基于WHO新分类的垂体腺瘤诊断及临床病理分析

Diagnosis,clinical and pathological analysis of pituitary adenomas based on the new World Health Organization classification

目的探讨基于新分类的垂体腺瘤的病理诊断现状,并分析其临床病理学特征。方法回顾性分析了134例垂体腺瘤病例的临床及影像学资料、病理形态学及免疫组织化学染色结果。结果 134例垂体腺瘤患者中男性74例,女性60例,中位年龄51岁。其中24.6%(33例)的病例为功能性垂体腺瘤,患者表现出肢端肥大、泌乳或激素水平异常等功能性表现。75.4%(101例)的静止性垂体腺瘤临床表现主要为压迫症状。影像学提示微腺瘤7例,大腺瘤120例,巨大腺瘤7例。依据2017版世界卫生组织(World Health Organization,WHO)垂体腺瘤分类,其中促性腺激素细胞腺瘤68例(50.7%),促肾上腺皮质激素细胞腺瘤25例(18.7%),生长激素细胞腺瘤17例(12.7%),泌乳激素细胞腺瘤11例(8.2%),静止性Pit-1阳性垂体腺瘤4例(3.1%),双激素细胞腺瘤3例(2.2%),多激素细胞腺瘤3例(2.2%),零细胞腺瘤2例(1.5%),促甲状腺激素细胞腺瘤1例(0.7%)。本研究中共有13例高风险垂体腺瘤,其中稀疏颗粒型生长激素细胞腺瘤2例、男性泌乳激素细胞大腺瘤6例、静止性促肾上腺皮质激素细胞腺瘤2例及多激素Pit-1阳性腺瘤3例。结论新的分类系统根据转录因子的不同将垂体腺瘤进行了更为科学的分类,能够更好地反映肿瘤特征及提示预后。

Objective To analyze the diagnosis,clinical and pathological characteristic and to investigate the value of the new World Health Organization(WHO)classification of pituitary adenomas.Method The clinical features of 134 cases diagnosed as pituitary adenomas were retrospectively reviewed.The characteristic of morphology and the result of immunohistochemical expression were analyzed.Results The study population was composed of 134 patients(74 male and 60 female)and the median age was 51.Totally 24.6%of all pituitary adenomas were functional or hormone-secreting,while the remaining 75.4%were non-functional present with symptoms related to local mass effects.The imaging showed 7 cases with microadenomas,120 cases with macroadenomas and 7 cases with giant adenomas.According to the 2017 WHO classification of pituitary adenomas,there were 68(50.7%)gonadotroph adenomas,25(18.7%)corticotroph adenomas,17(12.7%)somatotroph adenomas,11(8.2%)lactotroph adenomas,4(3.1%)silent Pit-1 positive pituitary adenomas,3(2.2%)plurihormonal adenomas,3(2.2%)double adenmoas,2(1.5%)null cell adenomas,and 1(0.7%)thyrotroph adenomas.This classification also recognizes some subtypes of pituitary adenomas as high-risk pituitary adenomas,which include 2 sparsely granulated somatotroph adenoma,6 lactotroph adenoma in men,2 silent corticotroph adenoma,and 3 newly introduced plurihormonal Pit-1-positive adenoma.Conclusion According to the different transcription factor,the new classification of pituitary adenomas was of important effect and significance to the clinical diagnosis and treatment.