SELLAR TUBERCULOMA:AN UNUSUAL INFECTION

摘要

Summary:Tuberculomas are common intracranial lesions in our country. However, tubercular infection of pituitary gland is very unusual. We present a case of intrasellar tuberculoma mimicking pituitary adenoma, and suggest the radiological features and management. A 22-year-old woman had presented with generalized dull aching mild to moderate headache for 8 months and decreased vision in both eyes for 6 months. Visual acuity was 6/9 in both eyes but visual fields and fundus examination were normal. There were no other significant findings. CT scan and MRI (brain) showed a sellar- suprasellar lesion. The pituitary stalk was thickened, as was the mucosa of sphenoid sinus, which raised the suspicion of an infectious pathology other than pituitary macroadenoma. Surgery was performed through sublabial transsphenoid route. A firm, rubbery, yellowish, non-suckable and relatively avascular lesion was found in the sella. Only subtotal decompression was done. Frozen section biopsy was suggestive of inflammatory pathology. Histopathology revealed features compatible with tuberculosis. We suggest that tuberculosis should be considered in the differential diagnosis of sellar lesions, especially if associated with contrast enhancement and thickening of sphenoid sinus mucosa or pituitary stalk, particularly in patients from tuberculosis endemic areas. Most of these patients are negative for workup for systemic tuberculosis. Intraoperatively, a frozen section should be sent and if it shows inflammatory pathology, only a decompression for biopsy should be done. We do not advise radical decompression of these lesions as anti-tubercular treatment is sufficient for cure.