表现为垂体腺瘤卒中的黄色瘤性垂体炎

Xanthomatous hypophysitis behaving like pituitary adenoma

目的报告1例黄色瘤性垂体炎病例,总结其临床表现、实验室、影像学和组织病理学特征。方法与结果患者为河北省人民医院2018年7月确诊并治疗的男性黄色瘤性垂体炎病例,临床表现为头痛伴恶心呕吐;头部CT显示鞍区呈软组织密度影,较饱满;MRI显示蝶鞍扩大,鞍内可见一类圆形肿物影。临床考虑为“垂体腺瘤卒中”,于神经内镜下经鼻蝶入路行垂体腺瘤切除术,术后病理学检查,组织细胞呈弥漫性片状浸润,免疫组化染色CD68和波形蛋白呈强阳性,S⁃100蛋白和CD1α呈阴性,Ki⁃67抗原标记指数为10%~20%,最终诊断为鞍区黄色瘤性垂体炎。结论黄色瘤性垂体炎临床罕见,症状及影像学表现无特异性,临床诊断极具挑战性,神经内镜活检是诊断与鉴别诊断的“金标准”,伴出血时应注意与垂体腺瘤卒中相鉴别。

Objective To report a case of xanthomatous hypophysitis(XH),and summarize its clinical manifestations,laboratory,imaging and histopathological features.Methods and Results The patient was a male XH diagnosed and treated by Hebei General Hospital in July 2018.The clinical manifestations were headache with nausea and vomiting.Head CT showed the sella area was dense and full;MRI showed enlargement of the sella and a type of circular mass within the sella.The clinical diagnosis was pituitary adenoma apoplexy,and pituitary adenoma resection was performed through nasal sphenoid approach under neuroendoscopy.The postoperative pathological examination showed the histopathological cells showed flake dense infiltration,the immunohistochemical staining showed strong positive CD68 and vimentin(Vim),and S⁃100 protein and CD1αwere negative,Ki⁃67 antigen labeling index was 10%-20%,and the final diagnosis was sellar XH.Conclusions XH is rare in clinic,and its symptoms and imaging findings are nonspecific,making clinical diagnosis extremely challenging.Neuroendoscopic biopsy pathology is the"gold standard"for diagnosis and differential diagnosis,and attention should be paid to distinguishing pituitary adenoma apoplexy when accompanied by bleeding.