Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan.
Brain Tumor Pathol. 2012 Jan;29(1):58-62. doi: 10.1007/s10014-011-0063-z. Epub 2011 Sep 15.
We report an unusual case of neurohypophyseal germinoma with abundant fibrous tissue and clival invasion that was initially misdiagnosed as lymphocytic hypophysitis. A 40-year-old woman presented with diabetes insipidus and panhypopituitarism after delivering her second son and which lasted for 4 years. Magnetic resonance imaging showed the intrasellar mass extending to the suprasellar region with enlarged pituitary stalk. The mass was heterogeneously enhanced and invaded the clivus. Biopsy of the intrasellar mass was performed via the trans-sphenoidal route, and histological examination revealed marked fibrous tissue and infiltration of lymphocytes, with no evidence of tumor cells. Lymphocytic hypophysitis was the initial diagnosis, and corticosteroid therapy was begun. Despite intensive treatment, the lesion enlarged and clinical symptoms worsened 2 weeks after surgery. Subtotal removal of the mass was performed, and a second histological examination revealed typical findings of the germinoma. Subsequently, the patient underwent chemoradiotherapy, and complete remission was achieved. Histological diagnosis is sometimes incorrect in fibrous tumors at the sellar region, and biopsy from several points is strongly recommended for this entity.
我们报告了一例罕见的伴有丰富纤维组织和颅底侵犯的神经垂体生殖细胞瘤病例，该病例最初被误诊为淋巴细胞性垂体炎。一位 40 岁的女性在生下第二个儿子后出现了 4 年的尿崩症和全垂体功能减退症。磁共振成像显示鞍内肿块延伸至鞍上区域，垂体柄增大。肿块不均匀增强并侵犯颅底。通过经蝶窦入路对鞍内肿块进行了活检，组织学检查显示明显的纤维组织和淋巴细胞浸润，没有肿瘤细胞的证据。最初诊断为淋巴细胞性垂体炎，并开始使用皮质类固醇治疗。尽管进行了强化治疗，但术后 2 周病变仍增大，临床症状恶化。进行了肿块次全切除术，第二次组织学检查显示典型的生殖细胞瘤表现。随后，患者接受了化疗和放疗，达到完全缓解。在鞍区的纤维性肿瘤中，组织学诊断有时不正确，对于此类病变强烈建议进行多点活检。
