Kusakawa Akari, Inoue Akihiro, Nakamura Yawara, Nishida Naoya, Fukushima Mana, Senba Hidenori, Suehiro Satoshi, Matsumoto Shirabe, Nishikawa Masahiro, Ozaki Saya, Shigekawa Seiji, Watanabe Hideaki, Matsuura Bunzo, Kitazawa Riko, Kunieda Takeharu
Departments of Neurosurgery, Ehime University School of Medicine, Shitsukawa, Toon, Ehime, Japan.
Departments of Otolaryngology, Ehime University School of Medicine, Shitsukawa, Toon, Ehime, Japan.
Surg Neurol Int. 2020 May 9;11:101. doi: 10.25259/SNI_111_2020. eCollection 2020.
Granular cell tumor (GCT) of the sellar region is a rare tumor of the sellar and suprasellar regions that originate from the neurohypophysis. This tumor is very difficult to differentiate from other pituitary neoplasms, such as pituitary adenoma, pituicytoma, and spindle cell oncocytoma. We report a rare case of GCT arising from the posterior pituitary of the sellar region and suggest a useful indicator for accurate diagnosis and pitfalls for surgical procedures.
A 42-year-old woman was admitted to our hospital with bitemporal hemianopsia. Neuroimaging showed a large pituitary tumor in the sellar and suprasellar regions with a hypointense part on T2-weighted magnetic resonance imaging, and the enhanced anterior pituitary gland was displaced anteriorly. Laboratory findings showed mild hyperprolactinemia. Subtotal resection of the tumor was achieved using an endoscopic endonasal transsphenoidal approach. Histological findings showed round or polygonal cells with abundant granular eosinophilic cytoplasm staining strongly for thyroid transcription factor 1. The tumor was, therefore, diagnosed as a GCT of the sellar region, belonging to tumors of the posterior pituitary. After surgery, visual impairment and anterior pituitary function were improved. Follow-up neuroimaging after 1 year showed no signs of recurrence.
GCT of the sellar region is difficult to diagnose on routine neuroimaging. Therefore, accurate diagnosis requires careful identification of clinical signs, magnetic resonance imaging including hypointensity on T2-weighted imaging, and analysis of combined morphological and immunohistochemical studies.
鞍区颗粒细胞瘤（GCT）是一种起源于神经垂体的鞍区和鞍上区罕见肿瘤。该肿瘤很难与其他垂体肿瘤相鉴别，如垂体腺瘤、垂体细胞瘤和梭形细胞嗜酸细胞瘤。我们报告一例起源于鞍区垂体后叶的罕见GCT病例，并提出有助于准确诊断的指标以及手术操作中的注意事项。
一名42岁女性因双颞侧偏盲入院。神经影像学检查显示鞍区和鞍上区有一个大的垂体肿瘤，在T2加权磁共振成像上有一个低信号部分，增强后的垂体前叶向前移位。实验室检查结果显示轻度高催乳素血症。采用鼻内镜经蝶窦入路实现了肿瘤的次全切除。组织学检查结果显示圆形或多边形细胞，胞质丰富，嗜酸性颗粒状，甲状腺转录因子1染色强阳性。因此，该肿瘤被诊断为鞍区GCT，属于垂体后叶肿瘤。术后视力障碍和垂体前叶功能得到改善。1年后的随访神经影像学检查未显示复发迹象。
鞍区GCT在常规神经影像学检查中难以诊断。因此，准确诊断需要仔细识别临床体征、包括T2加权成像上低信号的磁共振成像，以及综合形态学和免疫组织化学研究分析。
