一名年轻男性患者患有垂体大腺瘤，伴有持续的密集淋巴细胞浸润。
Pituitary macroadenoma with persisting dense lymphocytic infiltration in a young male patient.
作者信息
Cakir E, Bayindir C, Sabanci P A, Imer M, Ozbey N C
机构信息
Department of Pathology, Department of Neurosurgery and Department of Medicine, Division of Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
出版信息
Clin Neuropathol. 2011 Nov-Dec;30(6):318-23. doi: 10.5414/np300378.
CONTEXT
Lymphocytic anterior hypophysitis in association with a pituitary adenoma was reported previously. In rare instance, inflammatory infiltration was confined to adenoma tissue itself, excluding anterior pituitary.
CASE
The patient - a 27-year-old male - presented with visual field defect. Further examination revealed a pituitary mass with suprasellar extension. Hormonal evaluation indicated mild hyperprolactinemia (42 ng/ml, normal < 19). After transsphenoidal resection, a pituitary adenoma showing cytoplasmic immunoreactivity to prolactin was identified. Dense and diffuse lymphocytic infiltration was seen within the tumor. At 15th month, a second transsphenoidal operation was necessary because of rapid development of visual compromise and headache. Excised surgical specimen consistent with previously resected adenoma showed diffuse lymphocytic infiltration composed of B and T cells within the adenoma tissue again.
CONCLUSION
Presence of dense, hypophysitis-like lymphocytic infiltration within pituitary adenoma tissue obtained by two consecutive operations may reflect an host-mediated immune reaction to tumor. This rare finding could be challenging in terms of differential diagnosis and follow-up course.
背景
先前曾报道淋巴细胞性垂体前叶炎合并垂体腺瘤。在罕见情况下，炎症浸润局限于腺瘤组织本身，不累及垂体前叶。
病例
该患者为一名27岁男性，表现为视野缺损。进一步检查发现垂体肿块并向鞍上延伸。激素评估显示轻度高泌乳素血症（42 ng/ml，正常<19）。经蝶窦切除术后，确诊为对泌乳素呈细胞质免疫反应的垂体腺瘤。肿瘤内可见密集且弥漫的淋巴细胞浸润。在第15个月时，由于视力损害和头痛迅速加重，需要进行第二次经蝶窦手术。再次切除的手术标本与先前切除的腺瘤一致，腺瘤组织内再次出现由B细胞和T细胞组成的弥漫性淋巴细胞浸润。
结论
通过连续两次手术获得的垂体腺瘤组织内存在密集的、类似垂体炎的淋巴细胞浸润，可能反映了机体对肿瘤介导的免疫反应。这一罕见发现可能在鉴别诊断和随访过程中具有挑战性。
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