Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
World Neurosurg. 2019 Dec;132:e423-e429. doi: 10.1016/j.wneu.2019.08.126. Epub 2019 Aug 27.
To systematically review and analyze clinical, diagnostic, and management trends in sellar and parasellar brown tumors reported in existing literature.
In this systematic review, PubMed, Ovid MEDLINE, Scopus, and Google Scholar databases were searched for reported cases of sellar/parasellar brown tumors. Relevant titles and abstracts were screened in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Articles meeting inclusion criteria were subjected to data extraction, summarization, and analysis. A rare case of parasellar brown tumor was also presented.
Eight reports (including the current report) were eligible for inclusion. Mean patient age was 42.75 years. Reported symptoms included visual disturbances (n = 6), headache (n = 5), fatigue (n = 3), nausea/vomiting (n = 2), chest pain (n = 1), neck pain (n = 1), and dysphagia (n = 1). In cases where computed tomography findings were provided (n = 6), lesions were noted to be expansile and lytic. Lesions were hyperintense on T2-weighted magnetic resonance imaging (66.7%) and demonstrated contrast enhancement (83.3%). Histology unanimously showed multinucleated giant cells in a fibrovascular connective tissue stroma. Dramatic symptom resolution was noted in all patients who underwent resection of the sellar/parasellar brown tumor (n = 4; 50%).
Sellar/parasellar brown tumors are a rare, tertiary manifestation of hyperparathyroidism and can be elusive to diagnose. Diagnosis requires a high index of clinical suspicion in addition to comprehensive biochemical testing, imaging, and histopathologic analysis. Surgical extirpation is favored in cases where the lesion is causing compressive symptoms, or if it is unresponsive to management of hyperparathyroidism.
系统回顾和分析现有文献中报道的鞍旁棕色瘤的临床、诊断和治疗趋势。
在这项系统回顾中，检索了 PubMed、Ovid MEDLINE、Scopus 和 Google Scholar 数据库中报道的鞍旁/鞍旁棕色瘤病例。根据系统评价和荟萃分析的首选报告项目协议筛选相关标题和摘要。符合纳入标准的文章进行数据提取、总结和分析。还报告了一例罕见的鞍旁棕色瘤病例。
有 8 份报告（包括本报告）符合纳入标准。患者平均年龄为 42.75 岁。报道的症状包括视力障碍（n=6）、头痛（n=5）、疲劳（n=3）、恶心/呕吐（n=2）、胸痛（n=1）、颈部疼痛（n=1）和吞咽困难（n=1）。在提供计算机断层扫描结果的病例中（n=6），病变表现为膨胀性和溶骨性。病变在 T2 加权磁共振成像上呈高信号（66.7%），并显示对比增强（83.3%）。组织学一致显示多核巨细胞位于纤维血管结缔组织基质中。所有接受鞍旁/鞍旁棕色瘤切除术的患者（n=4；50%）症状均显著缓解。
鞍旁/鞍旁棕色瘤是甲状旁腺功能亢进的罕见三级表现，诊断较为困难。诊断需要高度的临床怀疑，以及全面的生化检测、影像学和组织病理学分析。如果病变引起压迫症状，或对甲状旁腺功能亢进的治疗无反应，手术切除是首选。
