Kunihiro Joji, Inoue Akihiro, Miyake Teruki, Ohno Teruyuki, Kitazawa Riko, Kunieda Takeharu
Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan.
Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan.
Int J Surg Case Rep. 2023 Aug;109:108536. doi: 10.1016/j.ijscr.2023.108536. Epub 2023 Jul 21.
Spindle cell oncocytoma (SCO) of the pituitary gland is very difficult to differentiate from other pituitary neoplasms and is often misdiagnosed based on imaging procedure features. We report a rare case of SCO arising from the neurohypophysis and suggest a useful diagnostic criterion for accurate diagnosis and surgical pitfalls.
A 53-year-old man was admitted to our hospital with slight headache and diplopia. Neuroimaging revealed pituitary tumour in the suprasellar and sellar regions with speckled gadolinium enhancement on T1-weighted magnetic resonance imaging, as a so-called blooming artefact. The enhanced anterior pituitary gland was located anteriorly. Computed tomography (CT)-scan demonstrated an isodense mass without calcification showing strong contrast enhancement with iodine contrast medium. Laboratory findings showed no abnormalities. Subtotal resection of the tumour was achieved by an endoscopic endonasal transsphenoidal approach. Histological examinations showed spindle-shaped to epithelioid tumour cells featuring eosinophilic and granular cytoplasm staining strongly for anti-mitochondrial antibody and thyroid transcription factor 1. The tumour was therefore diagnosed as SCO, belonging to tumours of the posterior pituitary. Headache and diplopia were disappeared immediately postoperatively, and follow-up at 12 months demonstrated no signs of recurrence.
SCO of the pituitary gland is a rare tumour that originates from the neurohypophysis and is difficult to diagnose on routine neuroimaging procedure.
Accurate diagnosis requires careful identification of clinical signs, neuroimaging features including contrast-enhanced CT, and analysis of combined results from morphological and immunohistochemical evaluation of tumour tissue.
垂体的梭形细胞嗜酸细胞瘤（SCO）很难与其他垂体肿瘤相鉴别，常基于影像学检查特征被误诊。我们报告1例起源于神经垂体的罕见SCO病例，并提出有助于准确诊断及手术操作要点的诊断标准。
一名53岁男性因轻微头痛和复视入院。神经影像学检查显示鞍上和鞍区有垂体肿瘤，在T1加权磁共振成像上有斑点状钆增强，即所谓的“开花”伪影。增强的垂体前叶位于前方。计算机断层扫描（CT）显示等密度肿块，无钙化，碘造影剂增强明显。实验室检查结果无异常。通过鼻内镜经蝶窦入路对肿瘤进行了次全切除。组织学检查显示梭形至上皮样肿瘤细胞，其嗜酸性和颗粒状细胞质对抗线粒体抗体和甲状腺转录因子1染色强烈。因此，该肿瘤被诊断为SCO，属于垂体后叶肿瘤。术后头痛和复视立即消失，12个月的随访未发现复发迹象。
垂体SCO是一种罕见肿瘤，起源于神经垂体，在常规神经影像学检查中难以诊断。
准确诊断需要仔细识别临床体征、包括增强CT在内的神经影像学特征，以及对肿瘤组织形态学和免疫组化评估的综合结果进行分析。
