垂体腺瘤对鞍底硬膜影响的形态学研究

Pathomorphological study on effects of pituitary adenoma on seila floor＇s dura

目的从病理形态学角度研究垂体腺瘤对鞍底硬膜的影响。方法选取侵袭性垂体腺瘤患者20例，均行经单鼻孔蝶窦入路进行术中取“膜＋瘤”标本，常规染色，显微镜下观察。结果肿瘤均一期满意切除，临床症状改善或保持稳定者18例。术后影像学复查受肿瘤压迫的瘤周结构明确复位的有11例。无死亡病例；术后无脑脊液漏，脑膜炎或视力恶化发生。18例取材标本符合实验要求，通过倒置显微镜下阅片发现，18例均能见到垂体囊，但厚度不一，平均厚度均小于正常垂体囊厚度。2例垂体囊发现疑似肿瘤细胞，但垂体囊完整，未见疑似瘤细胞突破垂体囊；所有病例硬膜完整，未见肿瘤细胞浸润；垂体囊与硬膜之间的间隙（囊膜间隙）可辩者有12例，但此间隙显微镜下观察大小不一，其余囊膜间隙有部分难辩。结论侵袭性垂体腺瘤肿瘤周边膜性层次仍然存在，传统意义的“侵袭”概念并不准确；垂体囊内可见疑似瘤细胞可能是目前造成侵袭性误判的主要原因。

Objective To explore the influence of pituitary adenoma on sella floor＇ s dura. Methods According to Hardy - Wilson and Knosp＇s diagnostic criteria, 20 patients suffering from invasive pituitary adenoma （IPA） were selected and accepted transsphenoidal operation, from which pathological samples were acquired intraoperativly, and each one consisted of dura plus tumor tissue. All samples were conventionally fixed, embeded, sliced and stained through H. E and Massion＇ s trichrome stain technique. Then the samples were put under Olympus - DP70 inverted microscope to observe, record and take a photo of the relations between dura and tumor tissue and between tumor tissue and pituitary capsule. Results All tumors were removed in the content technique during the fist operation. After opteration, 18 cases got better recovery or kept the same as the symptoms before operation. There are no patients dead and there are not complications such as cerebrospinal rhinorrhea , meningitis and visual deterioration. In MRI after operation, strcutures went back to normal place in 11 cases. 18 pathological samples were successfully acquired intraoperativly. Under Olympus - DP70 inverted microscope, it was found that the relation beween dura and tumor isn＇ t invasive one, because there aren＇ t tumor cells in dura and the dura is undamaged. However, pituitary capsules could be observed in 1 lcases, of which, six capsules were complete, and one was imcomplete. Moreover, the gap between pituitary and dura could be observed in 9 cases, which did not have the same width. Conclusions The membrane structures around pituitary adenoma are still exist, which suggests that traditional concept of IPA is not precise. It might be the key factor to misdiagnose IPA that there are few tumor cells in pituitary capsules.