Kinoshita Yasuyuki, Taguchi Akira, Yamasaki Fumiyuki, Nakamori Masahiro, Amatya Vishwa Jeet, Iida Koji
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan.
Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan.
NMC Case Rep J. 2022 Mar 4;9:31-35. doi: 10.2176/jns-nmc.2021-0296. eCollection 2022.
Because of nonspecific clinical and radiological findings, it is difficult to diagnose isolated neurosarcoidosis without histological examination. Distinguishing neurosarcoidosis from neoplasm, infectious disease, or granulomatous disease can be challenging. In this study, we present a case of a 61-year-old female who presented with unilateral blindness. Magnetic resonance imaging (MRI) revealed a large invasive mass lesion located in the neurohypophysis with homogeneous enhancement after the injection of gadolinium. The lesion involved the bilateral cavernous sinus, which extended along the dura of the skull base with leptomeningeal lesions. Contrast-enhanced computed tomography (CT) and fluorodeoxyglucose positron emission tomography/CT of the entire body showed no other lesions. Biochemical examinations showed no useful data, including angiotensin-converting enzyme, β-glucan, soluble interleukin-2 receptor, and T-SPOT. Cerebrospinal fluid examination revealed only the elevation of total protein. Under the preoperative diagnosis of a malignant tumor or metastatic tumor, followed by tuberculosis, fungal infection, or granulomatous disease, a biopsy was performed to immediately determine the appropriate therapy, which revealed the histological diagnosis of sarcoidosis. After steroid therapy, the lesions had markedly shrunk as observed on MRI, and the eyesight of the patient's right eye was completely restored. In this case, without a biopsy, discriminating between sarcoidosis and a malignant tumor was difficult. We believe that a prompt histological diagnosis of an invasive isolated neurohypophysial mass lesion involving the bilateral cavernous sinus, which is similar to a malignant tumor, is essential for selecting the appropriate therapy.
由于临床表现和影像学表现缺乏特异性，在没有组织学检查的情况下，很难诊断孤立性神经结节病。将神经结节病与肿瘤、传染病或肉芽肿性疾病区分开来具有挑战性。在本研究中，我们报告了一例61岁女性患者，其表现为单侧失明。磁共振成像（MRI）显示一个位于神经垂体的巨大侵袭性肿块，注射钆后呈均匀强化。病变累及双侧海绵窦，沿颅底硬脑膜延伸并伴有软脑膜病变。全身对比增强计算机断层扫描（CT）和氟脱氧葡萄糖正电子发射断层扫描/CT未发现其他病变。生化检查未发现有用数据，包括血管紧张素转换酶、β-葡聚糖、可溶性白细胞介素-2受体和T-SPOT。脑脊液检查仅显示总蛋白升高。在术前诊断为恶性肿瘤或转移性肿瘤，其次考虑为结核病、真菌感染或肉芽肿性疾病的情况下，进行了活检以立即确定合适的治疗方法，活检结果显示为结节病的组织学诊断。类固醇治疗后，MRI显示病变明显缩小，患者右眼视力完全恢复。在这种情况下，若不进行活检，很难区分结节病和恶性肿瘤。我们认为，对于涉及双侧海绵窦的侵袭性孤立性神经垂体肿块病变，迅速进行组织学诊断至关重要，因为该病变与恶性肿瘤相似，这对于选择合适的治疗方法至关重要。
