神经垂体肿瘤临床影像诊断分析

目的 探讨和了解神经垂体肿瘤的影像学表现、组织学发生及其个性化治疗.方法 对11例神经垂体肿瘤影像学表现和临床资料进行回顾性分析.结果 神经垂体肿瘤多表现为局限于垂体后叶及垂体柄的微小病变,极少累及垂体前叶,偶可沿垂体柄向鞍上生长,形成较大的占位性病灶.MRI表现:T1W呈混杂信号,T2W呈稍高或混杂信号.注射Gd-DTPA后病灶可被强化,但信号略低于周围正常的垂体组织,两者可以藉此分辨.组织学检查:垂体颗粒细胞肿瘤GFAP染色弱阳性,胞质内富含各种小囊泡和各级溶酶体颗粒,偶见有不等量的中间微丝.垂体噬酸性颗粒细胞腺瘤FSH、TSH、LH染色弱阳性,胞质内的颗粒成份为密集肿胀变形的线粒体.结论 神经垂体肿瘤包括沿垂体柄向上移行生长的垂体腺瘤和原发于神经垂体部位的肿瘤.颗粒细胞肿瘤可能是胶质细胞来源的肿瘤,多局限于垂体后叶和垂体柄.神经垂体肿瘤的MRI特征性表现有助于临床诊断.经鼻经蝶入路手术和立体定向放射外科治疗是目前较理想的治疗方法.

Tumor in stalk and neurohypophysis

Objective To investigate and further elucidate the image feature, neuropathological observations and therapeutic methods of the tumor in stalk and neurohypophysis. Methods Clinical information and image manifestation of 11 patients with the tumor in stalk and neuropophysis were analyzed retrospectively. Results The tumor in stalk and neuropephysis was revealed most often as a tiny or small lesion localized in pituitary posterior lobe and stalk. The tumor developed into suprasellar region along stalk and formed a mass lesion were also found occasionally. Involvement in pituitary anterior lobe was not observed. MRI examination demonstrated that the tumor lesion showed isosignal in Tl W and iso- or high signal in T2W; the lesion could be enhanced by Gd-DTPA injection and showed a high signal, which was somewhat lower than that of normal pituitary tissue. Abundant autophagic vacuoles, lysosome and count numbers of intermediate filament in cytoplasm of pituitary granular cell tumor was observed under transmission electric microscopy accorded evidently with the cytoplasmic granulars under light microscopy and weaken positive GFAP stain revealed by immunohistochemistry. Rich swelled mitochondria under transmission electric microscopy was accordingly regarded as cytoplasmic granulars in pituitary oxyphilic granular cell adenoma under light microscopy. FSH, TSH and LH stains were weaken positive by immunohistochemistry. Condusion Tumor in stalk and neurohypophysis includes both of migrated along stalk or developed primarily. Pituitary granular cell tumor may originate from glial cells and localized mainly in pituitary posterior lobe and stalk. Specific characteristics on MRI may be conducive to the correct diagnosis. Transsphynoidal approach surgery and stereotactic radiosurgery may be the rational choice for the treatment.