Martinez Jose Hernan, Davila Martinez Mariel, Mercado de Gorgola Marcos, Montalvo Luis F, Tome Jaime E
Department of Internal Medicine, San Juan Bautista Medical Center, P.O. Box 4964, Caguas, PR 00726-4964, USA.
Case Rep Endocrinol. 2011;2011:941738. doi: 10.1155/2011/941738. Epub 2011 Oct 26.
The concomitant presence of three histopathologically different entities in the pituitary gland is a rare occurrence. Most publications identify at least two distinct pathologies, mainly, a pituitary adenoma coexisting with a second intrasellar lesion. We present a case of a 71-year-old female referred for evaluation and treatment of acromegaly. Questioning revealed she was experiencing facial palsy, visual disturbances, and syncopal spells for several weeks. When laboratory evaluation showed elevated somatomedin (IGF-I) levels and an oral glucose tolerance test failed to demonstrate any suppression of her growth hormone (GH) values, an MRI of the pituitary revealed a sellar mass. A presumptive diagnosis of pituitary adenoma was established. The patient underwent transsphenoidal resection of the sellar mass, which proved to be a large B-cell lymphoma (Stage I-E) associated with areas of adenoma and lymphocytic hypophysitis.
垂体中同时存在三种组织病理学不同的病变实体是一种罕见的情况。大多数出版物报道的至少有两种不同的病理情况，主要是垂体腺瘤与第二种鞍内病变并存。我们报告一例71岁女性患者，因肢端肥大症前来评估和治疗。询问得知她已经出现面部麻痹、视觉障碍和晕厥发作数周。实验室检查显示生长介素（IGF-I）水平升高，口服葡萄糖耐量试验未能显示其生长激素（GH）值有任何抑制，垂体MRI显示鞍区有肿块。初步诊断为垂体腺瘤。患者接受了鞍区肿块的经蝶窦切除术，结果显示为一个大的B细胞淋巴瘤（I-E期），伴有腺瘤和淋巴细胞性垂体炎区域。
