Fujisawa Hironori, Tohma Yasuo, Muramatsu Naoki, Kida Shinya, Kaizaki Yasuharu, Tamamura Hiroyasu
Department of Neurosurgery, Fukui Prefectural Hospital, Japan.
Neurol Med Chir (Tokyo). 2012;52(8):594-8. doi: 10.2176/nmc.52.594.
A 68-year-old male presented with a very rare case of spindle cell oncocytoma (SCO), a recently identified very rare neoplasm of the anterior pituitary, manifesting as panhypopituitarism and visual field defect. The pituitary tumor with suprasellar extension was only partially resected via transsphenoidal surgery because of the tumor consistency and bleeding. Histological diagnosis was consistent with schwannoma. The tumor regrew and angiography revealed hypervascularity, so a transcranial approach was employed for the re-operation which only achieved partial resection because of intraoperative extensive bleeding. The tumor cells showed similar histological and immunohistochemical profiles to the previous specimen, but electron microscopy demonstrated that cytoplasm abundantly filled with mitochondria. The final diagnosis of SCO was established and the patient received postoperative conventional radiation therapy of 50 Gy. Only 15 cases of SCO have been reported, and the diagnosis was mistaken in many cases as schwannoma, oncocytic pituitary adenoma, or craniopharyngioma, and multiple surgeries followed by radiation therapy were required.
一名68岁男性患者，患有极为罕见的梭形细胞嗜酸细胞瘤（SCO），这是一种最近才被确认的极其罕见的垂体前叶肿瘤，表现为全垂体功能减退和视野缺损。由于肿瘤质地及出血情况，经蝶窦手术仅部分切除了向鞍上扩展的垂体肿瘤。组织学诊断为神经鞘瘤。肿瘤复发，血管造影显示血管丰富，因此再次手术采用经颅入路，但因术中大量出血仅实现了部分切除。肿瘤细胞的组织学和免疫组化特征与之前的标本相似，但电子显微镜显示细胞质中充满大量线粒体。最终确诊为SCO，患者术后接受了50 Gy的常规放射治疗。目前仅报道了15例SCO，且在很多病例中诊断有误，被误诊为神经鞘瘤、嗜酸细胞垂体腺瘤或颅咽管瘤，需要多次手术并辅以放射治疗。
