Matsuno A, Hashizume K, Tsuzuki N, Suzuki K, Shibayama E, Ishikawa H, Matsutani M
Department of Neurosurgery, Tokyo University Hospital.
No Shinkei Geka. 1993 Jun;21(6):551-5.
A 21-year-old man was hospitalized with complaints of headache, nausea, polyuria, reduced body hair and reduced libido. Plain CT scan and MRI revealed multiple tumors in the pineal and suprasellar regions, and in the dorsal aspect of the medulla oblongata. Endocrinological examination showed hypopituitarism due to hypothalamic dysfunction. Replacement therapy with hydrocortisone was started preoperatively. Suprasellar tumor was explored. Postoperative CT scan and MRI showed marked diminishment of not only suprasellar tumor, but also tumors in the two other regions. These tumors were supposed to be sensitive to corticosteroid hormone. Histopathological diagnosis was T cell type malignant lymphoma. The patient was followed up for 10 months post-operatively with no recurrence on CT scan. Primary intracranial malignant lymphoma is not a rare disease today. However, primary intracranial T cell type lymphoma is extremely rare. Hypopituitarism due to suprasellar malignant lymphoma is also rare, and only 3 such cases have been reported previously. In our case, the tumor was located in the pineal and suprasellar regions, and the dorsal aspect of the medulla oblongata. Such disseminated malignant lymphoma as ours shows radiological resemblance to germ cell tumor. No such diseminated malignant lymphoma has been reported previously. We think that, in its radiological and clinical features, our case is very suggestive of primary intracranial malignant lymphoma.
一名21岁男性因头痛、恶心、多尿、体毛减少和性欲减退入院。普通CT扫描和MRI显示松果体区、鞍上区及延髓背侧有多个肿瘤。内分泌检查显示因下丘脑功能障碍导致垂体功能减退。术前开始使用氢化可的松进行替代治疗。对鞍上肿瘤进行了探查。术后CT扫描和MRI显示不仅鞍上肿瘤明显缩小，其他两个区域的肿瘤也明显缩小。这些肿瘤被认为对皮质类固醇激素敏感。组织病理学诊断为T细胞型恶性淋巴瘤。患者术后随访10个月，CT扫描未见复发。原发性颅内恶性淋巴瘤如今并非罕见疾病。然而，原发性颅内T细胞型淋巴瘤极为罕见。鞍上恶性淋巴瘤导致的垂体功能减退也很罕见，此前仅报道过3例。在我们的病例中，肿瘤位于松果体区、鞍上区及延髓背侧。像我们这样的播散性恶性淋巴瘤在影像学上与生殖细胞瘤相似。此前未见此类播散性恶性淋巴瘤的报道。我们认为，从其影像学和临床特征来看，我们的病例非常符合原发性颅内恶性淋巴瘤。
