Tajudeen Bobby A, Kuan Edward C, Adappa Nithin D, Han Joseph K, Chandra Rakesh K, Palmer James N, Kennedy David W, Wang Marilene B, Suh Jeffrey D
Department of Otorhinolarygology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States.
Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States.
J Neurol Surg B Skull Base. 2017 Apr;78(2):120-124. doi: 10.1055/s-0036-1592081. Epub 2016 Sep 9.
An ectopic pituitary adenoma presenting as a clival or sphenoid mass is a rare clinical occurrence that may mislead the clinician and result in unnecessary interventions or potential medicolegal consequences. Here, we present one of the largest multi-institutional case series and review the literature with an emphasis on radiological findings and critical preoperative workup. Retrospective chart review. Nine patients were identified with ectopic pituitary adenomas of the sphenoid or clivus. There were four females and five males. Median age was 60 years old (range, 36-73 years). The most common presenting symptom was headache (56%). Five (56%) patients presented with a mass arising from the clivus while four (44%) presented with a mass in the sphenoid. Six (67%) patients demonstrated biochemical evidence of hypersecretion on full endocrinology panel. All masses showed evidence of enhancement with gadolinium with a propensity for adjacent bone involvement. Lesions also had a predilection for growth toward the cavernous sinus, carotid artery, or sellar floor. Surgical intervention was performed in eight patients (89%). In eight patients (89%), tumors demonstrated immunoreactivity to prolactin. Pituitary adenomas can rarely present as an isolated sphenoid or clival mass. Lesions displayed similar magnetic resonance imaging findings with an erosive growth pattern toward the sellar floor, cavernous sinus, or adjacent carotid artery. Patients with clival or parasellar lesions with comparable features should have a preoperative workup which includes prolactin level and alert the physician to consider an ectopic pituitary adenoma in the differential to prevent unnecessary surgery and potential complications.
表现为斜坡或蝶骨肿块的异位垂体腺瘤是一种罕见的临床情况，可能会误导临床医生，导致不必要的干预或潜在的医疗法律后果。在此，我们展示了最大的多机构病例系列之一，并回顾文献，重点关注影像学表现和关键的术前检查。 回顾性病历审查。 确定了9例蝶骨或斜坡异位垂体腺瘤患者。其中女性4例，男性5例。中位年龄为60岁（范围36 - 73岁）。最常见的首发症状是头痛（56%）。5例（56%）患者表现为起源于斜坡的肿块，4例（44%）表现为蝶骨肿块。6例（67%）患者在内分泌全面检查中显示有分泌亢进的生化证据。所有肿块在钆增强扫描中均有强化表现，且倾向于累及相邻骨质。病变还倾向于向海绵窦、颈动脉或鞍底生长。8例患者（89%）接受了手术干预。8例（89%）患者的肿瘤对催乳素呈免疫反应阳性。 垂体腺瘤很少仅表现为孤立的蝶骨或斜坡肿块。病变在磁共振成像上表现相似，呈向鞍底、海绵窦或相邻颈动脉的侵蚀性生长模式。具有类似特征的斜坡或鞍旁病变患者术前应进行包括催乳素水平在内的检查，并提醒医生在鉴别诊断时考虑异位垂体腺瘤，以避免不必要的手术和潜在并发症。
