垂体腺瘤合并Rathke囊肿27例并文献复习

目的分析垂体腺瘤合并Rathke囊肿的临床特征与治疗方法。 方法回顾性分析自2010年1月至2018年12月在哈尔滨医科大学附属第一医院神经外科二病房收治的27例行经鼻蝶窦入路手术切除垂体腺瘤合并Rathke囊肿患者的临床资料。所有患者均在术前、术后行垂体MRI检查及内分泌检查。由经验丰富的病理学专家对取出的标本作出病理诊断,以确保功能型垂体腺瘤的精确分类。观察患者术后的病情变化并且记录术后第1天和第7天的内分泌结果。结合27例垂体腺瘤合并Rathke囊肿的临床资料并结合相关文献进行分析。 结果垂体腺瘤合并Rathke囊肿的临床症状与垂体腺瘤类似;MRI在垂体区均发现两种质地不同的信号（一侧为实质性病变,一侧为囊性病变）,这两种信号之间有或无明显的间隔,且增强可见实性病变增强而囊性病变未增强;27例患者病变全切,术中可见实质性肿瘤和半流质Rathke囊肿内容物;随访期间,1例合并泌乳素型的垂体腺瘤患者复发,泌乳素增高,其余患者均未复发,且激素水平均恢复正常。 结论垂体腺瘤合并Rathke囊肿罕见,症状与垂体腺瘤相似,确诊依赖于病理。MRI垂体区囊性和实性病变共存,应考虑垂体瘤合并Rathke囊肿可能,经蝶窦入路切除术可有效治疗该病。     

垂体Rathke囊肿的诊断与治疗

目的：探讨垂体Rathke囊肿的诊断与治疗。方法：对22例主要表现为头痛、视力损害和全垂体功能低下，MR及CT检查诊断为垂体Rathke囊肿的患者采用手术清除囊肿，其中20例采用经蝶窦入路，2例采用经翼点入路。结果：术后头痛均缓解，88％视力损害明显恢复，80％全垂体功能低下明显恢复，1例好转。结论：尽管垂体Rathke囊肿的临床及影像学表现呈多样性，但某些临床及影像学特征有助于本病的诊断。经蝶窦显微手术清除囊肿是治疗垂体：Rathke囊肿的有效方法。     

内镜下经鼻-蝶窦微创手术治疗Rathke囊肿的效果

目的 探讨内镜下经鼻-蝶窦微创手术治疗鞍区占位Rathke囊肿的效果。方法 回顾性分析12例经鼻-蝶窦内镜下切除、且经病理证实的Rathke囊肿病例资料,结合文献对Rathke囊肿的组织起源、发病机理、诊断、手术治疗及预后进行探讨。结果 12例Rathke囊肿病例根据解剖分为3种类型：纯鞍区占位（4例）、鞍区及鞍上延伸占位（7例）和纯鞍上占位（1例）。头痛是术前主要症状（9/12,75%）,术后头痛症状均得到改善;5 例最初表现为严重视力下降（5/12,41.67%）,术后有所改善;4例垂体功能障碍（4/12,33.33%）术后得到改善,所有病例均无永久性垂体功能障碍;1例术后脑脊液漏,经颅底重建和腰池外引流后改善;2例复发囊肿,其中1例再次接受手术治疗,另1例拒绝再次手术。结论 内镜下经鼻-蝶窦手术治疗Rathke囊肿安全、有效,术后并发症较少。     

单纯性Rathke囊肿患者内分泌功能改变的初步研究

回顾性分析65例单纯性Rathke囊肿患者手术前后内分泌功能改变,术前存在的垂体激素分泌异常以垂体-性腺激素分泌受损和高催乳素血症多见,最常见症状女性为月经紊乱及溢乳、男性为性欲减退及勃起功能障碍,严重者可发生全垂体功能减退甚至危象.手术可以有效改善受损的垂体功能,也可能导致新的损害.     

先天性肺囊肿和肺隔离症的诊断及外科治疗

目的 探讨先天性肺囊肿和肺隔离症的诊断与外科治疗经验。方法 术前行胸部X线拍片及CT检查，然后行手术治疗。结果 全组无手术死亡，无严重术后并发症，随访6个月～3年，疗效良好。结论 X线胸片是主要诊断手段，CT(或MRI)是必要的补充。手术可明确诊断，也是最佳治疗方法，对不同部位、不同类型病灶可选择不同手术方式。     

非肿瘤性胰腺真性囊肿21例诊治体会

目的 探讨非肿瘤性胰腺真性囊肿的诊断和治疗.方法 回顾性分析1999年6月至2006年9月收治的21例非肿瘤性胰腺真性囊肿患者的临床病理资料及随访结果.结果 21例患者中,男3例,女18例,男女比例1:6;年龄24～77岁,平均47岁.12例无任何症状和体征,9例有症状.实验室检查均未见异常.行B超、ERCP、CT、MRI检查分别有21例、5例、21例、和4例,诊断准确率分别为0%、40%、19%和50%.20例行手术治疗,1例行剖腹探查、活组织检查.5例术后出现胸腔积液,其中3例发胰瘘,经治疗后痊愈出院.病理检查浆液性囊肿15例、潴留性囊肿3例、黏液性囊肿2例、淋巴上皮样囊肿1例.本组2例失访,19例获随访,随访时间8个月～7年,除1例因脑出血死亡,其余均健在,无复发.结论非肿瘤性胰腺真性囊肿好发于中年女性,无特征性临床表现,术前诊断准确率较低.对无症状患者不需手术治疗.有症状的、且影像学上不能与囊性肿瘤鉴别或随访期囊肿有增大趋势者宜手术治疗.     

肾上腺髓样脂肪瘤的诊断及外科治疗(附10例报告)

回顾性分析10例肾上腺髓样脂肪瘤(AML)患者的临床资料.9例于术前经影像学检查确诊.肿瘤均经后腹腔镜手术完整切除,并经病理检查证实.术后内分泌检查均在正常范围.认为AML的诊断主要依靠B超、CT、MRI和生化检查,确诊需经病理检查;手术是有效的治疗方法,后腹腔镜手术可作为首选.     

非肿瘤性胰腺真性囊肿21例诊治体会

目的探讨非肿瘤性胰腺真性囊肿的诊断和治疗。方法回顾性分析1999年6月至2006年9月收治的21例非肿瘤性胰腺真性囊肿患者的临床病理资料及随访结果。结果21例患者中，男3例，女18例，男女比例1：6；年龄24～77岁，平均47岁。12例无任何症状和体征，9例有症状。实验室检查均未见异常。行B超、ERCP、CT、MRI检查分别有21例、5例、21例和4例，诊断准确率分别为0％、40％、19％和50％。20例行手术治疗，1例行剖腹探查、活组织检查。5例术后出现胸腔积液，其中3例并发胰瘘，经治疗后痊愈出院。病理检查浆液性囊肿15例、潴留性囊肿3例、黏液性囊肿2例、淋巴上皮样囊肿1例。本组2例失访，19例获随访，随访时间8个月～7年，除1例因脑出血死亡，其余均健在，无复发。结论非肿瘤性胰腺真性囊肿好发于中年女性，无特征性临床表现，术前诊断准确率较低。对无症状患者不需手术治疗。有症状的、且影像学上不能与囊性肿瘤鉴别或随访期囊肿有增大趋势者宜手术治疗。     

鼻窦黏液囊肿16例CT检查结果分析

鼻窦黏液囊肿发展较缓慢,囊肿较小时一般不产生症状,囊肿较大时常首先出现眼部或颅内症状,因而诊断较困难,且极易误诊。现对16例经手术及病理检查确诊的16例鼻窦黏液囊肿的术前CT检查结果进行分析,以探讨CT检查诊断鼻窦黏液囊肿的价值。     

骶管内囊肿的诊断及手术治疗

目的探讨骶管内囊肿的诊断及手术治疗方法。方法19例骶管内囊肿,均表现为腰骶部钝痛和骶神经压迫症状。均行M砌检查,确诊后行手术治疗。结果本组经MPd检查均确诊为骶管内囊肿。行囊肿完整切除2例、囊肿切除后在交通孔处高位结扎5例、囊肿大部切除残存囊壁缝扎修补6例、囊肿部分切除3例、囊肿切开旷置3例。术后随访1—5．5a,症状完全缓解11例、部分缓解6例、无改善2例（分别于术后9、15个月复查MRI示囊肿复发）。结论骶管内囊肿以腰骶部钝痛和骶神经压迫症状为主要表现,MRI检查可确诊。结合囊肿的类型可采取不同的手术方式进行治疗。     

Lateral orientation of Rathke cleft cysts may be associated with high rates of recurrence after surgery

Pituitary - Rathke cleft cysts (RCC) arise from the remnants of Rathke’s pouch, a structure that is midline in the pituitary. Therefore, an off-midline location on imaging is a finding that...     

Rathke’s cleft cysts: a 6-year experience of surgery vs. observation with comparative volumetric analysis

Pituitary - Rathke’s cleft cysts (RCCs) are common sellar lesions. Their management remains controversial, particularly when small or asymptomatic. Herein we review a consecutive series of...     

Branchial cleft cyst as the initial impression of a metastatic thyroid papillary carcinoma: two case reports

Branchial cleft cysts are the most common lesions in lateral neck cysts, predominantly occurring in the fourth decade of life and without sexual propensity. Rare branchial cleft cysts are associated with malignant tumors metastatic from the oral cavity, nasal cavity, pharynx or thyroid gland. Occult thyroid papillary carcinomas often present as a solid mass in the lateral neck, with only a few cases revealing a branchial cleft cyst as the initial manifestation. Herein, we report two cases of metastatic thyroid papillary carcinoma that presented as lateral neck cysts, with preoperative diagnosis of branchial cleft cyst. Finally, after complete surgical resection and histopathologic examination, one case was diagnosed as cystic change of metastatic lymph node from thyroid papillary carcinoma, and the other was determined to be a branchial cleft cyst with concurrent lymph node metastasis from thyroid papillary carcinoma. When a branchial cleft cyst is diagnosed by clinical or histopathologic examination, a metastatic thyroid papillary carcinoma should be considered as part of the differential diagnosis.     

Collision lesions of the sella: co-existence of craniopharyngioma with gonadotroph adenoma and of Rathke’s cleft cyst with corticotroph adenoma

Collision lesions of the sellar region are relatively uncommon. Most contributions include a pituitary adenoma or a cyst/cystic tumor, particularly a Rathke cleft cyst. The association of craniopharyngioma with an adenoma is particularly rare. Among reported cases, some have included secondary prolactin cell hyperplasia due to pituitary stalk section effect. Herein, we report two collision lesions, including a gonadotroph adenoma with adamantinomatous craniopharyngioma and a corticotroph adenoma with Rathke's cleft cyst. Clinicopathologic correlation and a review of the literature are undertaken.     

Surgical outcomes and quality of life in Rathke’s cleft cysts undergoing endoscopic transsphenoidal resection: a multicentre study and systematic review of the literature

Pituitary - To establish the effect of endoscopic endonasal surgery (EES) on quality-of-life (QoL) in symptomatic Rathke cleft cyst (RCC). Analysis of 38 patients with RCC treated by EES, with...     

Acute adrenal insufficiency due to symptomatic Rathke's cleft cyst.

A 65-year-old Japanese man who suffered from secondary hypopituitarism due to Rathke's cleft cyst is reported. Although computed tomography failed to detect any pituitary abnormality, magnetic resonance imaging demonstrated the presence of a cystic intrasellar mass, initially suggesting craniopharyngioma or abscess. Operative findings revealed Rathke's cleft cysts within the pituitary fossa which resulted in secondary hypopituitarism. Among cases of secondary hypopituitarism with abnormal findings in the pituitary, symptomatic Rathke's cleft cysts should be included in the differential diagnosis of adrenal insufficiency.     

Clinical features of nonpituitary sellar lesions in a large surgical series

Context Pituitary adenomas are the most common lesions in the sellar region, but other pathologies need to be considered in the differential diagnosis. Objective To assess the prevalence of unusual sellar masses in a large series of patients and identify clinicopathological factors that may aid the pre‐operative diagnosis. Design Retrospective case series. Patients We analysed the records of 1469 transsphenoidal procedures performed between 1998 and 2009. One hundred sixteen cases (7·9%) were not pituitary adenomas. Measurements Final pathological diagnosis. Results One hundred sixteen patients (45 men, 71 women; mean age (±SD): 45 ± 17 years) with nonadenomatous lesions were divided into four major aetiological groups: cystic lesions (CYS) (53%); benign neoplasms (BEN) (22%); malignancies (MAL) (16%) and inflammatory lesions (INF) (9%). Rathke’s cysts, the most common lesions, represented 42% of all cases. Twenty‐five per cent of malignant lesions were metastases, and some of the MAL (e.g., fibrosarcoma, lung metastasis) had a radiographical appearance suggestive of a pituitary adenoma. The most common presenting symptoms were visual field impairment (51%) and headache (34%). Pre‐operative pituitary dysfunction was present in 58% of cases, with hyperprolactinaemia (35%), hypogonadism (23%) and hypocortisolism (23%) found most frequently. Postoperative resolution of headache and visual symptoms occurred in 63% and 65% of patients, respectively. Hyperprolactinaemia resolved in 77% of cases. Conclusions A substantial minority of sellar masses are not pituitary adenomas. While they frequently present with the symptoms, hormone abnormalities and radiographical appearance typical of pituitary tumours, the possibility of a nonadenomatous lesion needs to be considered in the differential diagnosis.