摘要：

目的 总结梭形细胞嗜酸细胞瘤的临床表现、影像学和病理学特点、诊断与鉴别诊断要点。方法与结果 男性患者，59 岁，主诉双眼视物模糊1年余伴反应迟钝、易疲劳；头部 MRI显示鞍区占位性病变。组织学形态，肿瘤组织由梭形细胞构成，呈束状或不规则排列，肿瘤细胞胞质丰富、呈嗜酸性颗粒样，胞核呈卵圆形或短梭形、无明显核分裂象，间质内可见散在淋巴细胞浸润。免疫组织化学染色，部分肿瘤细胞胞核甲状腺转录因子-1 阳性，胞质抗线粒体抗体、S-100 蛋白、半乳糖凝集素-3 和波形蛋白阳性，Ki-67 抗原标记指数约 3%。最终病理诊断为（鞍区）梭形细胞嗜酸细胞瘤。患者术后 2 个月出现视力急剧下降，复查 MRI 显示鞍上占位性病变，遂予放射治疗。随访 10 个月，视力无好转，肿瘤无明显改变。结论 梭形细胞嗜酸细胞瘤是临床罕见的发生于鞍区的肿瘤，属 WHOⅠ级，应注意与发生于鞍区的其他肿瘤相鉴别，治疗以手术全切除为主，部分切除患者术后辅以放射治疗。

关键词: 腺瘤, 嗜酸粒细胞, 蝶鞍, 免疫组织化学, 病理学

Abstract:

Objective To study the clinical manifestations, imaging and pathological features, diagnosis and differential diagnosis of spindle cell oncocytoma. Methods and Results A 59-year-old man presented with one year history of blurred vision, lags in response and fatiguability. Head MRI showed a mass at the sellar region. Histological examination showed the tumor was mainly composed of spindle cells arranged in fascicularis or irregularity with abundant eosinophilic granular cytoplasm and oval or short spindle nuclei without typical mitotic activity. Infiltration of scattered lymphocytes was observed in the stroma. Immunohistochemical staining showed partial tumor cells were immunoreactive to thyroid transcription factor-1 (TTF-1) in nuclei, anti-mitochondria antibody (AMA), S-100 protein (S-100), Galectin-3 and vimentin (Vim) in cytoplasm. Ki-67 labeling index was 3%. The final diagnosis was spindle cell oncocytoma in sellar region. The patient presented rapid loss of vision 2 months after surgery. Reexamined MRI showed a mass at the sellar region, and the patient was treated by radiotherapy. During the 10-month follow-up, the vision was not recovered, and the tumor was still existed. Conclusions Spindle cell oncocytoma is a rare benign tumor in the sellar region, which is considered as WHO grade Ⅰ tumor. It should be considered in the differential diagnosis of various sellar region lesions. Complete removal of tumor is important to prevent tumor recurrence. For patients who achieved partial resection, postoperative adjuvant radiotherapy is necessary.

Key words:  Adenoma, oxyphilic, Sella turcica, Immunohistochemistry, Pathology