鞍区转移癌六例临床分析

Clinical analysis of six cases with metastatic carcinoma in sellar region

目的鞍区转移癌为临床罕见病,探讨鞍区转移癌的转移来源、临床表现、诊断与鉴别诊断,总结鞍区转移癌的诊治经验。方法与结果共6例患者均为2014年1月至2019年10月行神经内镜或显微镜下经鼻蝶入路鞍区占位性病变切除术后经病理证实的鞍区转移癌,4例以鞍区占位效应首发,2例既往有恶性肿瘤史。临床表现以头痛、视力下降和视野缺损最为常见。病变主要累及海绵窦和垂体。3例病变累及腺垂体的患者表现为腺垂体功能减退症,其中2例入院诊断为无功能性垂体腺瘤。结论鞍区转移癌可作为恶性肿瘤的首发表现,与垂体腺瘤相比更易出现尿崩症、腺垂体功能减退症等,单纯依靠影像学诊断相对局限,临床实践中应结合多方面考虑鉴别诊断,降低误诊率。

Objective Metastatic carcinoma in sellar region is a rare disease.This article is todiscuss the metastatic origin,clinical manifestations,diagnosis and differential diagnosis of metastaticcMarectihnoodmsa ainnd sRelelsaur ltrsegion,and to summarize the experience in diagnosis and treatment of disease.From January 2014 to October 2019,six patients with metastatic carcinoma insellar region were confirmed by pathological examinations after endoscopic or microscopic transsphenoidalsurgery.Four patients presented with mass effect in sellar region as the first manifestation,and 2 patientswere associated with a history of malignant neoplasm.The common clinical manifestations were headacheand visual disturbance.The lesions mainly involved cavernous sinus and pituitary gland.Three patientswhose lesions involved adenohypophysis presented with pituitary hypofunction,of which 2 patients werediagnosed as non-functional pituitary adenoma on admission.ConclusionsPresentations associated withmetastatic carcinoma in sellar region can be the first manifestation of malignant neoplasm.Compared withpituitary adenomas,metastatic carcinoma in sellar region is more prone to present with diabetes insipidusand pituitary hypofunction.Relying solely on imaging diagnosis is relatively limited,and differentialdiagnosis should be considered in multiple aspects to reduce the misdiagnosis rate.