Department of Neurosurgery, AZ Delta, Roeselare, Belgium.
Department of Pathology, Ghent University Hospital, Ghent, Belgium.
World Neurosurg. 2020 Aug;140:60-62. doi: 10.1016/j.wneu.2020.05.027. Epub 2020 May 11.
Granular cell tumors of the pituitary gland are rare, slow-growing lesions arising from the neurohypophysis or pituitary stalk. We describe an extremely rare presentation of a pituitary granular cell tumor mimicking an anterior communicating artery aneurysmal rupture with ventricular hemorrhage. The patient was admitted in a comatose state and underwent urgent bilateral external ventricular drainage. Further diagnostic investigation revealed a sellar tumoral mass with suprasellar extension. No vascular anomalies, hormonal abnormalities, or visual disturbances were observed. Macroscopic complete resection without neurologic impairment was obtained via a right pterional approach. Posthemorrhagic hydrocephalus necessitated ventriculoperitoneal shunt placement, and hormonal substitution for panhypopituitarism was provided. The 5-year follow-up examination showed no tumor recurrence. The clinical course of these benign World Health Organization grade I lesions will normally correspond to nonsecreting pituitary adenomas with an insidious development of visual disturbances, hypopituitarism, or hydrocephalus. Sudden onset with potential catastrophic intratumoral and intraventricular hemorrhage is very uncommon.
垂体颗粒细胞瘤是一种罕见的、生长缓慢的肿瘤，起源于神经垂体或垂体柄。我们描述了一例非常罕见的垂体颗粒细胞瘤表现，类似于前交通动脉瘤破裂伴脑室出血。患者呈昏迷状态入院，并接受了紧急双侧脑室外引流。进一步的诊断性检查显示鞍内肿块伴有鞍上扩展。未观察到血管异常、激素异常或视觉障碍。通过右侧翼点入路实现了无神经功能障碍的大体完全切除。出血后脑积水需要放置脑室-腹腔分流管，并且提供了全垂体功能减退的激素替代治疗。5 年随访检查未发现肿瘤复发。这些良性的世界卫生组织 1 级病变的临床过程通常与无分泌功能的垂体腺瘤相对应，其表现为视觉障碍、垂体功能减退或脑积水的隐匿性发展。伴有潜在灾难性肿瘤内和脑室内出血的突发情况非常罕见。
