Tanriover Necmettin, Aydin Ovgu, Kucukyuruk Baris, Abuzayed Bashar, Guler Huseyin, Oz Buge, Gazioglu Nurperi
From the Departments of *Neurosurgery, and †Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey; and ‡Al Bashir Hospital, Amman, Jordan.
J Craniofac Surg. 2014 Jul;25(4):1277-9. doi: 10.1097/SCS.0000000000000580.
The authors share their experience on a collision tumor of growth hormone (GH)-secreting adenoma and gangliocytoma in the pituitary gland, which was reported by few articles in the literature. Also, an intraoperative view of this tumor, operated via endoscopic endonasal transsphenoidal approach, is presented for the first time. A 39-year-old female patient was admitted with clinical manifestation of acromegaly present in a 2-year period. Laboratory investigations revealed high levels of GH and insulinlike growth factor 1. Sellar computed tomography scan and magnetic resonance imaging showed a sellar mass diagnosed as a pituitary adenoma. Based on clinical, biochemical, and radiologic evaluations, GH-secreting pituitary adenoma was diagnosed and operated by endoscopic endonasal transsphenoidal approach achieving total removal of the tumor. Histopathologic examination revealed a collision tumor of GH-secreting adenoma and gangliocytoma. Postoperative radiologic and biochemical investigations showed no residual tumor and total remission. The endoscopic endonasal transsphenoidal approach promotes a close intraoperative view of sellar pathologies. We believe that a detailed histopathologic workup is necessary to diagnose collision tumors, because even a close intraoperative view does not facilitate to differentiate these tumors from a regular pituitary adenoma.
作者分享了他们关于垂体生长激素（GH）分泌性腺瘤与神经节细胞瘤碰撞瘤的经验，此类病例在文献中报道较少。此外，首次展示了经鼻内镜经蝶窦入路手术切除该肿瘤的术中视野。一名39岁女性患者因2年期间出现肢端肥大症临床表现入院。实验室检查显示GH和胰岛素样生长因子1水平升高。蝶鞍计算机断层扫描和磁共振成像显示蝶鞍区有一肿块，诊断为垂体腺瘤。基于临床、生化和影像学评估，诊断为分泌GH的垂体腺瘤，并经鼻内镜经蝶窦入路手术，实现肿瘤全切。组织病理学检查显示为GH分泌性腺瘤与神经节细胞瘤的碰撞瘤。术后影像学和生化检查显示无肿瘤残留，达到完全缓解。经鼻内镜经蝶窦入路可在术中清晰观察蝶鞍病变。我们认为，诊断碰撞瘤需要详细的组织病理学检查，因为即使术中视野清晰也难以将这些肿瘤与普通垂体腺瘤区分开来。
