂体腺瘤合并拉克氏裂囊肿的报道。本病例中非功能性垂体腺瘤与拉克氏裂囊肿共存的病因及发病机制尚未阐明。