Blackmon Melodie M, Gilbert Andrea R, Floyd John, Hafeez Shaheryar, Seifi Ali
Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA.
Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, USA.
Cureus. 2020 Aug 15;12(8):e9763. doi: 10.7759/cureus.9763.
Invasive giant prolactinomas are a rare type of prolactin-secreting tumors. Most lactotroph adenomas, including giant prolactinomas, consist of the sparsely granulated subtype and respond well to medical therapy with dopamine agonists. Proptosis due to intra-orbital tumor extension and ischemic infarction are two rare complications associated with these tumors. We report a case of a 51-year-old woman with a 30-year history of a macroprolactinoma who was lost to follow-up and returned with severe proptosis, a 10-cm invasive sellar mass on imaging, and markedly elevated serum prolactin levels, consistent with invasive giant prolactinoma. She was initially managed with dopamine agonists followed by palliative debulking of the tumor, which microscopically demonstrated a highly proliferative neoplasm predominantly consisting of sparsely granulated lactotroph adenoma with a minor component of the rare and aggressive acidophil stem cell adenoma subtype. Postoperatively, she developed a large left middle cerebral artery infarct and ultimately died. This case is notable in that it demonstrates the aggressive nature of invasive giant prolactinomas when not treated and highlights two rare findings in patients with this tumor: orbital invasion and ischemic infarct.
侵袭性巨大泌乳素瘤是一种罕见的分泌泌乳素的肿瘤。大多数催乳素细胞腺瘤，包括巨大泌乳素瘤，由稀疏颗粒型亚型组成，对多巴胺激动剂药物治疗反应良好。眶内肿瘤扩展导致的突眼和缺血性梗死是与这些肿瘤相关的两种罕见并发症。我们报告一例51岁女性，患有大泌乳素瘤30年，失访后因严重突眼、影像学显示鞍区有一个10厘米的侵袭性肿块以及血清泌乳素水平显著升高而复诊，符合侵袭性巨大泌乳素瘤。她最初接受多巴胺激动剂治疗，随后对肿瘤进行姑息性减瘤手术，显微镜检查显示肿瘤高度增殖，主要由稀疏颗粒型催乳素细胞腺瘤组成，还有少量罕见且侵袭性的嗜酸干细胞腺瘤亚型。术后，她发生了左侧大脑中动脉大面积梗死，最终死亡。该病例值得注意的是，它显示了侵袭性巨大泌乳素瘤未经治疗时的侵袭性本质，并突出了该肿瘤患者的两个罕见发现：眼眶侵袭和缺血性梗死。
