Ebrahimzadeh Kaveh, Mirahmadi Eraghi Mohammad, Ansari Mohammad, Dmytriw Adam A
Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
Front Surg. 2024 May 22;11:1359787. doi: 10.3389/fsurg.2024.1359787. eCollection 2024.
Hemangiopericytoma (HPC) constitutes less than 1% of all primary central nervous system tumors. It is a vascular neoplasm with potential malignancy that, in rare instances, manifests as a primary lesion within the brain. Typically, it originates from the meninges. Here, we describe an exceptionally uncommon sellar region solitary fibrous tumor/hemangiopericytoma (SFT/HPC) that mimicked a nonfunctional pituitary adenoma.
A 54-year-old male was referred to our hospital due to progressive blurred vision in the left eye over the past year. A homogeneous iso-dense extra-axial intrasellar round mass with extension into the suprasellar region, mainly on the left side, along with bony erosion and osteolysis around the sellar region, was observed on a brain computed tomography (CT) scan. Brain magnetic resonance imaging (MRI) revealed a well-defined 251,713 mm mass with iso-signal on T1-weighted images and hypersignal on T2-weighted images, originating from the pituitary gland within the sella turcica. The mass avidly enhanced following Gadolinium injection and adhered to both carotid arteries without vascular compression or invasion. It extended to the suprasellar cistern and compressed the optic chiasm. The diagnosis was nonfunctional pituitary macroadenoma, leading to the decision for Endoscopic Trans-Sphenoidal Surgery (ETSS). A non-sustainable, soft, grayish mass was grossly and totally resected during the operation. Subsequently, there was a significant improvement in visual acuity during the early postoperative period. Histopathologic examination confirmed hemangiopericytoma (WHO grade II).
Due to its malignant nature, hemangiopericytoma should be included in the differential diagnosis of a sellar mass, both from a clinical and morphological perspective.
血管外皮细胞瘤（HPC）占所有原发性中枢神经系统肿瘤的比例不到1%。它是一种具有潜在恶性的血管性肿瘤，在极少数情况下表现为脑内原发性病变。通常，它起源于脑膜。在此，我们描述了一例极为罕见的鞍区孤立性纤维性肿瘤/血管外皮细胞瘤（SFT/HPC），其表现类似无功能垂体腺瘤。
一名54岁男性因过去一年左眼视力逐渐模糊而转诊至我院。脑部计算机断层扫描（CT）显示鞍内均匀等密度轴外圆形肿块，延伸至鞍上区域，主要在左侧，同时鞍区周围有骨质侵蚀和骨溶解。脑部磁共振成像（MRI）显示一个边界清晰的251,713 mm肿块，在T1加权图像上呈等信号，在T2加权图像上呈高信号，起源于蝶鞍内的垂体。注射钆后肿块明显强化，与双侧颈动脉粘连，但无血管受压或侵犯。它延伸至鞍上池并压迫视交叉。诊断为无功能垂体大腺瘤，因此决定进行内镜经蝶窦手术（ETSS）。手术中肉眼可见一个质地柔软、呈灰色且不可持续的肿块被完整切除。术后早期视力有显著改善。组织病理学检查确诊为血管外皮细胞瘤（世界卫生组织二级）。
鉴于其恶性性质，无论从临床还是形态学角度，血管外皮细胞瘤都应列入鞍区肿块的鉴别诊断。
