166例无功能性垂体腺瘤的临床特征及病理分型分析  

Clinical and pathological features of 166 patients with nonfunctioning pituitary adenomas

作　　者：王林杰 段炼 阳洪波 潘慧 幸兵[2] 姚勇[2] 邓侃[2] 朱惠娟 Wang Linjie;Duan Lian;Yang Hongbo;Pan Hui;Xing Bing;Yao Yong;Deng Kan;Zhu Huijuan(Department of Endocrinology,Key Laboratory of Endocrinology of National Health Commission,the Translational Medicine Center of PUMCH,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China;Department of Neurosurgery,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院内分泌科,国家卫生健康委员会内分泌重点实验室,协和转化医学中心,100730 [2]中国医学科学院,北京协和医学院,北京协和医院神经外科100730

出　　处：《中华内分泌代谢杂志》2020年第10期861-865,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：中国医学科学院医学与健康科技创新工程项目(2016-I2M-1-002、2017-I2M-1-011)。

摘　　要：目的探讨单中心经手术治疗的无功能性垂体腺瘤(NFPAs)的临床特征及依据2017版世界卫生组织病理分类的分型特征。方法回顾性分析2019年4月至2020年1月北京协和医院166例临床诊断NFPAs的临床及病理特征。结果在166例患者中,男女比例相当(1.05∶1),接受手术的平均年龄为(49.9±12.3)岁,显著高于同期的功能性垂体瘤患者。就诊首要原因以头痛、视力下降、视野缺损最为常见。肿瘤最大径均超过10 mm,巨大肿瘤15例(9.0%)。复发病例18例(10.8%)。结合垂体前叶激素及转录因子免疫组化结果进行病理分型,最常见类型为促性腺激素细胞腺瘤(50.6%),其次为ACTH细胞腺瘤(24.7%)、多激素细胞腺瘤(11.4%)、嗜酸细胞系来源肿瘤(6.6%)及零细胞腺瘤(6.6%)。促性腺激素细胞腺瘤中男性更为多见(男∶女=4.1∶1),ACTH细胞腺瘤中则以女性为主(男∶女=1∶12.7)。促性腺激素细胞腺瘤平均年龄最高,而嗜酸细胞系来源腺瘤及不常见免疫组化阳性组合多激素细胞腺瘤平均年龄则显著低于前者。不同病理类型间在肿瘤平均最大径、巨大腺瘤占比及复发病例占比上差异无统计学意义。但嗜酸细胞系来源腺瘤的Ki-67指数显著高于其他各组(P=0.001)。结论经手术治疗的NFPAs虽临床表现类似,但病理分型上男性以促性腺激素细胞腺瘤为主,女性则以ACTH细胞腺瘤更为常见。不同病理类型腺瘤间可能存在预后差异。Objective To investigate the clinical features and pathological classification of patients with nonfunctional pituitary adenomas(NFPAs)in single medical center according to 2017 World Health Organization.Methods The clinical and pathological characteristics of 166 patients with NFPAs diagnosed by neurosurgery in Peking Union Medical College Hospital from April 2019 to January 2020 were analyzed retrospectively.Results In 166 patients,the ratio of male to female was almost equal(1.05∶1).Their average operation age was(49.9±12.3)years,which was significantly higher than that of functional pituitary tumor patients in the same period.Headache,visual acuity decline,and visual field defect were the most common causes for the first visit.All the maximum diameter of tumors was more than 10 mm,and 15 cases(9.0%)were giant tumors.18 patients(10.8%)were recurrent cases.According to the results of immunohistochemistry for anterior pituitary hormones and transcriptional factors,the most common pathological type was gonadotroph adenomas(50.6%),followed by corticotroph adenomas(24.7%),plurihormonal pituitary adenomas(11.4%),PIT-1-positive adenomas(6.6%),and null cell adenomas(6.6%).Gonadotroph adenomas were more common in men(male∶female ratio=4.1∶1),while corticotroph adenomas occurred mainly in women(male∶female ratio=1∶12.7).The average age of patients with gonadotroph adenomas was the highest,while those of patients with PIT1-positive adenomas and rare combining IHC plurihormonal pituitary adenoma were significantly lower than that of the former.There were no significant differences in the mean diameters of tumors,the proportion of giant adenomas,and recurrent cases among different pathological types of tumors.However,the mean Ki-67 index of PIT-1-positive adenomas was significantly higher than those of other groups(P=0.001).Conclusion Although the clinical manifestations of NFPAs were similar,their pathological classifications were different.Gonadotroph adenomas occurs mainly in male patients while corticotroph

关 键 词：无功能垂体腺瘤 疾病特征 病理分型 

分 类 号：R736.4[医药卫生—肿瘤]