摘要
目的:探讨高风险垂体腺瘤的临床病理特征及诊断要点。方法:选取2017年6月至2020年9月北京大学国际医院收治的24例高风险垂体腺瘤患者,进行形态学观察、免疫组织化学染色及基因检测,同时收集患者的临床资料并进行随访,综合分析病理特点与临床特征的相互关系。结果:24例高风险垂体腺瘤中男性14例,女性10例,发病年龄28~68岁,平均年龄45.4岁,临床表现为鞍区占位或激素分泌异常的症状。肿瘤最大径0.7~4.8 cm,影像学提示侵袭性腺瘤12例。根据固有激素、转录因子和低分子量角蛋白的免疫组织化学染色特点,结合临床症状及血清激素水平进行诊断,其中稀疏颗粒型生长激素细胞腺瘤4例,沉默性促肾上腺皮质激素细胞腺瘤12例,男性泌乳激素细胞大腺瘤6例,多激素PIT-1阳性腺瘤2例。基因检测1例存在GNAS基因突变。14例获得随访资料,2例复发(其中1例因肿瘤复发死亡)。结论:高风险垂体腺瘤的诊断应该结合免疫组织化学、血清激素水平及临床症状综合分析,并且需要提示临床复发和进展的风险。
Objective:To investigate the clinicopathological features and diagnosis of high-risk pituitary adenomas.Methods:From June 2017 to September 2020,the clinicopathological and follow-up data of 24 patients diagnosed with high-risk pituitary adenomas from Peking University International Hospital were collected,and morphological observation,immunohistochemical(IHC)staining,and sequencing were performed.Results:Of the enrolled patients,14 were male and 10 were female,with an onset age ranging from 28 to 68 years and a median age of 45.4 years.Clinically,mass effects and symptoms caused by inappropriate hormone secretion were commonly presented.Tumor size ranged from 0.7 cm to 4.8 cm;12 cases were invasive adenoma according to maging examinations.Tumor type was determined by IHC staining combined with serum hormone level and clinical features.Four cases were diagnosed as sparsely granulated somatotroph adenomas,12 were silent corticotroph adenomas,6 were lactotroph macroadenomas in men,and 2 were plurihormonal PIT-1 positive adenomas.One case had GNAS mutation.Follow-up data were available for 14 patients,of whom 2 developed local recurrence and one died.Conclusions:The exact diagnosis of high-risk pituitary adenoma should be based on IHC,serum hormone level assessment,and clinical symptoms.The risk of recurrence and more-aggressive behaviour should be considered by surgeons and patients.
作者
张铭
钟延丰
朱晓云
张恩龙
王丽华
饶晓松
Ming Zhang;Yanfeng Zhong;Xiaoyun Zhu;Enlong Zhang;Lihua Wang;Xiaosong Rao(Department of Pathology,Peking University International Hospital,Beijing 102206,China;Department of Pathology,Peking University Health Science Center,Beijing 100191,China;Department of Radiology,Peking University International Hospital,Beijing 102206,China)
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2021年第15期777-781,共5页
Chinese Journal of Clinical Oncology
关键词
高风险
垂体腺瘤
激素
转录因子
侵袭性
high-risk
pituitary adenoma
hormone
transcription factor
aggressive
