垂体转移癌四例误诊分析并文献复习

Pituitary Metastatic Carcinoma:Analysis of Four Misdiagnosed Cases and a Literature Review

目的分析垂体转移癌的临床特点及误诊原因,提高对该病的认识和诊治水平。方法对首都医科大学附属北京天坛医院2010年8月—2013年8月收治的4例垂体转移癌误诊病例资料进行回顾分析,并复习相关文献。结果 4例均以视力减退为主要症状,伴尿崩症、头痛各2例,1例有眼球运动障碍,均伴不同程度的垂体前叶功能减退表现。4例术前均经影像学检查提示鞍区占位性病变,分别误诊为颅咽管瘤、垂体腺瘤、鞍结节脑膜瘤和脊索瘤。均行肿瘤切除术,术后病理检查确诊为转移性腺癌。2例原发病灶在肺脏,1例在乳腺,1例因经济原因未查找原发病灶。结论垂体转移癌是颅内罕见病变,主要来源于乳腺和肺部,多以视神经损害、尿崩症、垂体功能低下和眼外肌麻痹为首发症状,术前与鞍区其他肿瘤鉴别诊断困难,确诊需行病理检查。

Objective To analyze clinical features and misdiagnosed causes of pituitary metastatic carcinoma so as to improve the diagnosis and treatment for pituitary metastatic carcinoma. Methods Clinical data of 4 misdiagnosed patients with pituitary metastatic carcinoma admitted during August 2010 to August 2013 was retrospectively analyzed, and related lit- erature was also reviewed. Results The main symptom of the 4 patients was hypopsia, there were 2 patients associated by diabetes insipidus, 2 patients associated by headache and 1 patient associated by ocular motility disorders, and all patients had different degrees of hypopituitarism. Preoperative iconography examination for the 4 patients showed that occupying lesions in saddle area, but the 4 patients were misdiagnosed as having craniopharyngioma, pituitary adenoma, tuberculum sellae meningioma and chordoma respectively. Tumor resection was performed for all patients, and metastatic adenocarcinoma was confirmed by postoperative pathological examination. Primary lesions of two patients came from the lung, and one came from mammary gland, but another patient did not find source because of the economy. Conclusion Pituitary metastatic carcinoma is a rare lesion in intracalvarium, and most lesions come from mammary gland and lungs. Primary manifestations mainly are optic nerve lesion, diabetes insipidus, hypopituitarism and extraocular palsy. The differential diagnosis of pituitary metastatic carcinoma with other tumors in saddle area is difficult, and confirmed diagnosis should be performed pathological examination.