Krypciak S, Alonso E, Berle M, Ajzenberg C, Combes C, Caillet P, Taillandier-Heriche E, Paillaud E
Département de médecine interne et de gériatrie, CHU Chenevier-Mondor, 51, avenue du Maréchal-de-Tassigny, 94000 Créteil, France.
Rev Med Interne. 2010 Feb;31(2):140-5. doi: 10.1016/j.revmed.2009.05.006. Epub 2009 Sep 8.
Tumors of the pituitary stalk are rare and their diagnosis is sometimes difficult.
We report a case of a primary lymphoma of the pituitary stalk in a 78-year-old patient. To our knowledge, only seven similar cases have been previously published: prominent symptoms were headache, fatigue and diplopia; biologically, anterior pituitary low secretion or hyperprolactinemia were found in the majority of cases; regarding the imaging, only three patients presented an initial and isolated lesion of the stalk; histological evidence was obtained by a trans-sphenoidal biopsy in case of hypothalamic or pituitary associated lesion or by a trans-cranial biopsy in the event of an isolated lesion. As an alternative, a lumbar puncture could be performed; although less invasive, its diagnostic performance is lower.
Current treatment relies on chemotherapy with intravenous methotrexate associated with intrathecal methotrexate infusion if cerebrospinal showed abnormal cells. Unfortunately, the results remain poor with a median survival of 9 months.
垂体柄肿瘤罕见，其诊断有时颇具难度。
我们报告一例78岁患者的垂体柄原发性淋巴瘤。据我们所知，此前仅发表过七例类似病例：主要症状为头痛、乏力和复视；生物学检查方面，多数病例发现垂体前叶低分泌或高催乳素血症；影像学检查方面，仅三名患者最初表现为孤立的垂体柄病变；对于下丘脑或垂体相关病变，通过经蝶窦活检获取组织学证据，对于孤立病变则通过经颅活检获取。作为替代方法，可进行腰椎穿刺；虽然侵入性较小，但其诊断效能较低。
目前的治疗依赖于静脉注射甲氨蝶呤化疗，若脑脊液显示异常细胞则联合鞘内注射甲氨蝶呤。不幸的是，治疗效果仍然不佳，中位生存期为9个月。
