垂体腺瘤放射治疗后继发鞍区纤维肉瘤1例并文献复习

目的探讨垂体腺瘤放射治疗后继发鞍区纤维肉瘤的临床及病理学特点。方法对1例垂体腺瘤手术加放射治疗后8年继发纤维肉瘤患者的临床及病理学特点进行分析,并结合文献复习进行讨论。结果继发肿瘤经蝶窦手术切除,术后病理学检测证实为高分化纤维肉瘤(NCI分级Ⅰ级)。术后患者临床症状得到显著缓解,但1年后复发,病理类型为低分化纤维肉瘤(NCI分级Ⅲ级),恶性度升高。免疫组化结果示肿瘤细胞Vimentin(+),pan-CK(-),S-100(-),SMA(-),GFAP(-),CD117(-),GH(-),PRL(-),LH(-),FSH(-),TSH(-),ACTH(-)。结论垂体腺瘤放射治疗后可继发鞍区纤维肉瘤,但比较罕见,诊断须有严格的标准。接受过放射治疗的患者若突然出现新的临床症状或影像学提示有颅内占位时需考虑放射治疗后继发肿瘤的可能。继发肿瘤易复发,预后较差。

Fibrosarcoma Caused by Postoperative Radiotherapy for a Pituitary Adenoma Report of a Case and Review of the Literature

Objective To study the clinical and histological characteristics of fibrosarcoma caused by postoperative radiotherapy for pituitary adenoma. Methods We analyzed a case of post-irradiation fibrosarcoma 8 years after surgery followed by irradiation for pituitary adenoma. Results The patient underwent transsphenoidal resection of the recurrent tumor. This led to significant relief in the patient's symptoms, but the tumor recrudescent a year later original. Humor was histologically verified to be a well differentiated fibrosarcoma(NCI grading system Ⅰ). The recrudescenttumor had high grade characteristics as a poorly differentiated fibrosarcoma(NCI grading system Ⅲ). The tumor cells responded positively in response to immunohistochemical staining for vimentin, but negatively for pan-CK, S-100, SMA, GFAP(-), CD117, GH, PRL, LH, FSH, TSH, ACTH. Conclusion Radiotherapy for pituitary adenomas can rarely induce fibrosarcomas. They should be suspected in patients following sellar irradiation who show abrupt new symptoms and has appropriate radiological findings. The secondary tumors are easy to regrow and the prognosis is poor.