Goulart Carlos R, Upadhyay Smita, Ditzel Filho Leo F S, Beer-Furlan Andre, Carrau Ricardo L, Prevedello Luciano M, Prevedello Daniel M
Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, USA.
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA.
World Neurosurg. 2017 Oct;106:254-265. doi: 10.1016/j.wneu.2017.06.139. Epub 2017 Jun 30.
The use of combined positron emission tomography/computed tomography for staging in patients with cancer and the widespread use of magnetic resonance imaging has led to increased detection of incidental sellar masses. The imaging findings can be suggestive of a benign pituitary tumor, but metastasis can never be completely ruled out with noninvasive work-up. Appropriate diagnosis of sellar masses is critical, as the treatment paradigm might change in the presence of a pituitary metastasis. Definitive tissue diagnosis might prevent unnecessary radiotherapy to the skull base or the need for systemic treatment when benign pituitary disease is confirmed.
A retrospective chart review from 2010 to 2015 of all patients with recently diagnosed cancer and undergoing surgery for sellar region masses was performed.
There were 9 patients (3 female and 6 male) identified. Lung cancer was the primary condition in 4 patients; the remaining 5 patients had breast cancer, follicular thyroid cancer, cutaneous melanoma, colorectal carcinoma, and renal cell carcinoma. On final pathology, the sellar mass was a benign pituitary adenoma in 5 patients, metastatic cancer in 3 patients, and a granular cell tumor in 1 patient.
Surgical resection of a sellar mass in patients with known cancer helps in the definitive diagnosis, relieves compressive symptoms, and avoids unnecessary empiric radiotherapy in cases of confirmed benign pituitary disease.
正电子发射断层扫描/计算机断层扫描联合用于癌症患者分期以及磁共振成像的广泛应用，导致偶发性鞍区肿块的检出率增加。影像学表现可能提示为良性垂体肿瘤，但在无创检查中永远无法完全排除转移的可能。鞍区肿块的准确诊断至关重要，因为存在垂体转移时治疗模式可能会改变。明确的组织诊断在确诊为良性垂体疾病时可避免对头颅底部进行不必要的放疗或避免全身治疗。
对2010年至2015年期间所有近期诊断为癌症且接受鞍区肿块手术的患者进行回顾性病历审查。
共确定9例患者（3例女性，6例男性）。4例患者的原发疾病为肺癌；其余5例患者分别患有乳腺癌、滤泡性甲状腺癌、皮肤黑色素瘤、结肠直肠癌和肾细胞癌。最终病理结果显示，5例患者的鞍区肿块为良性垂体腺瘤，3例为转移性癌，1例为颗粒细胞瘤。
对已知患有癌症的患者进行鞍区肿块手术切除有助于明确诊断，缓解压迫症状，并在确诊为良性垂体疾病的情况下避免不必要的经验性放疗。
