Wu Arthur W, Bhuta Sunita, Salamon Noriko, Martin Neil, Wang Marilene B
Division of Head and Neck Surgery, David Geffen School of Medicine at UCLA, 10833 LeConte Ave., 62-132 CHS, Los Angeles, CA 90095, USA.
Ear Nose Throat J. 2015 Oct-Nov;94(10-11):E47-9.
We report an unusual case of a chondroid chordoma of the sella turcica that mimicked the clinical and radiologic presentation of the more common pituitary adenoma. A 50-year-old man presented with bitemporal visual field deficits. Magnetic resonance imaging (MRI) detected a sellar mass that was suggestive of a pituitary adenoma. However, the intraoperative appearance of the mass was not consistent with an adenoma, and frozen-section pathology was obtained. Pathology identified the mass as a malignant lesion. Based on this finding, the mass was treated more aggressively. Chondroid chordomas are rare and slowly growing but locally aggressive tumors. The prognosis depends on the ability to totally resect the mass, so differentiating this tumor from a benign lesion is critical. An intrasellar chordoma can be confused clinically and radiologically with a pituitary adenoma. These two lesions are nearly identical on MRI, although T2-weighted imaging sometimes demonstrates higher intensity with a chondroid chordoma. Computed tomography may be helpful in demonstrating bony destruction by these lesions, as can the presence of intralesional calcifications. Intraoperative findings of bony invasion or a purple-red color may also lead the surgeon to suspect a diagnosis other than pituitary adenoma.
我们报告了一例罕见的蝶鞍区软骨样脊索瘤病例，其临床表现和影像学表现酷似更为常见的垂体腺瘤。一名50岁男性患者出现双颞侧视野缺损。磁共振成像（MRI）检测到一个蝶鞍区肿块，提示为垂体腺瘤。然而，肿块的术中表现与腺瘤不符，遂进行了冰冻切片病理检查。病理结果显示该肿块为恶性病变。基于这一发现，对肿块采取了更积极的治疗措施。软骨样脊索瘤罕见，生长缓慢但具有局部侵袭性。预后取决于能否完全切除肿块，因此将这种肿瘤与良性病变区分开来至关重要。蝶鞍内脊索瘤在临床和影像学上可能与垂体腺瘤混淆。这两种病变在MRI上几乎相同，尽管T2加权成像有时显示软骨样脊索瘤的信号强度更高。计算机断层扫描可能有助于显示这些病变引起的骨质破坏，病变内钙化的存在也有助于诊断。术中发现骨质侵犯或紫红色外观也可能使外科医生怀疑诊断并非垂体腺瘤。
