Inoue Eri, Kesumayadi Irfan, Fujio Shingo, Makino Ryutaro, Hanada Tomoko, Masuda Keisuke, Higa Nayuta, Kawade Shigeru, Niihara Yuichiro, Takagi Hirosuke, Kitazono Ikumi, Takahashi Yutaka, Hanaya Ryosuke
Department of Neurosurgery, Kagoshima University, Kagoshima, Japan.
Department of Neurosurgery, Diponegoro University, Tembalang, Semarang, Indonesia.
Surg Neurol Int. 2024 Mar 1;15:69. doi: 10.25259/SNI_947_2023. eCollection 2024.
Although rare, cases of hypophysitis resembling a pituitary abscess (PA) have been reported. Differential diagnosis between hypophysitis and PA is crucial as the two diseases require different treatments.
A 38-year-old woman with headaches underwent head magnetic resonance imaging (MRI), which revealed an 11-mm mass lesion in the sella turcica. Due to breastfeeding, contrast-enhanced MRI was avoided. Pituitary adenomas and Rathke's cleft cyst (RCC) were suspected, and she was initially treated conservatively. Five months later, she acquired syndrome coronavirus two infections, and while the fever subsided with acetaminophen, the headache persisted. One month later, the headache worsened, followed by fever and diabetes insipidus. MRI revealed a pituitary cystic mass with ring-shaped contrast enhancement on T1-weighted MRI and increased signal intensity on diffusion-weighted imaging (DWI). PA was suspected, and emergency endoscopic transsphenoidal surgery was performed. The microbiological examination of the yellowish-brown content drained from the cystic mass was negative. Microscopically, the cystic lesion was covered with ciliated columnar epithelium and stratified squamous epithelium, with a dense inflammatory cell infiltrate consisting mainly of lymphocytes and plasma cells observed around the cyst. This supported the diagnosis of secondary hypophysitis associated with RCC without PA.
We report a case of hypophysitis secondary to RCC resembling PA with ring-shaped contrast enhancement on MRI and increased signal intensity on DWI. This case emphasizes the need for cautious diagnosis of secondary hypophysitis due to RCC in individuals with MRIs and clinical manifestations resembling an abscess.
尽管垂体炎类似垂体脓肿（PA）的病例罕见，但已有报道。垂体炎与PA的鉴别诊断至关重要，因为这两种疾病需要不同的治疗方法。
一名38岁头痛女性接受头部磁共振成像（MRI）检查，结果显示蝶鞍内有一个11毫米的肿块病变。由于处于哺乳期，未进行增强MRI检查。怀疑为垂体腺瘤和拉克氏囊肿（RCC），她最初接受了保守治疗。五个月后，她感染了严重急性呼吸综合征冠状病毒2，虽然对乙酰氨基酚使发热消退，但头痛仍持续。一个月后，头痛加重，随后出现发热和尿崩症。MRI显示垂体囊性肿块在T1加权MRI上有环形强化，在扩散加权成像（DWI）上信号强度增加。怀疑为PA，遂进行了急诊内镜经蝶窦手术。从囊性肿块中引流的黄褐色内容物的微生物学检查为阴性。显微镜下，囊性病变覆盖有纤毛柱状上皮和复层鳞状上皮，在囊肿周围观察到主要由淋巴细胞和浆细胞组成的密集炎性细胞浸润。这支持了与RCC相关的继发性垂体炎而非PA的诊断。
我们报告了一例继发于RCC的垂体炎病例，其在MRI上表现为环形强化，在DWI上信号强度增加，类似PA。该病例强调了对于MRI和临床表现类似脓肿的个体，因RCC导致的继发性垂体炎需要谨慎诊断。
