Wang Yuefei, Cheng Haixia, He Wenqiang, Zhang Qilin, Yao Shun, Chen Zhengyuan, Ma Zengyi, Shou Xuefei, Shen Ming, Wang Yongfei
Department of Neurosurgery, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China.
Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
J Neurosurg Case Lessons. 2025 Jun 30;9(26). doi: 10.3171/CASE25237.
Mixed gangliocytoma-adenoma (MGA) is an uncommon tumor found in the sellar region, characterized by both gangliocytic and pituitary adenomatous components. Preoperative differentiation of these mixed tumors from typical pituitary adenomas can be challenging, making thorough histological examination following resection essential for accurate diagnosis. However, the presence of the neural component in the gangliocytoma does not seem to affect its aggressiveness or recurrence risk after surgery.
In the present study, the authors report a case of Cushing's disease secondary to a mixed pituitary adrenocorticotropin adenoma coexisting with an intrasellar gangliocytoma. Innovative preoperative C-X-C chemokine receptor type 4 (CXCR4)-targeted positron emission tomography (PET)/MRI and an intraoperative indocyanine green (ICG) fluorescence endoscope were used to localize the pathology. Biochemical remission was achieved after gross-total resection.
Gross-total resection of the tumor is a curative management strategy for MGAs. MGA should be suspected if the intraoperative frozen section shows gliosis with ganglion-like neurons but not adenomas. Preoperative CXCR4-targeted PET/MRI can help to localize the pathology causing Cushing's disease. An intraoperative ICG fluorescence endoscope can be used to differentiate the pathology from normal gland tissue. https://thejns.org/doi/10.3171/CASE25237.
混合性神经节细胞瘤-腺瘤（MGA）是一种罕见的鞍区肿瘤，其特征是同时具有神经节细胞和垂体腺瘤成分。术前将这些混合性肿瘤与典型垂体腺瘤区分开来具有挑战性，因此切除术后进行全面的组织学检查对于准确诊断至关重要。然而，神经节细胞瘤中神经成分的存在似乎并不影响其手术后的侵袭性或复发风险。
在本研究中，作者报告了一例继发于混合性垂体促肾上腺皮质激素腺瘤并伴有鞍内神经节细胞瘤的库欣病病例。采用创新的术前靶向C-X-C趋化因子受体4（CXCR4）的正电子发射断层扫描（PET）/磁共振成像（MRI）以及术中吲哚菁绿（ICG）荧光内镜对病变进行定位。肿瘤全切术后实现了生化缓解。
肿瘤全切是MGA的一种治愈性治疗策略。如果术中冰冻切片显示有胶质增生伴神经节样神经元但无腺瘤，则应怀疑为MGA。术前靶向CXCR4的PET/MRI有助于定位导致库欣病的病变。术中ICG荧光内镜可用于将病变与正常腺组织区分开来。https://thejns.org/doi/10.3171/CASE25237 。
