垂体肾透明细胞癌转移瘤1例报道

A case report of renal clear cell carcinoma with pituitary metastasis

摘要

目的 报道1例肾透明细胞癌垂体转移瘤并结合相关文献，总结垂体转移瘤流行病学、临床特征、影像学表现及治疗手段等，提高对垂体转移瘤的认识和诊断水平。病例报告 患者男性，57岁，因“无明显诱因头痛伴夜尿增多3个月”就诊，4年前因左肾透明细胞癌伴右侧肾上腺转移行手术切除，2年前因左侧肾上腺转移再次手术切除。本次入院行头颅磁共振成像（MRI）检查示鞍区有一约2.0 cm×2.3 cm×2.5 cm（前后径×左右径×上下径）的实性占位，T1WI及T2WI示高低混杂信号影，增强不均匀明显强化，考虑垂体大腺瘤。拟经蝶窦行垂体肿物切除术，术中出血严重，遂停止手术。术中病理显示肾透明细胞癌病理分级（世界卫生组织/国际泌尿病例协会标准）3级。术后6个月复查MRI，于1年后接受伽玛刀治疗，之后定期复查未见新发转移灶。3年后复查胸部CT及超声检查考虑肺转移及右侧腋下淋巴结转移，口服阿昔替尼靶向治疗（5 mg/次，2次/d），随访至今未见新发转移征。结论 肾癌垂体转移罕见且缺乏特异性影像学与临床表现，若患者短时间内出现尿崩症、视力下降等症状，同时影像学显示鞍区病变有侵袭性及丰富血供，结合肿瘤病史需警惕垂体转移瘤。

Abstract

Objective To report a case of renal clear cell carcinoma with pituitary metastasis, and summarize the epidemiology, clinical characteristics, imaging manifestations and treatment methods, so as to improve the understanding and diagnosis of pituitary metastasis. Case Report The patient was a 57-year-old male who presented with headache without obvious cause and increased nocturia for 3 months. Four years ago, he underwent surgery for left renal clear cell carcinoma with right adrenal metastasis. Two years ago, he had another surgery for left adrenal metastasis. At this admission, MRI showed a solid mass in the sellar region, approximately 2.0 cm×2.3 cm×2.5 cm (anteroposterior×transverse×craniocaudal), with mixed high and low signal intensity on T1WI and T2WI, and significant heterogeneous enhancement. A large pituitary adenoma was suspected. The planned transsphenoidal pituitary tumor resection was discontinued due to severe intraoperative hemorrhage. Intraoperative pathology revealed renal clear cell carcinoma with grade 3 (World Health Organization/International Society of Urological Cases standard, WHO/ISUP). Follow-up MRI was performed 6 months later, and Gamma knife therapy was administered 1 year postoperatively. Subsequent regular follow-ups showed no new metastatic lesions. After 3 years, chest CT and ultrasound examinations suggested lung metastasis and right axillary lymph node metastasis. The patient received oral axitinib targeted therapy (5 mg, twice daily). No new metastases have been found to date. Conclusion Renal clear cell carcinoma with pituitary metastasis is rare with no specific imaging and clinical manifestations. If a patient develops symptoms such as diabetes insipidus and visual impairment within a short period of time, and imaging results show an invasive lesion in the sellar region with rich blood supply, pituitary metastasis should be considered.

关键词

垂体转移瘤 / 尿崩症 / MRI

Key words

pituitary metastatic tumor / diabetes insipidus / MRI

参考文献

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基金资助

中国金属学会冶金安全与健康分会健康卫生科研项目(jkws202551)