2276例不同激素类型垂体腺瘤的临床及病理特点分析  

Clinicopathologic features of 2276 cases of pituitary adenomas of different types

作　　者：赵昭[1] 金树梅[2] 张学斌[2] 唐帆[2] 闫学江[3] 薛凯[3] 阎晓玲[2] 姚鑫[3] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市环湖医院病理科,300060 [3]天津市环湖医院神经外科,300060

出　　处：《中华神经医学杂志》2015年第10期1031-1037,共7页Chinese Journal of Neuromedicine

摘　　要：目的分析不同激素类型垂体腺瘤的临床及病理学特点。方法收集天津市环湖医院神经外科自1997年1月至2013年12月手术切除并经病理确诊的垂体腺瘤患者2276例．其中生长激素（GH）腺瘤181例、泌乳激素（aRE）腺瘤391例、泌乳生长激素（GI-VPRE）腺瘤75例、促肾上腺皮质激素（ACTH）腺瘤68例、促甲状腺激素（TsH）腺瘤32例、促性腺激素（FSH/LH）腺瘤493例、零细胞（NULL）腺瘤866例、多激素腺瘤170例，回顾性分析不同激素类型垂体腺瘤患者的临床资料，比较侵袭性垂体腺瘤与非侵袭性垂体腺瘤患者ki-67指数、卒中发生率的差异。结果本组患者压迫症状发生率为79．5％，包括头痛头晕、视力视野改变以及多饮多尿等，多发于NULL、FSH／LH、TSH、ACTH腺瘤。内分泌症状发生率为26．8％，包括肢端肥大、闭经泌乳、库欣综合征等，其中GH、PRL腺瘤患者多伴有内分泌症状；不同激素类型垂体腺瘤中，PRL腺瘤和GH／PRL腺瘤患者ki-67指数较高。PRL、ACTH及NULL腺瘤患者中侵袭性垂体腺瘤发生率较高。侵袭性与非侵袭性垂体腺瘤ki．67指数（2．4±2．2vs2．1±2．0）比较差异无统计学意义（P〉0．05）。侵袭性与非侵袭性垂体腺瘤患者卒中发生率（9．4％vs9-3％）差异无统计学意义（P〉0．05）。结论不同激素类型垂体腺瘤患者的临床表现多样，与病理分型并非一一对应的关系。侵袭性与非侵袭性垂体腺瘤的增殖、卒中特性并无差异。Objective To analyze the clinical and pathological features of pituitary adenomas of different types. Methods The clinical data of 2276 patients with pituitary adenomas, surgically resected and conformed by pathology in our hospital from January 1997 to December 2013, were collected. In these patients, 181 were growth hormone （GH） adenomas, 391 were prolactin （PRL） adenomas, 75 were GH/PRL adenomas, 68 were adrenocorticotropic hormone （ACTH） adenomas, 32 were thyrotropic hormone （TSH） adenomas, 493 were follicle-stimulating hormone/luteinizing hormone （FSH/LH） adenomas, 866 were NULL cell adenomas, and 170 were plurihormonal adenomas; the clinicopathologic characteristics of these patients were retrospectively analyzed; the ki-67 index and incidence of stroke were compared between invasive pituitary adenomas and non-invasive pituitary adenomas. Results The percentage of patients with symptoms caused by mass effects （headaches, nausea/vomiting, vision loss, visual field defects and polydipsia polyuria） and hormone abnormality （acromegaly, amenorrhea, galactorrhea and Cushing syndrome） were 79.5% and 26.8%, respectively; endocrine symptoms were common in GH adenomas and PRL adenomas. PRL adenomas, ACTH adenomas and null cell adenomas had higher incidence of invasion among different types of pituitary adenomas. The ki-67 index was not statistically significant between invasive and non-invasive adenomas（2.4±2.2 vs. 2.1 ±2.0,P〉0.05）. The incidence of stroke was not statistically significant between invasive and non-invasive adenomas （9.4% vs. 9.3%, P〉0.05）. Conclusion Pituitary adenomas of different types have different clinical manifestations, and the clinical manifestations and pathological classification is not a one-to-one relationship; the proliferation and apoplexy features in invasive and non-invasive adenomas are not different.

关 键 词：垂体腺瘤 免疫组织化学染色 侵袭性 垂体卒中 

分 类 号：R736.4[医药卫生—肿瘤]