Velho Vernon, Guha Amrita, Naik Harish, Bhople Laxmikant, Jain Nimesh
Department of Neurosurgery, J.J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India.
Department of Radiology, J.J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India.
Asian J Neurosurg. 2018 Oct-Dec;13(4):1005-1007. doi: 10.4103/ajns.AJNS_17_17.
Lesions of the pituitary gland and the juxtasellar region are quite frequently encountered in daily practise of a neurologist/neurosurgeon. While the differentials of sellar masses are quite large and form an extensive list and the management protocol varies in each case, the onus of properly categorizing and diagnosing the pituitary mass often falls on the reporting radiologist. We hereby present two such unusual masses in the sellar-suprasellar region which were masquerading as pituitary macro adenomas.
Two cases of sellar-suprasellar masses which were preoperatively diagnosed as pituitary macro-adenomas on radiological imaging proved out to be pituitary natural killer cell lymphoma and lepromatous abscess.
The first one is a rare case of pituitary abscess seen in a lepromatous patient which is not yet reported in the literature. The second case is of primary pituitary natural killer cell lymphoma which is almost entirely unknown, with only two such cases being reported worldwide till date.
It is important to realize that all enhancing pituitary lesions are not macro adenomas and it is necessary to have a high index of suspicion in such cases. The clinical implications of such an error and steps that can be taken to prevent misinterpretations of unusual sellar masses camouflaging as pituitary macro adenomas have been briefly outlined.
垂体及鞍旁区域病变在神经科医生/神经外科医生的日常工作中较为常见。虽然鞍区肿块的鉴别诊断范围很广，种类繁多，且每种情况的治疗方案各不相同，但正确分类和诊断垂体肿块的责任往往落在报告的放射科医生身上。我们在此介绍两例鞍上区域的异常肿块，它们伪装成垂体大腺瘤。
两例鞍上肿块在术前影像学检查中被诊断为垂体大腺瘤，术后病理证实为垂体自然杀伤细胞淋巴瘤和瘤型麻风脓肿。
第一例是瘤型麻风患者中罕见的垂体脓肿病例，文献中尚未见报道。第二例是原发性垂体自然杀伤细胞淋巴瘤，几乎完全不为人知，迄今为止全世界仅报道过两例。
必须认识到，并非所有强化的垂体病变都是大腺瘤，对此类病例必须保持高度怀疑。本文简要概述了此类误诊的临床影响以及为防止将伪装成垂体大腺瘤的异常鞍区肿块误诊而可采取的措施。
