蝶窦垂体腺瘤的临床病理学观察

Clinicopathologic features of sphenoid sinus pituitary adenoma

目的探讨蝶窦垂体腺瘤（sphenoid sinus pituitary adenoma，SSPA）的临床病理特征，提高对蝶窦垂体腺瘤的认识和病理诊断水平。方法对12例SSPA进行临床、组织病理学和SP法免疫组化染色（PRL、hGH、ACTH、LH、TSH、FSH等）。结果12例SSPA，男5例，女7例，年龄39～66岁，平均48．4岁，中位年龄55.5岁。其中原发于蝶窦和原发于垂体窝侵至蝶窦者各6例，原发于蝶窦者年龄较原发于垂体窝者偏大。临床症状多样。镜下，原发于蝶窦的垂体腺瘤的形态学与蝶鞍垂体腺瘤相同；SSPA可伴有较明显的慢性炎症细胞浸润（2／12，16、67％）。10例行免疫组织化学染色的结果，瘤细胞PRL阳性6例；瘤细胞各项标记物均阴性2例；瘤细胞ACTH阳性、hGH阳性各1例。结论原发于蝶窦的垂体腺瘤比较少见，主要根据光镜及免疫组化确诊，应注意与慢性蝶窦炎和浆细胞瘤鉴别。

Purpose To study the clinicopathologic features of sphenoid sinus pituitary adenoma （SSPA） to improve the cognition and diagnostic level of this tumor. Methods 12 cases of SSPA were observed with their clinical findings and histopathology,in which immunohistochemical staining for PRL, hGH, ACTH, LH, TSH and FSH was performed in 10 cases. Results 5 of the patients with SSPA were male and 7 were female. The age of the patients ranged from 39 to 66 years （ mean age = 48. 4, median age = 55.5 ）. 6 cases derived from sphenoid sinus and 6 from pituitary fossa that invaded into sphenoid sinus. The age of the patients of sphenoid sinus genesis was older than the patients of pituitary fossa genesis. Clinical symptoms were variable. Histopathologically, the morphology was identical between pituitary adenoma derived from sphenoid sinus and that from pituitary fossa. SSPA might show a great deal of chronic inflammatory cell infiltration. Immunohistochemically, 6 of 12 cases of SSPA were positive only for PRL, other antibodies were negative in 2 cases, and in the rest 2 cases were positive for ACTH and hGH respectively. Conclusions Sphenoid sinus pituitary adenoma is rare and can be misdiagnosed as sphenoiditis or plasmocytoma. The diagnosis is dependent on histopathologic analysis and immunohistochemical staining.