Rozlany chłoniak złośliwy typu B przebiegający z naciekiem skrzyżowania wzrokowego, zaburzeniami widzenia, niedoczynnością przysadki, hiperprolaktynemią i moczówką prostą. Opis przypadku i przegląd literatury

The case is reported of a 55-year-old man with diffuse malignant lymphoma type B associated with transient optic chiasm infiltration and visual disturbances but with persistent hypopituitarism, hyperprolactinaemia and diabetes insipidus. The patient was administered chemotherapy and radiotherapy. Repeated MR and CT scans showed optic chiasm infiltration, which disappeared in the course of the chemotherapy but then recurred, changed its appearance and finally disappeared again. In the meantime visual disturbances occurred and disappeared during the therapy. Hypopituitarism, diabetes insipidus and hyperprolactinaemia were diagnosed and replacement therapy was administered. Later on abdominal pain occurred, and a CT scan revealed bilateral kidney masses and enlarged retroperitoneal lymph nodes. These were diffuse malignant lymphoma with regional lymphonodulitis in histology. Finally, hydrothorax and hydroretroperitoneum were diagnosed. The patient died as a result of systemic complications of the disease. The length of survival time documented following the hypothalamochiasmatic infiltration and diagnosis of lymphoma makes the case an unusual one for patients with CNS lymphoma. Hormonal disturbances accompanying the suprasellar region infiltration are very important from the practical point of view.Przedstawiono opis przypadku 55-letniego mężczyzny chorującego na rozlanego chłoniaka złośliwego typu B z towarzyszącym przemijającym naciekiem skrzyżowania wzrokowego i zaburzeniami widzenia oraz przetrwałą niedoczynnością przysadki, hiperprolaktynemią i moczówką prostą. Chorego leczono chemio- i radioterapią. Powtarzane badania za pomocą jądrowego rezonansu magnetycznego (NMR, nuclear magnetic resonance) i tomografii komputerowej (TK) wykazywały naciek skrzyżowania nerwów wzrokowych, który ustępował w wyniku chemioterapii i znowu nawracał, zmieniał swój charakter i w końcu wycofał się. Równocześnie pojawiły się zaburzenia widzenia, które również ustąpiły w czasie leczenia. Stwierdzono wymagające substytucji niedoczynność przysadki i moczówkę prostą, a także hiperprolaktynemię. W późniejszym czasie dołączyły się objawy brzuszne i w badaniu TK stwierdzono obustronne zmiany w nerkach i powiększenie pozaotrzewnowych węzłów chłonnych. W badaniu histolopatologicznym potwierdzono rozpoznanie rozlanego chłoniaka złośliwego i miejscowe zapalenie węzłów chłonnych. Następnie wykazano obecność płynu w jamie opłucnej i przestrzeni pozaotrzewnowej, a pacjent zmarł z powodu powikłań choroby zasadniczej. W opisywanym przypadku udokumentowano długie przeżycie od czasu rozpoznania nacieku okolicy podwzgórza i skrzyżowania wzrokowego w przebiegu chłoniaka, co jest rzadkością w chłoniakach ośrodkowego układu nerwowego. Z praktycznego punktu widzenia ważne są zaburzenia hormonalne towarzyszące nacieczeniu okolicy nadsiodłowej

Guzy przysadki - trzy warianty kliniczne; różne konsekwencje terapeutyczne

Autorzy omówili 3 przypadki guzów przysadki. Przedstawiono chorych z guzem hormonalnie czynnym, hormonalnie nieczynnym oraz guzem bezobjawowym, określanym jako incydentaloma. W każdym z tych przypadków kliniczne objawy guza oraz schemat postępowania leczniczego były różne. Podkreślono znaczenie badań obrazowych przysadki (rezonans magnetyczny) oraz badań hormonalnych - zarówno w postępowaniu diagnostycznym, jak i w ustalaniu indywidualnych algorytmów leczenia. Zwrócono również uwagę na brak typowego obrazu klinicznego większości guzów przysadki

Przypadek rozrodczaka podwzgórza i szyszynki

A case of 19-year-old male with idiopathic diabetes insipidus diagnosed 9 years ago. 1.5 years from the onset of the disease vision disturbances, neurologic deficiencies and symptoms of hypopituitarism showed up. MRI examination revealed an advanced hypophyseal and pineal gland tumor - germinoma. Total regression was achieved with radio- and chemotherapy. For 7 years from the end of treatment patient has not declared any complains except for vision disturbances and hypopituitarism has been substituted succesfully. The case puts on the necessity of a strict endocrinologic and radiologic follow-up in patients with idiopathic diabetes insipidus due to the possibility of existing potencially curable disease ie. intracranial tumor. (Pol J Endocrinol 2007; 58 (5): 448-452)W pracy przedstawiono 19-letniego chorego, u którego przed 9 laty rozpoznano idiopatyczną moczówkę prostą. Po półtora roku wystąpiły zaburzenia widzenia, neurologiczne i objawy niewydolności przedniego płata przysadki, a w badaniu rezonansem magnetycznym (MRI, magnetic resonance imaging) ujawniono zaawansowanego guza okolicy podwzgórza i szyszynki o typie germinoma. Po radio- i chemioterapii stwierdzono całkowitą regresję zmian. Po 7 latach od zakończenia leczenia, poza znacznym ograniczeniem pola widzenia, chory nie zgłasza dolegliwości, a niewydolność przysadki jest wyrównana substytucyjnie. Przedstawiony przypadek i dane z piśmiennictwa wskazują na konieczność częstej kontroli endokrynologicznej i obrazowej w przypadkach samoistnej moczówki prostej, gdyż po miesiącach lub latach może ujawnić się guz, w tym także o typie rozrodczaka, a podjęcie odpowiedniego postępowania lekarskiego rokuje nawet wyleczenie. (Endokrynol Pol 2007; 58 (5): 448-452

Comparison of post-surgical MRI presentation of the pituitary gland and its hormonal function

Background: Post-surgical evaluation of the pituitary gland in MRI is difficult because of a change of anatomical conditions. It depends also on numerous other factors, including: size and expansion of a tumour before surgery, type of surgical access, quality and volume of filling material used and time of its resorption.The aim of the study was to compare MR image of the pituitary gland after surgery with clinical findings and to establish a correlation between MRI presentation of spared pituitary and its hormonal function. Material/Methods: 124 patients after resection of pituitary adenomas - 409 MRI results in total - were studied. With a 1.5-T unit, T1-weighted sagittal and coronal, enhanced and unenhanced images were obtained. Results: The pituitary gland seemed to be normal in MRI in 11 patients, 8 of them had completely regular pituitary function but in 3 of them we noticed a partial hypopituitarism. In 99 patients only a part of the pituitary gland was recognised, 53 of them had hypopituitarism but 46 of them were endocrinologically healthy. 14 patients seemed to have no persistent pituitary gland in MRI, in comparison to hormonal studies: there was panhypopituitarism in 6 and hypopituitarism in 8 cases. Conclusions: MRI presentation of post - surgical pituitary gland doesn't necessarily correlate with its hormonal function - there was a significant statistical difference. Some patients with partial pituitary seems normal hormonal function. In some cases the pituitary seem normal in MRI but these patients have hormonal disorders and need substitution therapy

MRI image characteristics of materials implanted at sellar region after transsphenoidal resection of pituitary tumours

Background: Post-surgical evaluation of the pituitary gland in MRI is difficult because of a change in anatomical conditions. It depends also on numerous other factors, including: size and expansion of the tumour before surgery, type of surgical access, quality and volume of implanted materials and time of its resorption. The purpose was to demonstrate the characteristics of the implanted materials on MRI performed after transsphenoidal resection of pituitary tumours and to identify imaging criteria helpful in differential diagnosis of masses within the sellar region. Material/Methods: One hundred and fifty-four patients after transsphenoidal resection of pituitary tumours were included in the study. In general, 469 MRI examinations were performed with a 1.5T scanner. We obtained T1-weighted sagittal and coronal, enhanced and unenhanced images. In 102 cases, additional T2-weighted coronal, unenhanced images with 1.5 T unit were obtained as well. Results: The implanted materials appeared in 95 patient: fat in 86 and muscle with fascia in 3 patients. We could recognise implanted muscle and fascia in T2-weighted images, because of high signal intensity of the degenerating muscle and the line of low signal representing fascia. The implanted titanium mesh was found in 4 patients. Haemostatic materials were visible only in 2 patients in examinations performed at an early postoperative stage (1 month after the procedure). Conclusions: The knowledge of MRI characteristics of the materials implanted at the sellar region is very important in postoperative diagnosis of pituitary tumours and may help discriminate between tumorous and non-tumorous involvement of the sellar region. Some implanted materials, like fat, could be seen on MRI for as long as 10 years after the operation, others, like haemostatic materials, for only 1 month after surgery. T2-weighted imaging is a useful assessment method of the implanted muscle and fascia for a long time after surgery

Analysis of metabolic changes of brain in HIV-1 seropositive patients with proton magnetic resonance spectroscopy

Background: Asymptomatic central nervous system involvement may occur in the early stages of the HIV infection. The aim of the study was to evaluate early brain metabolic changes by means of proton MR spectroscopy (H1MRS) in the HIV-1 seropositive patients without neurological deficits or significant abnormalities in the plain MR study. Material/Methods: The H1MRS examinations were performed with the use of a MR GE Signa 1,5T system. There were 39 subjects examined, aged 21 to 57 years (mean age 35 years) were examined, including 25 patients infected with HIV-1 and 14 healthy volunteers who constituted a control group. The examinations were performed using the Single Voxel Spectroscopy technique with the PRESS sequence, with following parameters: TR=1500 ms, TE=35 ms, number of acquisitions =128, time of acquisition =3 min. 43 sec. Voxels of 8 cm3 (20×20×20 mm) in size were located in the following 5 regions: posterior cingulate gyrus, grey matter of the frontal area, left basal ganglia, white matter of the left parietal area and white matter of the frontal area. The NAA/Cr, Cho/Cr, mI/Cr ratios in the defined regions of interest were statistically analyzed. Results: There was a statistically significant decrease (p<0.05) in the NAA/Cr ratios in the posterior cingulate area and white matter of the left parietal area in HIV-1 seropositive patients, as compared to the control group. Other metabolite ratios in all the above mentioned locations showed no statistically significant differences, as was also the case for NAA/Cr ratios in grey matter of the frontal area, left basal ganglia and white matter of the frontal area. Conclusions: The reduction of NAA/Cr values revealed in H1MRS studies suggests loss of neurons/neuronal activity in the posterior cingulate area and white matter of the left parietal area, in patients with HIV-1 at the stage before clinical manifestations of retroviral infection and structural changes in the plain MR study. This may reflect a direct neurotropic activity of HIV