1 case of pituitary tumor misdiagnosed with a large atypical chamber tube membrane tumor in the saddle area.

The male, aged 73, was admitted to hospital with cognitive function and vision loss for 1 year.
levels of pituitary-related hormones.
MRI butterfly saddle significantly expanded, the saddle saw a huge lump shadow, clear boundary, size of about 57mm x 53mm x 67mm, lump growth down into the butterfly sinuses, upward growth breakthrough butterfly saddle, two-sided brain chamber obvious pressure, two-sided vision cross-display unclear, T1WI signal, T2WI signal, DWI slightly high signal, ADC and other low signals, In the lesions see multiple irregular point flakes with long T1 long T2 cystic signal, the boundary is clear, the enhanced scanning lesions are obviously unevenly strengthened, the lumps around see a large area of edema signal shadow, and the finger-like distribution around the side of the brain chamber, the left side of the brain chamber significantly increased, the right side of the brain chamber pressure significantly narrowed, the pituitary pressure is not clear, the middle line structure significantly shifted to the right, moving distance is about 17mm.
MRI diagnosis: pituitary tumors are more likely.
Surse operation seen: the tumor is located in the saddle area, left side of the brain chamber, visible tumor envelope intact, pink, the tumor in the envelope is soft, the tumor is sac-solid, the fluid inside the sac is pale yellow, the blood supply around the tumor is rich, the size is about 6 cm X 5 cm x 5 cm, tumor and surrounding brain tissue demarcation is not clear, pituitary pressure flattened, tumor and pituitary boundary adhesion is serious, the two are not clearly divided, and the brain artery, the brain a foreuitary artery is not clearly demarcation, adhesion.
pathological immunomarker test results: GFAP(-), S-100(-), CK(-), EMA(-), Ki67,lt;3%, CK7(-), TTF-1(-).
pathological diagnosis: in-saddle, saddle and under-saddle tube tumor (Figures 1 to 4).
1 to 4 in the saddle, on the saddle and under the saddle atypical chamber tube tumor.
Figure 1: The axis position shows that the left side of the saddle is mixed and other signals on the T2 sequence, the inside of the lump is seen multiple cystic signal (fine arrow), the left side of the brain chamber expansion water (rough arrow).
edema band (triangle) can be seen around the expanding lateral brain chamber.
2: Coronary bit enhancement scan shows that the lesions are unevenly and significantly strengthened, and the normal pituitary division is not clear, pituitary handle, pituitary display is not clear.
3: The vector bits are enhanced with Figure 2, and the cross-display is not clear.
4: Pathology shows that tumor cells are rich, spindle-shaped, cell dense arrangement is nipple-like, tube cavity-like, and can be seen chrysanthemum group-like structure (HE).
discussion chamber membrane tumor is a common tumor in children, accounting for about 10% of children's central nervous system tumors, accounting for 5% of all glioblastomas in children.
the high incidence of the disease is about 3 years old, the high incidence of epidural tumor is 5 to 6 years old.
the disease generally originates on the surface of the chamber tube membrane of the brain system, 40% occurs on the curtain, with the lateral throes triangle being the most common and can span the brain chamber and brain growth.
15% of the epidural tube tumors are located in the third brain chamber.
60% occurs under the curtain, the vast majority of which is located in the fourth brain chamber, where the lesions originate at the bottom of the fourth brain chamber and grow in the fourth brain chamber or spread along the side pores to the corners of the bridge cerebrocephaly.
In summary, the possibility of the occurrence of this disease in the saddle area is small, and this case tumor is located in the saddle, saddle, break through the saddle bottom to the saddle under the subsidence, and tired of the left side of the brain chamber, resulting in the left side of the brain room with water around the side of the brain room serious edema, whether this case is the age of onset, good hair, or imaging characteristics, in recent years, the relevant literature reports are relatively few, relatively rare.
therefore, for such cases of lack of specificity and atypicalness, positioning can only be performed before surgery, which is more difficult to make a clear qualitative diagnosis.
case tumor is a cystic lesions, mainly located in the saddle, saddle and under the saddle, in the shape of a torch, therefore, the image diagnosis is mainly with the saddle area occupied lesions phase identification.
Common saddle area occupied lesions are as follows: (1) pituitary tumor: pituitary tumor, especially pituitary adenoma originated in the pituitary gland, most of the development outside the saddle, to the saddle pool affected the most common, but also affect the butterfly sinuses and sponge sinuses.
if the pituitary large adenoma grows upward and breaks through the saddle, it can be seen that the pool on the saddle is deformed, closed, and the cross is pressed, and the characteristic "8" signs and "waist" signs can be seen.
the lump grows downwards into the butterfly sinuses, and the bottom of the saddle is thinned and trapped.
grows to both sides and wraps around the sponge sinuses.
T1WI is equal or slightly lower signal, a few are low, equal, high mixed signal, T2WI is equal, slightly high signal or equal, high mixed signal, enhance the sweep tumor significantly strengthened, such as the occurrence of cystic change, necrotasia, bleeding, etc., is unevenly strengthened.
The MRI performance of this lesion is more in line with the typical performance of pituitary tumor, while the chamber tube membrane tumor rarely causes the under-saddle trap, butterfly saddle enlargement and so on, and the chamber tube membrane tumor rarely causes the disappearance of normal pituitary structure.
therefore, the identification of ocymosaurs and pituitary tumors in the saddle area is more difficult and needs to rely on the final pathological diagnosis.
(2) ancing area meninges: general pattern comparison rules, MRI flat sweep performance is more uniform low signal or iso signal, T2WI is slightly higher or equal signal, tumors rarely occur cystic transformation, the vast majority of meningococoma enhancement scan after uniform strengthening, the appearance of a typical "meningoentalic tail" signs, and saddle meninges will not cause the saddle, and normal pituitary boundaries clear, normal pituitary display clear.
its characteristics, it can be distinguished from the ancilloblast membrane tumor in the saddle area.
(3) craniofacial tube tumor: one of the common tumors in the saddle area, with cysticity and partial cysticity, saddle people are mostly cystic, saddle people are mostly solid, good in people under 20 years of age.
tumor is cystic, the cystic wall is more calcified, enhances the scanning sac wall more see ring reinforcement.
above characteristics can be distinguished from the bladosaur tumor.
(4) aneurysm in the saddle area: the tumor wall can be seen calcification, the aneurysm on the MRI shows the flow signal, is its characteristic performance.
addition, MRA and CTA testing helps with the identification of a tyma in the adration area.
In short, for the saddle sac real occupier lesions, in addition to considering common diseases, should also think of the possibility of the saddle upper chamber tube membrane tumor, but the final diagnosis still needs to rely on pathological examination.
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