2例腺垂体梭形细胞嗜酸细胞瘤临床病理观察及文献复习

Clinicopathological Observation and Literature Review of Two Cases with Spindle Cell Oncocytoma of Adenohypophysis

目的探讨腺垂体梭形细胞嗜酸细胞瘤(spindle cell oncocytoma,SCO)的临床病理特征、鉴别诊断及免疫组织化学指标的表达情况。方法对2例鞍区腺垂体SCO的临床表现、影像学特征、组织形态学及免疫表型进行分析,并复习相关文献。结果光镜下梭形肿瘤细胞呈束状排列,细胞质丰富,嗜酸性,其中夹杂少许上皮样细胞。免疫组织化学染色显示波形蛋白(vimentin)、S-100、甲状腺转录因子1(thyroid transcription factor-1,TTF-1)及上皮细胞膜抗原(epithelial membrane antigen,EMA)阳性。广谱细胞角蛋白(pan-cytokeritin,PCK)、B细胞白血病/淋巴瘤2基因(B-cell leukemia/lymphoma 2 gene,Bcl-2)、结蛋白(desmin)、神经元特异性核蛋白(neuron specific nuclear protein,NeuN)、促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)、生长激素(growth hormone,GH)、促卵泡生成激素(follicle-stimulating hormone,FSH)、催乳素(prolactin,PRL)、促甲状腺激素(throid stimulating hormone,TSH)、黄体生成激素(luteinizing hormone,LH)、平滑肌肌动蛋白(smooth muscle actin,SMA)、巢蛋白(nestin)均阴性,其中1病例白细胞分化抗原99(cluster of differentiation 99,CD 99)重组蛋白阳性。结论 SCO临床及影像学表现均无特异性,术前诊断比较困难,诊断主要依靠光镜下所见结合免疫组织化学。

Objective To study the clinicopathological features,differential diagnosis and the expression of immunohistological of spindle cell oncocytoma(SCO)of adenohypophysis.Methods The clinic manifestations,radiologic and histopathological features,and immunohistochemistry were analyzed in two cases of SCO of the adenohypophysis,and the related literatures were reviewed.Results The light microscope examination revealed spindle tumor cells were arranged in bundles with abundant cytoplasm,eosinophilic,and a few epithelioid cells.Immunohistochemistry showed that vimentin,S-100,thyroid transcription factor-1(TTF-1)and epithelial membrane antigen(EMA)were positive,while the pan-cytokeritin(PCK),B-cell leukemia/lymphoma 2 gene(Bcl-2),desmin,neuron-specific nuclear protein(Neun),adrenocorticotropic hormone(ACTH),growth hormone(GH),follicle-stimulating hormone(FSH),prolactin(PRL),throid stimulating hormone(TSH),luteinizing hormone(LH),smooth muscle actin(SMA),nestin were all negative,and 1 case of cluster of differentiation 99(CD 99)was positive.Conclusion There are no evident features in clinic and radiology for SCO,resulting in diagnostic difficulties before operation.Therefore,light microscope combine with immunohistochemical features may help for correct diagnosis.