垂体腺瘤209例临床病理学分析

目的:探讨垂体腺瘤临床表现与病理学之间的关系,以期为临床诊断和选择治疗方法提供参考.方法:回顾性分析1990年3月至2002年12月209例经手术切除的垂体腺瘤临床病理学资料(包括常规病理和免疫组化).其中8例另行胶体金标记免疫电镜观察.结果:本组临床表现为内分泌症状113例(54.1％),其发生率免疫组化检测阳性组[60.1％(95/158)]明显高于阴性组[35.3％(18/51)](P<0.01).内分泌症状与激素检测相符合者87例(77.0％).免疫组化分类中垂体单激素腺瘤55例(26.3％),以PRL和GH腺瘤多见;垂体多激素腺瘤103例(49.2％),以GH-PRL腺瘤最多见.多激素腺瘤患者表现为一种内分泌症状者50例(48.5％),表现为两种不同症状者7例(6.8％).1例免疫组化阴性结果的垂体腺瘤分泌颗粒中见有胶体金颗粒.结论:垂体腺瘤的免疫组化检测能很好地与临床表现相联系,可作为功能性垂体腺瘤病理诊断的主要手段.免疫电镜能够在超微结构水平对垂体激素进行定位,具有潜在的临床应用价值.

Clinicopathologic analysis of 209 cases of pituitary adenomas

Objective:To study the relationship between the clinical manifestations and pathology in patients with pituitary adenomas, providing references for the diagnosis and treatment. Methods: The routine pathology and immunohistochemistry methods were used to analyze 209 patients received pituitary adenoma resection. Colloidal gold double labeled immunocytochemistry was done in 8 patients. Results: Hormonal symptom was found in 133(54.1%) patients, and it occurred more frequently in immunopositive group[60.1% (95/158)] than in immunonegative group[35.3%(18/51)]( P <0.01). The coincidence of hormonal symptoms and hormonal test was 77.0%(87/133). Immunohistochemistry found there were 55 (26.3%) patients with single hormonal pituitary adenomas(mainly PRL and GH), 103 with plurihormonal pituitary adenomas(mainly GH PRL). Fifty(48.5%) patients with plurihormonal pituitary adenomas had symptoms of one hormone and 7(6.7%) had symptoms of 2 hormones. One patients with negative immunohistochemistry result showed colloidal gold granules. Conclusion: There is an obvious relationship between the immunohistochemistry and clinical manifestations in patients with pituitary adenomas, which may contribute to the diagnosis of pituitary adenomas, especially secreting ones. Immunoelectron microscopy is promising in clinical application.