摘要：

目的 鞍区转移癌为临床罕见病，探讨鞍区转移癌的转移来源、临床表现、诊断与鉴别诊断，总结鞍区转移癌的诊治经验。方法与结果 共6例患者均为2014年1月至2019年10月行神经内镜或显微镜下经鼻蝶入路鞍区占位性病变切除术后经病理证实的鞍区转移癌，4例以鞍区占位效应首发，2例既往有恶性肿瘤史。临床表现以头痛、视力下降和视野缺损最为常见。病变主要累及海绵窦和垂体。3例病变累及腺垂体的患者表现为腺垂体功能减退症，其中2例入院诊断为无功能性垂体腺瘤。结论 鞍区转移癌可作为恶性肿瘤的首发表现，与垂体腺瘤相比更易出现尿崩症、腺垂体功能减退症等，单纯依靠影像学诊断相对局限，临床实践中应结合多方面考虑鉴别诊断，降低误诊率。

关键词: 垂体肿瘤, 蝶鞍, 肿瘤转移

Abstract:

Objective Metastatic carcinoma in sellar region is a rare disease. This article is to discuss the metastatic origin, clinical manifestations, diagnosis and differential diagnosis of metastatic carcinoma in sellar region, and to summarize the experience in diagnosis and treatment of disease. Methods and Results From January 2014 to October 2019, six patients with metastatic carcinoma in sellar region were confirmed by pathological examinations after endoscopic or microscopic transsphenoidal surgery. Four patients presented with mass effect in sellar region as the first manifestation, and 2 patients were associated with a history of malignant neoplasm. The common clinical manifestations were headache and visual disturbance. The lesions mainly involved cavernous sinus and pituitary gland. Three patients whose lesions involved adenohypophysis presented with pituitary hypofunction, of which 2 patients were diagnosed as non- functional pituitary adenoma on admission. Conclusions Presentations associated with metastatic carcinoma in sellar region can be the first manifestation of malignant neoplasm. Compared with pituitary adenomas, metastatic carcinoma in sellar region is more prone to present with diabetes insipidus and pituitary hypofunction. Relying solely on imaging diagnosis is relatively limited, and differential diagnosis should be considered in multiple aspects to reduce the misdiagnosis rate.

Key words: Pituitary neoplasms, Sella turcica, Neoplasm metastasis