Atypical tentorial meningioma 30 years after radiotherapy for a pituitary adenoma

Although the human central nervous system used to be considered relatively resistant to the carcinogenic action of ionizing radiation, several lines of evidence now document a high incidence of secondary tumors in irradiated patients. The numerous reports of radiation-induced cerebral meningiomas generally distinguish those induced by high-dose radiation from those induced by low-dose radiation. We describe the case of patient who underwent subtotal resection of a chromophobe pituitary adenoma at the age of 18 years, who was successively treated by conventional fractionated radiotherapy with gamma rays emitted by a source of ⁶⁰Co until a total dose of 41 Gy. Over the next 30 years the patient experienced all the known late effects of radiation, including panhypopituitarism, cranial-nerve deficits (II, III and VI), massive radiation necrosis involving the left cerebral hemisphere and causing right hemiparesis and aphasia and, ultimately, an atypical tentorial meningioma with early recurrence after total resection. Received: 13 December 2000 / Accepted in revised form: 19 November 2001     

Pituitary adenoma with amyloid deposits and hyperprolactinemia

Summary Amyloid deposits were observed in a prolactinoma accompanying an amenorrhea-galactorrhea syndrome. The amyloid showed typical fibrils that were grouped in compact bundles. The seven other cases described in the literature are reviewed; evidence is accumulating that this amyloid can be secreted by epithelial cells.     

Pituitary Apoplexy due to Pituitary Adenoma Infarction

Cause of pituitary apoplexy has been known as hemorrhage, hemorrhagic infarction or infarction of pituitary adenoma or adjacent tissues of pituitary gland. However, pituitary apoplexy caused by pure infarction of pituitary adenoma has been rarely reported. Here, we present the two cases pituitary apoplexies caused by pituitary adenoma infarction that were confirmed by transsphenoidal approach (TSA) and pathologic reports. Pathologic report of first case revealed total tumor infarction of a nonfunctioning pituitary macroadenoma and second case partial tumor infarction of ACTH secreting pituitary macroadenoma. Patients with pituitary apoplexy which was caused by pituitary adenoma infarction unrelated to hemorrhage or hemorrhagic infarction showed good response to TSA treatment. Further study on the predisposing factors of pituitary apoplexy and the mechanism of infarction in pituitary adenoma is necessary.     

Pituitary growth hormone cell adenoma with cytoplasmic tubular aggregates in the capillary endothelium

Summary Electron microscopy revealed the presence of cytoplasmic tubular aggregates in the capillary endothelium of a sparsely granulated growth hormone cell adenoma removed surgically from a 25-year-old female patient with acromegaly. To our knowledge, this is the second publication describing these structures in hypophysial growth hormone cell adenomas.     

Pituitary Hemorrhage : Classification and Related Factors

Objective

Clinical features of pituitary hemorrhage vary from asymptomatic to catastrophic. The purpose of this study was to evaluate the factors related to severity of hemorrhage of pituitary adenoma.

Methods

Pituitary hemorrhage was noted in 32 of 88 patients who underwent operations between January 2000 and December 2007. Clinical status was classified into group I (no hemorrhage symptoms), II (mild to moderate symptoms without neurological deficit), and III (with neurological deficit), and was compared to radiological, pathological, and operative findings. All patients were operated by transsphenoidal approach, and hemorrhage-related symptoms were relieved.

Results

Groups I, II, and III comprised 15, 10 and 7 patients, respectively. In group I, hemorrhage volume was under 1 mL in 11 (73.3%), but, it was above 1 mL in 7 (70%) of group II and in all cases of group III. Hemorrhage stage based on MRI findings was chronic or subacute in 11 (73.3%) of group I, acute in 6 (60%) of group II, and acute or hyperacute in 6 (85.7%) of group III. Pathological examination revealed chronic-stage hematomas in 5 (50%) group II patients. Functioning adenomas were found in 5 (33.3%) group I patients but none in group II or III patients. Silent adenomas were found in 4 (26.7%), 8 (80%), and 3 (42.9%) in groups I, II, and III, respectively.

Conclusion

Clinical features of pituitary hemorrhage may differ with the radiological and immunohistopathlogical findings. Persistent symptoms are related to the chronic stage of hematoma requiring surgery for symptom relief. Neurological deficits are caused by large amount of acute hemorrhage requiring emergency operation. Silent adenoma is related to the severity of pituitary hemorrhage.     

大型、巨大型垂体腺瘤与垂体柄显微解剖关系的术中观察

目的在切除大或巨大型垂体腺瘤术中更好地保留垂体柄的解剖和功能.方法回顾性分析123例大型和巨大型垂体腺瘤的手术资料和影像学资料.在鞍结节至鞍背的平面上按时钟划分为6个区间,观察垂体柄在此6个区的分布.结果垂体柄没有位于第Ⅰ区间者,位于第Ⅱ区间者12例（9.8%）,第Ⅲ区间者46例（37.4%）,第Ⅳ区间者29例（23.6%）,第Ⅴ区间者31例（25.2%）,第Ⅵ区间者5例（4.1%）.结论大多的垂体柄位于垂体腺瘤的后方或侧后方,术中按其分布特点可更好地寻找垂体柄.     

巨大垂体腺瘤切除术中的垂体柄保护及意义

目的 探讨巨大型垂体腺瘤切除手术中的垂体柄保护。方法 采用经纵裂蝶窦入路显微手术切除巨大型垂体腺瘤52例。结果 肿瘤全切除39例（75％）。垂体柄保留34例（65％）。术后发生尿崩32例（62％），其中23例在术后1－2周内恢复正常，占术后尿崩总数的72％；7例在3个月内恢复；2例尿崩症状持续1年以上。结论 垂体腺瘤手术中的垂体柄保留可有效降低术后尿崩症，特别是永久性尿崩症的发生，是提高手术效果的重要措施。     

LRIG2基因表达与垂体腺瘤侵袭性的关系

目的探讨富含亮氨酸重复序列和免疫球蛋白样多肽2（LRIG2）基因在垂体腺瘤中的表达及其与肿瘤侵袭性的关系。方法采用逆转录聚合酶链反应（RT-PCR）技术检测临床手术切除的23例侵袭性（13例）和非侵袭性（10例）垂体腺瘤标本中，LRIG2基因在mRNA表达水平上的差异。结果RT-PCR显示在侵袭性与非侵袭性垂体腺瘤中mRNA表达的阳性率均为100％。在表达强度上，LRIG2在侵袭性垂体腺瘤中mRNA表达明显高于非侵袭性垂体腺瘤（P〈0．05）。结论LRIG2可能与垂体腺瘤的侵袭性密切相关。     

Manifestation, management and outcome of subclinical pituitary adenoma apoplexy

The objective of this study was to investigate the clinical features, diagnosis, treatment and outcomes of subclinical pituitary adenoma apoplexy (SPAA) in 185 consecutive patients between January 1990 and May 2007. Of the 185 patients, 133 (71.89%) underwent transsphenoidal tumor decompression and the remaining 52 patients (28.11%) underwent transcranial surgery. Preoperative and postoperative endocrinological hormone concentrations were measured in all patients. Pituitary imaging was obtained by CT scans or MRI. Follow-up outcomes were obtained from the records of outpatient visits and by telephone interviews. Visual disturbance, headache and pituitary function impairment improved significantly in all patients. Prolactinoma was the most frequent type of pituitary adenoma in our series (51.89%). SPAA usually occurred in patients with large or giant adenomas (85.95%). Postoperative follow-up ranged from 1 year to 17 years with a mean of 7.4 ± 1.6 years. The tumor recurred in 23 patients, 18 of whom were treated with postoperative radiotherapy for either residual tumors (n = 8) or recurrence (n = 10). Long-term thyroid hormone replacement was necessary in eight patients and steroid hormone replacement in six patients. The incidence of SPAA is relatively high compared with that of acute pituitary apoplexy. The exact pathogenic mechanism of SPAA remains unknown. MRI is significantly better than CT scans for detection of SPAA. Transsphenoidal decompression is safe and effective. Surgical decompression should be performed as early as possible.     

垂体腺瘤中PCNA蛋白表达的研究

目的 探讨良性垂体腺瘤中增殖细胞核抗原（PCNA）蛋白表达与肿瘤发生及生物学行为的关系。方法 应用免疫组化ABC法检测58例垂体腺瘤中PCNA的表达。结果 PCNA的表达在垂体腺瘤患者中,复发者PCNA增殖指数明显高于非复发患者（P＜0．05）。在出血组与非出血组、囊性变组与非囊性变组及巨大型组与非巨大型组中,PCNA蛋白的表达均无显著性差异（均P＞0．05）。结论 PCNA蛋白表达较准确地反映了垂体腺瘤细胞的增殖活性,可作为判断复发和预后的指标之一。     

垂体腺瘤类型与患者性别、年龄的关系

对781例不同激素类型垂体腺瘤分析发现,无激素型腺瘤最常见(28.68％),其次是PRL腺瘤(26.12％),多激素腺瘤(17.67％),FSH、LH腺瘤(15.62％),GH腺瘤(7.68％),而ACTH腺瘤及TSH腺瘤极少。只有FSH·LH腺瘤多发于男性,其他类型垂体腺瘤均多发于女性。PRL型、多激素型、GH型腺瘤多发于年轻者,而无激素型、FSH·LH型腺瘤多发于年龄大者。     

垂体腺瘤患者血浆神经肽Y与垂体激素水平相关性研究

目的 探讨垂体腺瘤患者血浆神经肽Y（NPY）与垂体激素之间的相关关系。方法 收集82例垂体腺瘤患者及20例对照组空腹静脉血3ml，进行血浆NPY放免测定分析，并与垂体激素水平进行相关分析。初步探讨NPY与部分其他临床指标之间的相关性。结果 （1）垂体腺瘤患者、泌乳素细胞腺瘤、生长激素细胞腺瘤、无内分泌功能细胞腺瘤及多分泌功能细胞腺瘤组中血浆NPY与PRL呈负相关。（2）垂体腺瘤患者血浆NPY与ACTH呈正相关。（3）促性腺激素细胞腺瘤中NPY与LH呈正相关而与GH呈负相关。（4）NPY在垂体腺瘤组与对照组中血浆含量明显不同，而且部分不同垂体腺瘤组之间也存在明显差异。（5）全组垂体腺瘤手术后血浆NPY的含量下降。结论 NPY参与了垂体腺瘤病理生理中下丘脑-垂体轴许多激素的调节，可能与垂体腺瘤的发生有关。     

经蝶窦垂体腺瘤切除术中鞍底的处理

目的 探索改进经蝶窦垂体腺瘤切除术中的鞍底处理方法。方法 对本院1995年以来82例经蝶窦显微手术的体腺瘤患,按鞍底处理分为三类。术中满意切除腺瘤,鞍隔蛛网膜囊满意贴向鞍底,用明胶海绵加EC胶单纯封闭鞍底（29例）;术中蛛网膜破损有脑脊液漏出,用明胶海绵加EC胶封堵（37例）;对肿瘤刮除不满意或刮除肿瘤后鞍隔蛛网膜下降不满意,鞍内填入明胶海绵或速即沙等止血物质,鞍底敞开不封闭（16例）。结果 患术后均无不良反应,也没有并发症。结论 本方法与目前传统方法的最大区别在于处理鞍底不用自体游离组织,而用明胶海绵、EC胶、其方法简便、安全、疗效可靠,且减少患的痛苦。     

垂体腺瘤术后早期并发症的处理体会（附26例报道）

目的探讨垂体腺瘤术后早期常见并发症的发生原因、预防措施及治疗效果。方法26例患者巾男13例，女13例，年龄25～78岁，病史1周～20年；手术采取经颅切除肿瘤16例，经口鼻蝶切除肿瘤10例。结果26例患者术后25例出现尿崩症，经过治疗后均得到缓解，最短2d就恢复正常，最长2（1d症状消失，均为暂时性的；2例术后出现脑脊液鼻漏，其中1例经保守治疗好转，另1例经过二次修补手术后也好转。结论垂体瘤术后早期可出现多种并发症，影响患者的生存和预后，因此提高术中显微操作技巧，术后严密监测生命体征，及时对症处理，可以减少并发症的发生，并促进并发症的恢复。     

垂体腺瘤的显微外科治疗

目的探讨外科治疗垂体腺瘤显微手术方法的选择。方法对CT或MRI证实的65例垂体腺瘤，采用经蝶入路或经翼点入路两种手术方法，在显微镜下切除肿瘤。结果经蝶手术44例，全切除29例，次全切除15例；无1例死亡。经翼点入路显微手术21例，全切除13例，次全切5例，部分切除3例；死亡1例(死于多器官功能衰竭)。结论采用显微外科技术，针对肿瘤的特点选择不同的手术入路是提高垂体腺瘤全切率、降低死亡率的关键。     

垂体腺瘤质地与手术入路的探讨

目的 探讨大垂体腺瘤的手术入路。方法 分析了100例实性垂体腺瘤的临床表现、内分泌检查结果、MR检查T2信号特点及手术情况。结果 肿瘤质地软易切除者88例,其中生长激素腺瘤36例,泌乳腺激素腺瘤21例,无功能性腺瘤31例;MR检查T2像;高信号76例,等信号12例。肿瘤质地较韧者12例,其中泌乳激素腺瘤4例,无功能性腺瘤8例;MR检查T2像,高信号4例,等信号8例。结论 垂体腺瘤的质地与MR检查T2像信号强度、内分泌测定有关,可以指导大垂体腺瘤的手术入路选择。     

原发性甲状腺功能减退致垂体增生四例报告及文献复习

目的 探讨原发性甲状腺功能减退致垂体增生的诊断和处理原则.方法 结合文献回顾性分析4例原发性甲状腺功能减退致垂体增生的临床资料.结果 4例均表现为促甲状腺激素(TSH)及催乳素(PRL)增高,FT3及FT4减少,MRI示垂体增大,甲状腺素替代治疗2-4个月后,垂体恢复正常,TSH及PRL水平亦恢复正常.结论 原发性甲状腺功能减退致垂体增生具有影像学特征,结合临床可明确诊断.治疗首选甲状腺素实验性替代治疗,而不宜行手术治疗.     

Invasive Crooke cell adenoma in a patient with diffuse large B-cell lymphoma

Crooke cell adenoma (CCA) is an aggressive corticotroph subtype of pituitary adenoma often with cyclically elevated blood adrenocorticotropic hormone (ACTH), which preoperative diagnosis is challenging especially in the context of a functionally silent invasive tumor and a history of high-stage malignancy such as diffuse large B-cell lymphoma (DLBCL). Here, we report the first case of invasive CCA in a patient with DLBCL. A 71 year-old previously healthy man was recently diagnosed with DLBCL that was treated with CHOP-R chemotherapy. Within one week of completing his first cycle of chemotherapy, he had a frontal headache that progressed to right-sided proptosis. Cranial MRI showed a heterogeneously enhancing mass with invasion into the sellar and suprasellar compartment, compression of the optic chiasm, as well as extension into the clivus, bilateral cavernous sinuses, and the prepontine cistern. He underwent a partial resection for the pituitary tumor debulking. Pathological examination revealed CCA with invasion into the adjacent tissue. The patient had no history of Cushing disease or syndrome, but his blood ACTH was found to be elevated on the operation day. Our present case and literature review suggest that comorbidity of CCA or ACTH-producing adenoma and B-cell lymphoma deserves awareness in our clinical practice, as these two diseases and/or their therapies may interact substantially. CAA should be considered in the major differential diagnosis for an invasive sellar tumor, even without blood ACTH elevation and/or with a history of malignant lymphoma.     

神经内镜在经鼻蝶入路垂体腺瘤显微手术中的应用

目的 探讨神经内镜在鼻蝶入路垂体腺瘤切除术中的应用价值。方法 对经鼻蝶入路垂体腺瘤手术中应用神经内镜的30例病人的资料进行回顾性分析，并进行随访观察。结果 神经内镜辅助下30例垂体腺瘤均全切。术后8例出现一过性尿量增多，4例病人出现尿崩，经对症处理治愈；无脑脊液漏及颅内感染发生。神经内镜可清晰地观察蝶窦内结构及分隔情况、鞍底及周围重要结构(海绵窦、颈内动脉隆凸及斜坡等)，并了解肿瘤的切除程度。结论 经鼻蝶垂体腺瘤切除术中应用神经内镜有助于术中辨认鞍底及周围重要结构，保持正确的中线手术操作方向，避免损伤重要结构，提高肿瘤的切除程度及减少手术并发症。