Hanna Bishoy, Li Yan M, Beutler Timothy, Goyal Parul, Hall Walter A
Department of Surgery, Staten Island University Hospital, 28 Arvin Road, Old Bridge, NJ 08857, USA.
Department of Neurosurgery, State University of New York, Upstate Medical University, Syracuse, NY, USA.
J Clin Neurosci. 2015 Jul;22(7):1091-7. doi: 10.1016/j.jocn.2015.01.019. Epub 2015 May 6.
We present a 69-year-old woman who presented with chronic headaches and was found to have a pituitary mass on MRI, which was biopsied and said to be lymphocytic hypophysitis. The woman was placed on prednisone and followed with routine eye examinations. Two years later, the lesion gradually increased in size and the woman developed a decrease in peripheral vision in the right eye. An MRI showed abutment of the right optic nerve by the mass. A repeat endoscopic transsphenoidal biopsy/resection of the pituitary lesion was performed. Histopathological analysis of the specimen was consistent with diagnosis of xanthomatous hypophysitis (XH). XH is an inflammatory disorder of the pituitary gland characterized by an infiltration of lipid-laden histiocytes, also known as xanthoma cells. The mass was biopsied and a diagnosis of lymphocytic hypophysitis was made. The woman reported improved visual acuity and peripheral vision postoperatively. One year after the second resection, her visual symptoms worsened. Repeat MRI revealed expansion of the residual pituitary tissue. She was referred to the radiation oncology department for external beam radiation therapy and was placed on a maintenance dose of steroids. Since undergoing radiation therapy, her vision has improved slightly and her 3month MRI revealed stable lesion size. This woman illustrates a rare pituitary pathology presented with a literature review of published patients describing xanthomatous hypophysitis. A discussion of the clinical presentation, epidemiology, etiology, diagnosis, histology and treatment is provided.
我们报告了一名69岁女性，她因慢性头痛就诊，MRI检查发现垂体有肿块，经活检诊断为淋巴细胞性垂体炎。该女性接受了泼尼松治疗，并定期进行眼科检查。两年后，病变逐渐增大，该女性右眼出现周边视野缺损。MRI显示肿块压迫右侧视神经。遂再次行经鼻蝶窦垂体病变活检/切除术。标本的组织病理学分析与黄色瘤性垂体炎（XH）的诊断一致。XH是一种垂体的炎症性疾病，其特征是富含脂质的组织细胞浸润，也称为黄色瘤细胞。最初对肿块进行活检时诊断为淋巴细胞性垂体炎。该女性术后报告视力和周边视野有所改善。第二次切除术后一年，她的视觉症状恶化。复查MRI显示残余垂体组织增大。她被转诊至放射肿瘤科接受外照射放疗，并接受维持剂量的类固醇治疗。自接受放疗以来，她的视力略有改善，3个月后的MRI显示病变大小稳定。本文通过对已发表的黄色瘤性垂体炎患者文献进行综述，展示了这种罕见的垂体病理情况。并对其临床表现、流行病学、病因、诊断、组织学及治疗进行了讨论。
