184.A Case Review Series : Case4

Case4

Macroadenoma (mimicking tuberculum sella meningioma (4a) & craniopharyngioma (4b))

大腺瘤，类似鞍结节脑膜瘤（4a）、颅咽管瘤（4b）

Clinical

Typically present with endocrinopathy or visual disturbance

Most common suprasellar mass in adults —-“snowman” appearance

End-organ failure in adolescent males can lead to pituitary hyperplasia with an adenoma- like mass

临床表现：典型表现为内分泌功能紊乱或视力障碍。是成年人中最常见的鞍上肿块---表现为“雪人征”。青少年男性终末器官衰竭可导致垂体增生，呈腺瘤样肿块改变。

Imaging

-No separate pituitary gland identified

-MRI: T1 and T2 isointense, heterogeneously enhancing

-By definition, >10 mm; if >4 cm, giant macroadenoma

-May appear invasive, however pituitary carcinoma is extremely rare

影像表现：垂体腺边界模糊不清。MRI：T1T2等信号，不均匀强化。理论上，病灶直径大于10mm，若大于4cm，则为巨大腺瘤。病灶可呈浸润性，但是垂体癌较罕见。

DDx: Pituitary hyperplasia, metastasis, meningioma, craniopharyngioma, aneurysm

鉴别诊断：垂体增生、转移瘤、脑膜瘤、颅咽管瘤、动脉瘤。

Tx: Surgical resection, typically transsphenoidal

Transsphenoidal resection likely to fail when lesions are solid and enhancing with restricted diffusion

~35% recurrence rate over 20 years

治疗：经典的经蝶骨外科手术切除。当病灶为实性和弥散受限时，经蝶骨切除术可能会失败。治疗后20年复发率约35%。

Notes：

1. Macroadenoma [meɪkəroʊde'noʊmə] 大腺瘤

2. tuberculum [tjʊ'bɜ:kjʊləm] n. 小块茎，小瘤，结节

3. sella [selə] 鞍

4. meningioma [məˌnɪndʒi:'oʊmə] n. 脑（脊）膜瘤

5. craniopharyngioma ['kreɪnɪoʊfəˌrɪndʒɪ'oʊmə] n. 颅咽管瘤

6. endocrinopathy [ˌendoʊkraɪ'nɒpəθɪ] n. 内分泌病

7. suprasellar [su:prə'selə] 蝶鞍上的

8. pituitary [pɪˈtu:əteri] n.（脑）垂体

9. hyperplasia [ˌhaɪpə'pleɪʒə] n. 增生，数量性肥大

10. aneurysm [ˈænjəˌrɪzəm] n. 动脉瘤

11. transsphenoidal [trænz'fi:noʊɪdl] 经蝶骨的;