[Pituitary germinoma presenting as a pseudotumoral lymphocytic hypophysitis in a man].
A 45-year-old man presented with headaches and extraocular muscle palsy due to a sellar mass extending into the right cavernous sinus. Hormonal determinations revealed a gonadotrophic insufficiency. A transsphenoidal surgical removal revealed a lymphocytic hypophysitis with fibrosis and necrosis. Rapid growth of the pseudotumor was noted despite a high dose steroid therapy (1 mg/kg/d) for a month. Further biological and histopathological investigations were performed. They showed a high cerebrospinal fluid (CSF) B-human chorionic gonadotropin (ss-HCG) level of 12 UI/L (normal<5 UI/L), normal plasma BHCG level, and undetectable CSF and plasma alpha-fetoprotein levels. The tumors cells showed a positive reactivity for placental alkaline phosphatase and for vimentin. These findings were consistent with an inflammatory lymphocytic process caused by an intrasellar germinoma. Chemotherapy was ill-tolerated and external radiotherapy was ineffective.
Torremocha
F
F
Services de Médecine Interne, Endocrinologie et Maladies Métaboliques, France.
Hadjadj
S
S
Menet
E
E
Kas
A
A
Bourgeois
H
H
Levillain
P
P
Bataille
B
B
Maréchaud
R
R
D000469:Alkaline Phosphatase / Q000032:analysis; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood / Q000134:cerebrospinal fluid; D003937:Diagnosis, Differential; D005355:Fibrosis; D018237:Germinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010902:Pituitary Gland / Q000473:pathology; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D014746:Vimentin / Q000032:analysis; D000509:alpha-Fetoproteins / Q000032:analysis / Q000134:cerebrospinal fluid
D018997:Chorionic Gonadotropin, beta Subunit, Human; D014746:Vimentin; D000509:alpha-Fetoproteins; D000469:Alkaline Phosphatase
Germinome hypophysaire révélé par une hypophysite lymphocytaire pseudo-tumorale chez un homme.