Baba M, Sugiura K, Takizawa H, Tatsuzawa T, Kamatsuka E, Hayama N, Kameda N, Akima M
No Shinkei Geka. 1985 Mar;13(3):337-42.
A 44-year-old man came to our clinic, complaining of slowly progressive disturbance of visual acuity and of ocular movement. This patient suffered from headache, narrowing of visual field and polyuria about 20 years ago, and received surgical and radiation therapy under the diagnosis of pituitary adenoma. Clinical symptoms and signs of this patient, except for bitemporal hemianopsia, almost completely disappeared after these treatment. The detailed information about the histology and radiation dose are not available at the present time. CT scan in our clinic revealed a round low-density area at the suprasellar region and a high density area at the left quadrigeminal cistern. Pineal calcification was compressed to the right about 2-3 mm from midline. This high density mass were not enhanced with contrast medium. Vertebral angiography showed a slight lateral displacement of the left medial posterior choroidal artery. Specimen of tissue removed 20 years ago was reexamined but definitive diagnosis could not be established. Presumptive diagnosis of an ectopic pinealoma in the suprasellar region treated successfully 20 years ago, and its recurrence in the pineal region was made. On May 24, the patient underwent a posterior fossa craniectomy and the pineal region was explored via the infratentorial supracerebellar approach. On sectioning the precentral cerebellar vein, yellowish mass was seen in the quadrigeminal cistern. Aspiration of this mass yielded dark red liquid hematoma. Incising into the capsule, a dark brownish mass of about 4g was removed en bloc.(ABSTRACT TRUNCATED AT 250 WORDS)
一名44岁男性前来我院门诊，主诉视力及眼球运动逐渐进行性障碍。该患者约20年前曾患头痛、视野缩小及多尿，在垂体腺瘤诊断下接受了手术及放疗。这些治疗后，除双颞侧偏盲外，该患者的临床症状和体征几乎完全消失。目前无法获取有关组织学及放疗剂量的详细信息。我院CT扫描显示鞍上区有一圆形低密度区，左侧四叠体池有一高密度区。松果体钙化从中线向右被压缩约2 - 3毫米。该高密度肿块在注入造影剂后未强化。椎动脉造影显示左后脉络膜内侧动脉有轻微侧方移位。对20年前切除的组织标本进行了重新检查，但未能确立明确诊断。推测该患者20年前成功治疗的鞍上区异位松果体瘤复发至松果体区。5月24日，患者接受了后颅窝开颅手术，并通过幕下小脑上入路探查松果体区。切开小脑中央前静脉时，在四叠体池可见淡黄色肿块。抽吸该肿块得到暗红色液体血肿。切开包膜，完整切除了一个约4克的深褐色肿块。（摘要截取自250字）
