180例垂体腺瘤的临床病理观察

目的：研究垂体腺瘤的临床激素过多症状与腺瘤组织激素检测之间的关系以及该病的发生、生物学行为分类。方法：对180例垂体腺瘤进行了临床病理分析。并对其中110例应用免疫组化ABC法检测了肿瘤的GH、PRL、ACTH、TSH、FSH、LH。结果：临床激素过多症状与激素检测相一致者占40%,且女性较男性相致者多,差异有显著性。免疫组化分型以PRL和GH腺瘤多见,多激素腺瘤以GH PRL腺瘤多见。结论：垂体腺瘤的免疫组化检测与形态功能相结合的分类方法简便易行较为实用。     

垂体腺瘤108例临床病理分析

目的研究垂体腺瘤的临床、病理学及预后特点。方法收集2005年5月～2007年12月复旦大学附属上海第五人民医院神经外科病理确诊的垂体腺瘤患者108例,回顾性分析其临床、放射学、随访资料及HE染色、免疫组化染色等临床病理特点。结果 108例患者中,男性45例,女性63例,发病年龄17～89岁,平均48.0岁。根据影像学显示大小,分为微腺瘤18例,大腺瘤87例,巨大腺瘤3例。依据免疫组化结果显示生长激素(growth hormone,GH)型腺瘤50例,泌乳激素(prolactin,PRL)型腺瘤28例,促肾上腺皮质激素(adenocorticotropic hormone producing adenoma,ACTH)型腺瘤11例,促性腺激素(gona-dotropin producing adenoma,FSH/LH)型腺瘤10例,裸细胞腺瘤(null cell adenoma)4例,其它混合型腺瘤5例。患者术后随访时间30～60个月,平均43.9个月,其中36例(33.3%)复发。结论肿瘤复发与肿瘤大小及切除完整与否有关(P<0.05),与患者年龄、性别及肿瘤免疫表型、是否侵袭无关(P>0.05)。免疫组化...     

混合性节细胞瘤/垂体腺瘤4例临床病理观察

目的探讨混合性节细胞瘤／垂体腺瘤发生机制、临床病理特征、诊断及鉴别诊断。方法复习4例混合性节细胞瘤／垂体腺瘤患者的临床资料，并对其进行组织学观察和免疫组化（EnVision—plus法）标记。结果4例混合性节细胞瘤／垂体腺瘤患者均为女性，年龄10～35岁，平均26．5岁。临床上3例表现内分泌症状，1例有癫痫症状。组织学上肿瘤由两种不同成分组成，一种结构主要由较多神经节细胞组成，节细胞体积大，可见圆形的尼氏小体，核大，核仁突出，免疫组化标记瘤细胞表达CgA、Syn、S-100蛋白，不表达GFAP；另一部分腺瘤细胞大小形态较一致，圆形或卵圆形，胞质丰富，嗜酸性或空淡，间质血窦丰富，瘤细胞表达GH和PRL。结论混合性节细胞瘤／垂体腺瘤是蝶鞍区极少见的肿瘤，好发于青年女性，常合并肢端肥大症。该瘤的诊断主要依靠组织病理学，并辅以免疫组化标记。治疗主要采用单纯手术切除，预后较好。     

垂体含淀粉样物质的催乳素细胞腺瘤1例

患者女 ,2 8岁 ,停经 7个月入院。无视力障碍 ,无多饮多食。开颅手术鞍区切口 1 5cm× 1cm ,在垂体部位见一肿瘤 ,黄白色 ,质韧呈胶皮样 ,刮圈不能刮除。其中央部分质软、粉红色 ,瘤组织向两侧扩展 ,紧靠海绵窦 ,约 1 0cm×0 8cm ,部分囊性变。病理检查　送检物为灰白灰红色破碎组织一堆 ,总体积1cm× 1cm× 0 6cm ,质软、韧。镜检 :包括肿瘤与少量正常脑垂体组织 ,肿瘤细胞排列成团块 ,其间有血窦。瘤细胞近圆形或多边形 ,胞质中等 ,嫌色性或透明 ,核圆 ,大小一致 ,核染色质细粒状。有些瘤细胞团块与血窦间具有粉红色 ,边界清楚、大小不…     

鼻咽巨大零细胞垂体腺瘤1例

患者女性,42岁,1年前因持续双侧鼻塞行CT检查,示鼻咽顶后壁巨大占位,颅底骨破坏;鼻咽部MRI平扫:颅底斜坡处软组织肿块影,大小4.4 cm×4.3 cm,侵及后组筛窦及鼻道,侵犯双侧蝶窦及右侧海绵窦(图1);鼻咽镜下见鼻咽部顶壁巨大新生物,表面有轻度糜烂.     

伽玛刀治疗垂体腺瘤54例随访分析

1994年1月～1995年12月对54例垂体瘤行伽玛刀治疗后随访,随访时间由3～18月,对资料分析讨论。 1 资料与方法 男22例,女32例。年龄10～63岁,病程1～16年,平均3.8年.诊断依据:①临床以头痛,视力视野损害和(或)内分泌功能障碍症状为主。②影像学检查:常规蝶鞍平片、CT及MR检查。③有关内分泌检查。④12例手术病理确诊,根据MR定位片确定肿瘤大小从6～52.8mm,平均26.2mm。 采用Leksell B型伽玛刀治疗,应用KULA程序进行剂量计算,尽量使肿瘤边缘达到满意覆盖,而到达视神     

垂体ACTH细胞腺瘤的免疫电镜研究

5 cases of pituitary adenomas associated with Cushing's disease or Nelson's syndrome were studied with electron microscopy and immunoelectron microscopy by using protein A--gold complex. Diversified ultrastructure was displayed in these tumors, among which 4 revealed presence of ACTH positive secretory granules. These granules were round or polyhedric in shape, varied in number, size and electronic density. Bundles of microfilaments could be seen in the tumor cells frequently, which were of the highest diagnostic value. There was no significant difference found in ultrastructure and immunocytochemical reaction of adenomas in Cushing's disease and Nelson's syndrome.     

垂体腺瘤细胞培养的实验研究

目的 通过对垂体腺瘤细胞体外培养以垂体腺瘤细胞为移植物供体进行颅外移植,补充垂体功能不足及为腺垂体移植细胞库的建立奠定基础。方法 利用术中切除的垂体腺瘤组织进行了体外培养,并通过染色和放射免疫测定技术,评价体外培养的垂体腺瘤组织的功能状态,寻找其功能最佳间期的规律。结果 没有NGF和HRP介入的情况下,垂体腺瘤细胞的形态和功能状态在培养的第6天为最佳。结论 体外培养的垂体腺瘤细胞仍具有分泌激素的功能,为以垂体腺瘤细胞为移植物供体进行颅外移植的研究奠定了实验基础。     

垂体促甲状腺素腺瘤的临床病理分析

目的 研究垂体促甲状腺素(TSH)腺瘤的临床及病理学特点。方法 利用光镜、电镜观察和免疫组织化学链霉素抗生物素蛋白一过氧化物酶法(SP法),结合临床资料对7例垂体TSH腺瘤进行临床病理分析。结果 7例患者均有甲状腺功能亢进的临床表现,血浆FT3、FT4、T3、T4均增高,血浆TSH不被抑制。蝶鞍MRI检查均为垂体大腺瘤或巨大腺瘤(直径2～5cm),光镜下显示5例为嫌色细胞性腺瘤,1例为弱嗜酸和嫌色细胞性腺瘤,1例为嗜酸细胞性腺瘤。免疫组织化学染色7例TSH强阳性,1例合并泌乳素阳性,2例合并生长激素阳性,3例合并散在生长激素和泌乳素阳性,Ki-67标记7例阳性率为0～0．4％,p53标记7例均为阴性。结论 7例垂体TSH腺瘤虽然都为大腺瘤和巨大腺瘤,1例侵犯额叶底部和第三脑室,但它们的增殖指数均在正常范围,肿瘤的复发与肿瘤侵犯周围组织不能彻底切除有关。     

The pathology of nonfunctional pituitary adenomas

The nonfunctional adenomas also known as undifferentiated, null cells, or nonsecretory adenomas are endocrinologically silent neoplasms of the anterior lobe of the pituitary gland. They constitute 50% of all pituitary adenomas in the present report. Most tumors are large, often growing beyond the confines of the sella turcica and characterized anatomically by displacement and compression of the adjacent sellar structures including the optic chiasm, hypothalamus, and third ventricle. Others may be truly invasive when they locally or diffusely infiltrate the adjacent structures. They may grow through the dura and the bone into the cranial cavity and/or the sphenoidal sinus and the nasopharynx or infiltrate one or both cavernous sinuses. Seventy-six adenomas were divided into 48 nononcocytic adenomas and 28 oncocytic adenomas or oncocytomas occurring in older patients. By light microscopy using conventional histologic stains, the majority of nononcocytic tumors were chromophobic. The oncocytomas were slightly acidophilic with a large granular cytoplasm. With the peroxidase-anti-peroxidase (PAP) method with anti-sera for the anterior pituitary hormones, the adenoma cells show no immunostaining. Ultrastructurally, the nononcocytic tumors possess a modest number of small secretory granules but no specific ultrastructural features. The oncocytic tumors are characterized by an excessive number of mitochondria in their cytoplasm. With the PAP method using cytochrome C oxidase antiserum, specific identification of mitochondria can be made. As the nonfunctional adenomas are devoid of anterior pituitary hormones they have been called "null cell" adenomas. However, most of the null-cell adenomas are positive for chromogranin. The diagnosis of nonfunctional adenoma can be suspected clinically when in the absence of signs of hypersecretion of pituitary hormones, there is radiologic evidence of ballooning of the sella and bulging of its diaphragm. An invasive adenoma can be detected by radiologic signs of destruction of the sella turcica and its boundaries or by neurosurgical intervention when there are findings of invasion of the dura, the parasellar, and suprasellar structures.     

经单鼻孔蝶窦入路垂体腺瘤切除45例分析

目的探讨经单鼻孔蝶窦入路显微手术垂体腺瘤切除的方法和效果。方法对45例垂体腺瘤患者采用经单鼻孔蝶窦入路显微手术切除6例微腺瘤及39例大腺瘤,其中泌乳素(PRL)腺瘤18例,生长激素(GH)腺瘤8例,混合性(PRL GH或PRL ACTH)腺瘤12例,无功能性腺瘤7例。结果显微镜下全切除43例,次全切除2例。术后一过性尿崩症28例,经治疗1周左右恢复。无手术死亡、脑脊液鼻漏、术区出血及脑膜炎等并发症。术后平均住院8 d,全组病例术中未输血;随访1~5年,1例复发。结论单鼻孔经蝶窦入路较传统经蝶入路具有安全、简便、微创、术后并发症少、恢复快、效果满意等优点,是鞍内肿瘤切除的良好径路。     

Sphenoidal pituitary adenoma.

A 62 year old female died of a chromophobe pituitary adenoma of the sphenoid bone. A normal pituitary gland was present within the sella turcica. She also had a chief cell parathyroid adenoma, a papillary thyroid carcinoma, and an ovarian thecoma (multiple endocrine neoplasia syndrome).     

Metastasis to pituitary adenoma

Neoplasm to neoplasm metastasis is a medical curiosity. We report two cases of adenocarcinoma metastatic to pituitary adenoma. In both, abrupt progression of symptoms referable to the sellar region was noted and followed by the death of the patient.     

Metastatic prolactin-secreting pituitary adenoma

A 62-year-old man had a malignant prolactin-secreting pituitary adenoma. The tumor was initially resected through a transfrontal approach. Recurrence six years later was manifested by an occipital metastasis, which was excised. Progressive clinical deterioration ensued despite irradiation and chemotherapy of the intrasellar and occipital recurrence, and the patient died. Pathologic examination of tumor tissue obtained from the occipital metastasis showed increased cellular pleomorphism and mitotic rate in comparison with the original surgical specimen. The only true indication of malignant transformation, however, was the invasion of tumor capsule by adenoma cells, observed in the autopsy specimen. These findings support the contention that the diagnosis of a malignant pituitary adenoma rests ultimately on the demonstration of local invasive growth and/or distant metastasis. Since prolactinomas are usually non-aggressive, malignant degeneration of adenomas is decidedly rare. Its occurrence underlines the need for aggressive follow-up and treatment.     

Clinical diagnosis of pituitary adenoma

Clinical symptoms, signs, endocrine examinations, image diagnosis of GH cell adenoma, prolactin cell adenoma, TSH cell adenoma and nonsecreting pituitary adenoma are discussed.     

A composite somatotroph-corticotroph pituitary adenoma

A 76-year-old woman presented with enlargement and weakness of her hands and feet coarsening of facial features, proximal muscle weakness, and worsening of her noninsulindependent diabetes mellitus. Serum growth hormone, somatomedin-C, and prolactin levels were elevated. Thyroid function test results and serum cortisol and adrenocorticotropic hormone levels were within normal limits. Luteinizing and follicle-stimulating hormone levels were both low, suggesting possible partial hypopituitarism. Magnetic resonance imaging of the sella demonstrated a pituitary lesion that measured 2.2 x 1 x 0.5 cm; it partially obliterated the suprasellar cistern and it distorted the optic chiasm. Light microscopic and ultrastructural examination of the trans-sphenoidally resected tissues identified characteristic features of 2 discrete pituitary adenomas that were in close apposition, but they were sharply demarcated. The 2 components were a corticotroph adenoma and a sparsely granulated somatotroph adenoma. Multiple adenomas of the pituitary are not rare; however, the majority are endocrinologically “nonfunctional.” We report a patient with clinical features of acromegaly whose tumor was a composite lesion: one area exhibited morphological characteristics of a corticotroph adenoma and another distinct area exhibited features of a somatotroph adenoma. The possible histogenesis is discussed.