脳下垂體腺腫の特發性出血死の1例

An Autopsy Case of Spontaneous Hemorrhage in Pituitary Adenoma

　腦下垂體線腫が變性を起こして嚢腫となり，そして顯微鏡的な小出血を起こすことは珍らしい事ではない。然し乍ら特發性に腺腫内に大出血を起こし短時日の間に死の轉機をとると云ふ例の報告は極めて珍らしい。從つて生前に確かな診斷がなされた例は甚だ少なく，多くは病理解剖學的に偶然發見されるものである。余等は最近その1例を經驗したので茲に報告する。

　患者は37才男。生果業。1952年1月6日入院

It is not rare that pituitary adenoma degene-rate to cyst and bleed microscopically, but sudden extensive hemorrhage in pituitary adenoma has been extremely seldom described. Brougham etc. (i950) reported these cases and called the attention of us to the matter. Recently we also experienced a case of this type.

This patient, a 37-year-old man, who had no signs of tumors of the pituitary body, com-plained to severe headache, nausea and vomit-ing suddenly after slight infraction of his dietary regulations. From these symptoms he recovered soon, but as he drank Sake after one week, severe headache, nausea and vomit-ing recurred again. After four days tempera-t re rose to 40℃., complete right ophthalmo-plegia occured and admitted in our hospital.

Examination and Course. There was complete ptosis of right eyelid and right eye was com-pletely ophthalmoplegic. In the left eye, on the contrary, there was only a palsy of adduction. Other cranial nerves were normal and there was no weakness, reflex change or sensory deficit of the limbs. A Lumber puncture revealed xanthochromic fluid under a pressure of 190mm. of water. Next day he became stuporous. At that night he became unconscious, temperature rose to 40℃. and even the left eye became completely ophthalmoplegic. Thus on the third day morning he died one week after his headache attack.

Pathological Findings. A rounded mass of dark red tissue protruded from the sella turcica. The expansions of the mass compressed the optic chiasm and tuber cinereum superio-posteriorly. Microscopic sections showed that the tumor was extensive hemorrhage in pitui-tary chromophobe adenoma and formed almost a coagulated mass. The adenomatous tissue was extremely scanty and the most part of hemorr-hage was fresh and a little part was old.

Comment, Brougham etc. have described that these hemorrhage appear to have been found more frequently in eosinophilic than basophilic tumors. It is typical symptoms that a patient who had had symptoms of a pituitary adenoma for months or years develops quite abruptly headache, amblyopia, diplopia, drowsiness, confusion or coma. With the development of coma the temperature usually rises and death often ensues within a few hours to days. But the illness occures often with no signs of pituitary adenoma previously as in this case and so the hemorrhagic adenoma is discovered sometimes unexpectedly by autopsy. It should be stressed that as long as the clinical course makes no progress or moves in the direction of recovery, reatment should remain conserva-tive. But when the symptoms are advancing, much is expected of carefull operative manage-ment to save one from death.