Pituitary macroadenoma presenting as a nasal tumor: case report

CONTEXT: Pituitary macroadenomas are rare intracranial tumors. In a few cases, they may present aggressive behavior and invade the sphenoid sinus and nasal cavity, causing unusual symptoms. In this paper, we report an atypical case of pituitary adenoma presenting as a nasal mass.CASE REPORT: The patient was a 44-year-old woman who had had amenorrhea and galactorrhea for ten months, with associated nasal obstruction, macroglossia and acromegaly. Both growth hormone and prolactin levels were increased. Magnetic resonance imaging showed a large mass originating from the lower surface of the pituitary gland, associated with sella turcica erosion and tumor extension through the sphenoid sinus and nasal cavity. Histopathological analysis demonstrated a chromophobe pituitary adenoma with densely packed rounded epithelial cells, with some atypias and rare mitotic figures. There was no evidence of metastases.CONCLUSION: Macroadenoma invading the nasal cavity is a rare condition and few similar cases have been reported in the literature. This study contributes towards showing that tumor extension to the sphenoid sinus and nasopharynx needs to be considered and investigated in order to make an early diagnosis when atypical symptoms like nasal obstruction are present.

背景：垂体大腺瘤（pituitary macroadenomas）是一类罕见的颅内肿瘤。少数病例可表现出侵袭性行为，侵袭蝶窦与鼻腔，引发非典型临床症状。本文报道1例以鼻腔肿物为首发表现的垂体腺瘤非典型病例。
病例报告：患者为44岁女性，闭经、溢乳病史10个月，伴随鼻塞、巨舌症与肢端肥大症。其生长激素与催乳素水平均升高。磁共振成像（magnetic resonance imaging）显示一巨大肿物起源于垂体下表面，伴蝶鞍侵蚀及肿瘤向蝶窦与鼻腔侵袭。组织病理学分析提示为嫌色性垂体腺瘤，上皮细胞呈致密排列的圆形形态，可见部分异型性及罕见核分裂象，未发现转移征象。
结论：侵袭鼻腔的垂体大腺瘤属于罕见病症，目前文献中报道的同类病例较少。本研究表明，当患者出现鼻塞等非典型症状时，需考虑并排查肿瘤侵袭蝶窦与鼻咽部的可能，以实现早期诊断。