垂体细胞瘤21例临床病理学特征

Pituicytoma:a clinicopathological analysis of twenty-one cases

目的探讨垂体细胞瘤的临床病理学特征及诊治要点。方法收集南京医科大学第一附属医院及东部战区总医院2009—2020年诊治的21例垂体细胞瘤患者资料,分析21例患者的临床资料、影像学、形态学及免疫组织化学结果,并结合文献进行分析。结果21例垂体细胞瘤中男性8例,女性13例;年龄4~68岁。所有患者均行手术治疗。镜下见肿瘤组织由排列呈束状或席纹状的细长双极梭形细胞构成,核分裂象罕见。肿瘤细胞一致表达S-100蛋白(21/21)、波形蛋白(15/15)、甲状腺转录因子1(14/14);胶质纤维酸性蛋白(13/16)及上皮细胞膜抗原(6/12)呈灶性或弱阳性表达;广谱细胞角蛋白均阴性,Ki-67阳性指数均小于5%。18例获随访资料患者均存活,2例术后复发。结论垂体细胞瘤是一种罕见的鞍区低级别胶质肿瘤,易与其他鞍区肿瘤混淆,术前诊断困难,需依靠组织病理及免疫组织化学确诊,显微手术是目前主要的治疗方法。

Objective To investigate the clinicopathological features and treatment strategies of pituicytoma.Methods Twenty-one cases of pituicytoma were collected at the First Affiliated Hospital of Nanjing Medical University and Jinling Hospital,Nanjing,China from 2009 to 2020.The clinical data of 21 pituicytoma patients was retrospectively analyzed,and the relevant literature was reviewed.Results Twenty-one patients aged 4 to 68 years,including 8 males and 13 females.All patients underwent surgical treatment.Histologically,the tumor was consisted almost entirely of elongate,bipolar spindle cells arranged in a fascicular or storiform pattern.Mitotic figures were rare.Immunohistochemically,tumor cells were diffusely positive for S-100 protein(21/21),vimentin(15/15)and TTF1(14/14),while they were weakly or focally positive for GFAP(13/16)and EMA(6/12).CKpan was negative in all cases and Ki-67 proliferation index was low(<5%).Among the 18 patients with follow-up,all survived and 2 relapsed after surgery.Conclusions Pituicytoma is a rare low-grade glioma of the sellar area.It is easily confused with other sellar tumors.Preoperative diagnosis is difficult.It needs to be confirmed by histopathology and immunohistochemistry.Microsurgery is the main treatment method at present.