1.Surgical Treatment of Hemangioblastoma in the Pituitary Stalk: An Extremely Rare Case.
Jaejoon LIM ; Sunghyun NOH ; Kyung Gi CHO
Yonsei Medical Journal 2016;57(2):518-522
Hemangioblastoma (HBL) in the pituitary stalk is extremely rare. Only 16 such cases have been reported in the past and 5 cases have been treated with surgical procedure. Here, we report surgical case of HBL in the pituitary stalk diagnosed in a 34-year-old woman. The patient underwent a gross-total resection via the modified lateral supra-orbital approach. No recurrence was observed in two years after surgery. To our knowledge, this is the 17th case of HBL in the pituitary stalk and the 6th surgical case. If the tumor is symptomatic and the volume is over 5 cubic centimeters as in our case, we recommend that the surgical resection of the HBL in the pituitary stalk is a more safe and reasonable than radiotherapy.
Adult
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Cerebellar Neoplasms/pathology/*surgery
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Female
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Hemangioblastoma/pathology/*surgery
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Humans
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Pituitary Gland/*pathology
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Treatment Outcome
2.First Male Case of Lymphocytic Hypophysitis in Korea.
Hyun Kyung CHUNG ; Doh Hyung KIM ; Sang Jun KIM ; Bong Jin PARK ; Eo Jin KIM ; Na Hye MYONG ; Sang Jeon CHOI
Journal of Korean Medical Science 2003;18(2):290-294
Lymphocytic hypophysitis is a rare inflammatory disorder which is caused by autoimmune destruction of the pituitary gland. Almost all reported cases have been in women and the disease is often associated with pregnancy. We describe here the first male case of lymphocytic hypophysitis in Korea. The patient presented with headache, impotence, decreased libido, and deteriorated vision. Endocrinologic studies showed panhypopituitarism, and pituitary MRI imaging revealed a homogeneously enhanced pituitary mass with a thickened stalk. Treatment with prednisolone and thyroid hormone for five months was ineffective. Transsphenoidal resection of the pituitary mass was performed successfully with normalization of the visual field defect. Histologic examination revealed diffuse lymphocytic infiltration with dense collagenous fibrosis, consistent with lymphocytic hypophysitis. Lymphocytic hypophysitis should be considered in differential diagnosis even in men with hypopituitarism and an enlarged pituitary gland.
Adult
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Autoimmune Diseases/diagnosis*
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Autoimmune Diseases/pathology
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Autoimmune Diseases/surgery
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Eosinophilia
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Female
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Human
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Korea
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Lymphocytes/cytology
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Lymphocytes/immunology*
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Lymphocytes/metabolism
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Magnetic Resonance Imaging
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Male
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Pituitary Diseases/diagnosis*
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Pituitary Diseases/pathology
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Pituitary Diseases/surgery
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Pituitary Gland/pathology*
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Pituitary Gland/surgery
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Pituitary Hormones/metabolism
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Pregnancy
3.Prospective study of transsphenoidal pituitary surgery: is tumor volume a predictor for the residual tumor?
Resha SHRESTHA ; Lei QI ; Gang BAO ; Mao-de WANG
Chinese Medical Journal 2012;125(14):2444-2448
BACKGROUNDThe presence of residual tumor after surgery for pituitary adenoma may necessitate further treatment. The suprasellar and parasellar extension of the tumor have been widely considered as the predictors for residual tumor. However there is scarcity of studies regarding the preoperative tumor volume and residual tumor. This study was conducted to evaluate if tumor volume could predict the outcome of transsphenoidal pituitary surgery.
METHODSA prospective study was designed and 48 patients who underwent transsphenoidal pituitary surgery within 1 year in the First Affiliated Hospital of Xi'an Jiaotong University were included in this study. The preoperative tumor volume and immediate postoperative tumor volume (within 4 - 7 days) were calculated in the contrast magnetic resonance imaging by using the formula of ellipsoid. All these volumes were divided into three subgroups, i.e. group 1, group 2 and group 3 with preoperative volume of less than 4 cm(3), 4 - 8 cm(3), and more than 8 cm(3) respectively. The parasellar and suprasellar extension of the tumor were also classified by Knosp and modified Hardy's classifications.
RESULTSBaseline characteristics were comparable. The preoperative tumor volume of more than 8 cm(3) (group 3, (12.1 ± 1.1) cm(3)) had increased risk on postoperative tumor residue (P < 0.01) than the other two groups ((2.1 ± 0.3) cm(3) and (6.1 ± 0.3) cm(3) in groups 1 and 2). The mean postoperative volume in group 3 patients ((2.2 ± 0.1) cm(3)) was significantly higher than the other two groups (P < 0.01).
CONCLUSIONPreoperative volume of more than 8 cm(3) can be considered as a predictor for postoperative residual volume.
Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pituitary Gland ; pathology ; surgery ; Pituitary Neoplasms ; pathology ; surgery ; Prospective Studies ; Treatment Outcome ; Tumor Burden ; physiology ; Young Adult
4.A Case of Idiopathic Granulomatous Hypophysitis.
Chul Ho CHUNG ; Min Soo SONG ; Hyun Deuk CHO ; Du Shin JEONG ; Yeo Joo KIM ; Hack Gun BAE ; Sang Jin KIM
The Korean Journal of Internal Medicine 2012;27(3):346-349
Granulomatous hypophysitis is a rare pituitary condition that commonly presents with enlargement of the pituitary gland. A 31-year-old woman was admitted to the hospital with a severe headache and bitemporal hemianopsia. Magnetic resonance imaging (MRI) showed an 18 x 10-mm sellar mass with suprasellar extension and compression of the optic chiasm. Interestingly, brain MRI had shown no abnormal finding 4 months previously. On hormonal examination, hypopituitarism with mild hyperprolactinemia was noted. The biopsy revealed granulomatous changes with multinucleated giant cells. We herein report this rare case and discuss the relevant literature.
Adult
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Biopsy
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Female
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Giant Cells/pathology
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Granuloma/complications/*diagnosis/therapy
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Headache/etiology
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Hemianopsia/etiology
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Humans
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Hyperprolactinemia/etiology
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Hypopituitarism/etiology
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Inflammation/complications/*diagnosis/therapy
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Magnetic Resonance Imaging
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Optic Chiasm/pathology
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Pituitary Diseases/complications/*diagnosis/therapy
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Pituitary Function Tests
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Pituitary Gland/*pathology/surgery
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Predictive Value of Tests
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Severity of Illness Index
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Treatment Outcome
5.Visual pathway and pituitary stalk protection in pituitary tumor surgery and the clinical outcome.
Shou-ping GONG ; Jian LÜ ; Qian SONG ; Qing-yu YANG
Journal of Southern Medical University 2009;29(2):305-306
OBJECTIVETo investigate the association of microsurgical anatomy and growth of pituitary tumors with the recovery of visual pathway, and describe the intraoperative protection of the pituitary stalk and visual pathway.
METHODSA total of 113 patients undergoing pituitary tumor surgery were retrospectively analyzed, including 102 with visual disorder and 106 with pituitary dysfunction with the tumor size ranging from 1.9 to 6.8 cm. All the operations were performed via a transpterygoid approach or transfrontal approach.
RESULTSRadical resection of the tumors was performed in 86 cases, subtotal resection in 21 cases, and partial resection in 5 cases. After operation, 133 eyes showed vision improvement (77.8%), 29 showed no vision changes (17%) and 9 had deteriorated vision. Two patients died due to hypothalamic disorder and multiple organ failure.
CONCLUSIONThe arachnoid barrier between the pituitary tumor and visual pathway is an important structure for visual pathway protection during operation. Total separation of the tumor from the visual pathway allows total removal of the tumor. The preoperative localization and intraoperative identification of the pituitary stalk are critical for pituitary stalk protection.
Adenoma ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Intraoperative Complications ; prevention & control ; Male ; Microsurgery ; adverse effects ; methods ; Middle Aged ; Neurosurgical Procedures ; methods ; Pituitary Gland ; pathology ; Pituitary Neoplasms ; pathology ; surgery ; Retrospective Studies ; Treatment Outcome ; Visual Pathways ; pathology ; Young Adult
6.MR Imaging of Central Diabetes Insipidus: A Pictorial Essay.
Ji Hoon SHIN ; Ho Kyu LEE ; Choong Gon CHOI ; Dae Chul SUH ; Chang Jin KIM ; Sung Kwan HONG ; Dong Gyu NA
Korean Journal of Radiology 2001;2(4):222-230
Central diabetes insipidus (DI) can be the outcome of a number of diseases that affect the hypothalamic-neurohypophyseal axis. The causes of the condition can be classified as traumatic, inflammatory, or neoplastic. Traumatic causes include postoperative sella or transection of the pituitary stalk, while infectious or inflammatory causes include meningitis, lymphocytic hypophysitis, and granulomatous inflammations such as sarcoidosis and Wegener's granulomatosis. Various neoplastic conditions such as germinoma, Langerhans cell histiocytosis, metastasis, leukemic infiltration, lymphoma, teratoma, pituitary adenoma, craniopharyngioma, Rathke cleft cyst, hypothalamic glioma, and meningioma are also causes of central DI. In affected patients, careful analysis of these MR imaging features and correlation with the clinical manifestations can allow a more specific diagnosis, which is essential for treatment.
Adolescent
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Adult
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Aged
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Diabetes Insipidus, Neurogenic/diagnosis/etiology/*pathology
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Female
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Human
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Inflammation/complications
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*Magnetic Resonance Imaging
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Male
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Middle Age
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Neoplasms/complications
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Pituitary Gland, Posterior/injuries/pathology
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Sella Turcica/pathology/surgery