Relationship Between Histopathology and Clinical Prognosis of Invasive Pituitary Adenoma

Objective: To study the relationship between histopathology and clinical prognosis of invasive pituitary adenoma subjected to transsphenoidal surgery. Methods: The enrolled were 82 patients with invasive pituitary adenomas undergoing transsphenoidal surgery during Jan. 2000 - May 2003 in our department with full MR imaging findings, pathology data and follow-up information. The follow-up duration was 5-30 months. Results: MR imaging findings of invasive pituitary adenoma included: depression of the sellar floor, involvement of sphenoid sinus and cavernous sinus, breakthrough of diaphragma sellae, encasement of internal carotid artery, etc. Pathological examination revealed that the invasion rate of dura in sella turcica was the highest among the structures around tumor. Pituitary adenoma apoplexy was found in 20 cases (24.4%). The total removal rate for PRL-secreting adenomas was significantly lower than that for non-secreting adenomas (P<0.01), but non-, GH-, ACTH-secreting adenomas had no significant differences. The recurrence rate of PRL-secreting adenomas was higher than that of non- and GH-secreting adenomas (P<0.05). Conclusion: Among invasive pituitary adenomas, the therapeutic effects of non-and GH-secreting pituitary adenomas are better than that of PRL-secreting adenomas. Invasive biological behaviors of invasive pituitary adenomas result in radical operation failure and postoperative recurrence.

Study on the Expression Levels of CXCR4, CXCL12, CD44, and CD147 and Their Potential Correlation with Invasive Behaviors of Pituitary Adenomas

Objective To evaluate the factors of CXCR4, CXCL12, CD44, and CD147 as early potential diagnostic biomarkers by determining their expression levels in invasive and non-invasive pituitary adenomas. Methods Fresh pituitary adenoma specimens were collected from 35 pituitary adenoma （21 invasive and 14 non-invasive） patients who underwent surgical treatment in our Neurosurgery Department between January and April of 2009. The expression levels of CXCR4, CXCL12, CD44, and CD147 were evaluated firstly by flow cytometry, fluorescence microscopy in single cell suspensions, and then by immunohistochemical staining of paraffin tissue sections. Results Flow cytometric analyses showed that the percentage of CXCR4- and CXCL12-positive cells from invasive pituitary adenomas （IPA） was significantly higher in the single cell suspensions than that from non-invasive pituitary adenomas （nlPA） （P〈O.05）. Immunohistochemical staining revealed that CXCR4 and CXCL12 staining index scores of the invasive pituitary adenomas were significantly higher than those of the non-invasive pituitary adenomas （P〈O.05）. In contrast, neither flow cytometry nor immunohistochemical staining demonstrated significant difference between CD44 and CD147 expression levels, respectively. Conclusion Expression levels of CXCR4 and CXCL12 are correlated with the invasiveness of pituitary adenomas. Therefore, rather than CD44 and CD147, CXCR4 and CXCL12 may potentially serve as biomarkers for early detection of pituitary adenomas.

Association of Expression of Leucine-rich Repeats and Immunoglobulin-like Domains 2 Gene with Invasiveness of Pituitary Adenoma

The Leucine-rich repeats and immunoglobulin-like domains-2（LRIG2） gene expression in pituitary adenoma and its correlation with tumor invasiveness were studied.The expression of LRIG2 mRNA and protein in human pituitary adenoma obtained surgically was detected by RT-PCR（39 cases） and immunohistochemical staining（30 cases）.It was found that LRIG2 was mostly localized at the nucleus of the pituitary adenoma cells.Its expression was significantly higher in the invasive cases than in the non-invasive cases.LRIG2 protein was positive in 14 cases out of 21 cases of invasive adenoma,but only 2 cases were positive in 9 cases of non-invasive adenoma.The positive expression rate of LRIG2 mRNA was 91.3% in invasive cases（total 23 cases） and 62.5% in non-invasive cases（total 16 cases）,respectively.LRIG2 gene is overexpressed in invasive pituitary adenoma.It may play an important role in pituitary adenoma invasiveness and further studies are necessary to elucidate the mechanism under this phenomenon.

Identification of CDK6 and RHOU in Serum Exosome as Biomarkers for the Invasiveness of Non-functioning Pituitary Adenoma

Objective To explore circulating biomarkers for screening the invasiveness of non-functioning pituitary adenomas(NF-PAs).Methods The exosomal RNAs were extracted from serum of patients with invasive NF-PA(INF-PA)or noninvasive NF-PA(NNF-PA).Droplet digital PCR was adapted to detect the mRNA expression of candidate genes related to tumor progression or invasion,such as cyclin dependent kinase 6(CDK6),ras homolog family member U(RHOU),and spire type actin nucleation factor 2(SPIRE2).Student’s t-test was used to analyze the statistical difference in the mRNA expression of candidate genes between the two groups.Receiver operating characteristic(ROC)curve was used to establish a model for predicting the invasiveness of NF-PAs.The accuracy,sensitivity,specificity and precision of the model were then obtained to evaluate the diagnostic performance.Results CDK6(0.2600±0.0912 vs.0.1789±0.0628,t=3.431,P=0.0013)and RHOU mRNA expressions(0.2696±0.1118 vs.0.1788±0.0857,t=2.946,P=0.0052)were upregulated in INF-PAs patients’serum exosomes as compared to NNF-PAs.For CDK6,the area under the ROC curve(AUC)was 0.772(95%CI:0.600-0.943,P=0.005),the accuracy,sensitivity,specificity and precision were 77.27%,83.33%,75.00%and 55.56%to predict the invasiveness of NF-PAs.For RHOU,the AUC was 0.757(95%CI:0.599-0.915,P=0.007),the accuracy,sensitivity,specificity and precision were 72.73%,83.33%,68.75%and 50.00%.In addition,the mRNA levels of CDK6 and RHOU in serum exosomes were significantly positively correlated(r=0.935,P<0.001).After combination of the cut-off scores of the two genes,the accuracy,sensitivity,specificity and precision were 81.82%,83.33%,81.25%and 62.50%.Conclusions CDK6 and RHOU mRNA in serum exosomes can be used as markers for predicting invasiveness of NF-PAs.Combination of the two genes performs better in distinguishing INF-PAs from NNF-PAs.These results indicate CDK6 and RHOU play important roles in the invasiveness of NF-PAs,and the established diagnostic method is valuable for directing the clinical screening and postoperative treatment.

The Expression of Integrinβ1 and FAK in Pituitary Adenomas and Their Correlation with Invasiveness

The expression and possible role of integrin-focal adhesion kinase signal pathway in invasive pituitary adenomas were explored. Forty-nine human pituitary adenomas were detected for the expression of integrinβ1 （INTβ1） and focal adhesion kinase （FAK） by immunohistochemistry, and their correlation with the invasiveness of pituitary adenomas as well as between themselves was ana- lyzed. The results showed that INTβ1 was expressed in 46 cases （93.9%） and FAK in 36 cases （73.5%）, respectively, and their expression levels were highly correlated with tumor invasiveness, but not with the tumor types. It was suggested that the integrin-focal adhesion kinase signal pathway plays a role in the invasiveness of pituitary adenomas.

Magnetic Resonance Imaging and Biological Markers in Pituitary Adenomas with Invasion of the Cavernous Sinus Space

Objective: To investigate the predictability of MRI and the possiblebiological markers of cavernous sinus invasion of pituitary adenomas associated with fourphenomenas: angiogenesis, cell proliferation, apoptosis and matrix metalloproteinase. Methods: Weevaluated 45 patients with pituitary adenoma according to the MRI, surgical findings and theimmunohistochemistry staining of tumor tissues. Results: The results have shown that the sensitivityof MRI for predicting cavernous sinus invasion in this prospective study was 60%, its specificity85%, its positive predictive value 83.33%, negative predictive value 62.96%. 45 specimens ofpituitary adenomas were analyzed for expression of F8, VEGF, Ki-67, c-myc, Bcl-2, nm23 and MMP-9immunoreactivity using immunoperoxidase staining. MVD was assessed using F8-related antigen. Theresults have shown that MVD of invasive pituitary adenomas was significantly higher than that ofnoninvasive (P 【 0.001). There was an association between the invasion of pituitary adenomas andKi-67 LI (P = 0.039) or the expression of VEGF (P 【 0.001) and MMP-9 (P 【 0.001). But c-myc LI andBcl-2 expression have no association with invasiveness of pituitary adenomas (P = 0.061 versus P =0.201). On the other hand, there is an inverse relationship between nm23 expression and tumorinvasion (P 【 0.001). Conclusion: Parasellar extension of pituitary adenomas through the medial wallof the cavernous sinus is diagnosed at surgery, and with sensitive gadolinium-enhanced MRI, itsextent can be partly determined by radiology. Although our study has shown that MVD and theexpression of VEGF, Ki-67, nm23 and MMP-9 have associations with invasiveness of pituitary adenomas,they are lack of specificity. These markers can only provide some useful information.

MicroRNA-149 Regulates Proliferation,Migration,and Invasion of Pituitary Adenoma Cells by Targeting ADAM12 and MMP14

Objective Pituitary adenomas(PAs)can adapt an aggressive phenotype by invading adjacent brain structures with rapid cellular proliferation.Previous studies demonstrated that excessive expression of metalloproteases ADAM12 and MMP-14 is instrumental for the active proliferation and invasiveness of PA cells in vitro and of tumors in vivo.However,the mechanisms regulating ADAM12 and MMP-14 expression in PAs remain unclear.Methods Target gene prediction and transcriptomic profiling of invasive vs.noninvasive human PA samples were performed to identify miRNA species potentially involved in the regulation of ADAM12 and MMP14.For cellular analyses of miRNA functions,two mouse PA cell lines(AtT20 and TtT/GF)were transfected with miR-149-3p and miR-149-5p,respectively.The effects of miR-149(3p and 5p)on expression levels of ADAM12 and MMP14 were determined by Western blotting followed by an analysis of proliferation and colony formation assays,scratch migration assays,and invasion assays.Results A significant downregulation of miRNA-149 was observed in invasive vs.noninvasive PA(0.32 vs.0.09,P<0.0001).In AtT-20 and TtT/GF mouse PAs cells,transfection of mimic miRNA-149(3p and 5p)caused a significantly reduced cell proliferation and matrigel invasion,whilst the effect on cell migration was less pronounced.Both strands of miRNA-149(3p and 5p)markedly reduced protein levels of ADAM12 and MMP-14 by at least 40%in both cell lines.Conclusion This study proved that the invasiveness of PA cells is,at least partly,regulated by miRNA-149-dependent expression of ADAM12 and MMP-14.

CD87-targeted BiTE and CAR-T cells potently inhibit invasive nonfunctional pituitary adenomas

Recently,bispecific T-cell engagers(BiTEs)and chimeric antigen receptor-modified T cells(CAR-Ts)have been shown to have high therapeutic efficacy in hematological tumors.CD87 is highly expressed in solid tumors with an oncogenic function.To assess their cytotoxic effects on invasive nonfunctioning pituitary adenomas(iNFPAs),we first examined CD87 expression and its effects on the metabolism of iNFPA cells.We generated CD87-specific BiTE and CAR/IL-12 T cells,and their cytotoxic effects on iNFPAs cells and in mouse models were determined.CD87 had high expression in i NFPA tissue and cell samples but was undetected in noncancerous brain samples.CD87×CD3 BiTE and CD87 CAR/IL-12 T-cells showed antigenic specificity and exerted satisfactory cytotoxic effects,decreasing tumor cell proliferation in vitro and reducing existing tumors in experimental mice.Overall,the above findings suggest that CD87 is a promising target for the immunotherapeutic management of iNFPAs using anti-CD87 BiTE and CD87-specific CAR/IL-12 T cells.

Expression of second mitochondria-derived activator of caspases, X-linked inhibitor of apoptosis protein, and caspase-3 in pituitary adenomas

Studies concerning correlations between pituitary adenomas and cell apoptosis have mainly focused on upstream apoptosis signaling, but seldom on downstream mediators. In the present study, second mitochondria-derived activator of caspases （Smac）, X-linked inhibitor of apoptosis protein （XIAP）, and caspase-3 protein were qualitatively analyzed using immunohistochemistry, and quantified by western blot. Smac, XIAP, and caspase-3 mRNA expressions were detected by reverse transcription-PCR. Results showed that XIAP protein and mRNA expressions were greater in the invasive pituitary adenoma group compared with the noninvasive pituitary adenoma group. However, Smac and caspase-3 protein and mRNA expressions were lower in the invasive pituitary adenoma group compared with the noninvasive pituitary adenoma group. In the invasive pituitary adenomas, Smac expression was positively correlated with caspase-3 protein and mRNA expression （Protein： r = 0.55, P 0.01; mRNA： r = 0.50, P 0.01）. Smac and caspase-3 expressions were negatively correlated with XIAP protein and mRNA expression （Protein： r = -0.56, -0.64, P 0.01; mRNA： r = -0.69, -0.67, P 0.01）. However, no significant differences in correlation among Smac, XIAP, and caspase-3 were detectable in noninvasive pituitary adenomas. These data indicated that high expression of XIAP and low expression of Smac and caspase-3 suppressed cell apoptosis and led to enhanced invasiveness of pituitary adenomas. Thus, Smac, XIAP, and caspase-3 may be useful markers in determining the invasive behavior of pituitary adenomas.

程序性细胞死亡蛋白配体-1与程序性细胞死亡蛋白配体-1抑制剂在垂体腺瘤中的研究进展

垂体腺瘤是垂体最常见的疾病,侵袭性垂体腺瘤和垂体癌对常规诊疗方式效果欠佳,是目前临床治疗的难点。免疫检查点抑制剂是肿瘤免疫治疗新的选择,在垂体腺瘤中的应用受到关注。程序性细胞死亡蛋白配体-1(PD-L1)/程序性死亡蛋白配体-1抑制剂目前研究得较为广泛,现重点阐述PD-L1/PD-L1抑制剂在侵袭性垂体腺瘤中的最新研究进展,以期为临床相关治疗提供参考。

胰岛素样生长因子-1在脑垂体腺瘤中的表达及临床意义

目的分析垂体腺瘤患者血清中胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)的表达并按照不同标准进行分组比较,探讨IGF-1在垂体腺瘤中的表达及其临床意义。方法选取2019年1月~2021年6月昆明医科大学第二附属医院收治的156例垂体腺瘤作为试验组,选取同期健康体检者22例作为对照组。采用磁微粒化学发光法测定血清IGF-1水平。综合磁共振成像(magnetic resonance imaging,MRI)测量所得最大径与术后肿瘤病理标本所得肿瘤最大径,将试验组按照不同临床特征进行分组,比较各亚组及对照组的IGF-1水平差异。结果生长激素细胞腺瘤、双激素和多激素细胞腺瘤患者IGF-1水平高于对照组及其余类型,差异均有统计学意义(P<0.05);巨腺瘤患者IGF-1水平高于对照组及其余类型,差异有统计学意义(P<0.05);侵袭性垂体腺瘤患者IGF-1水平高于非侵袭性患者及对照组,差异有统计学意义(P<0.05)。Logistic回归分析结果表明,IGF-1水平和肿瘤最大径为垂体腺瘤有侵袭性的危险因素,且IGF-1水平越高、肿瘤最大径越大,侵袭性风险越高;垂体腺瘤患者术后1个月内的IGF-1水平相较于术前有明显降低,差异有统计学意义(P<0.05)。结论IGF-1对不同功能类型垂体腺瘤的鉴别诊断、对垂体腺瘤早期侵袭性判断有一定价值,并有望作为术后随访的一项可信指标。

侵袭性垂体瘤的磁共振研究进展

磁共振平扫和动态增强检查是侵袭性垂体瘤(IPA)患者诊疗和随访的重要和基础工具。标准方案足够评估大多数患者,然而一些先进的磁共振检查技术,如磁共振波谱成像(MRS)、弥散张量成像(DTI)、磁共振弹性成像(MRE)、灌注加权成像(PWI)及弥散加权成像(DWI),可能会提供额外的信息,这对某些患者可能较为重要。本文将对磁共振(MRI)的成像方式及特点在IPA中的应用进展进行综述。

巨大侵袭性垂体腺瘤患者肿瘤切除程度和肿瘤进展的相关因素分析

目的研究影响手术治疗巨大侵袭性垂体腺瘤患者肿瘤切除程度和肿瘤进展的相关因素。方法回顾性选取2017年3月—2021年3月石家庄市人民医院神经外科收治的巨大侵袭性垂体腺瘤患者120例,依据手术类型分为近全切除和全切除组75例、次全切除组45例;再依据其肿瘤进展情况分为肿瘤进展组20例和肿瘤无进展组100例。收集患者的临床资料,应用多因素L ogistic回归分析影响手术治疗巨大侵袭性垂体腺瘤患者肿瘤切除程度和肿瘤进展的独立危险因素。结果单因素分析结果显示,次全切除组患者既往行手术治疗、既往行放疗、肿瘤Knosp分级为3~4级、肿瘤的最大径>5 cm、肿瘤侵入后颅窝、MR病灶强化特点不均匀、肿瘤质地为硬韧、肿瘤形状为分叶状或团块状的患者占比均高于近全切除和全切除组(χ^(2)/P=9.391/0.002、6.487/0.011、5.562/0.018、9.700/0.007、5.820/0.016、10.901/0.001、14.959/<0.001、14.415/0.001);肿瘤进展组患者病理学检查可见核分裂象、Ki-67指数≥3%、肿瘤切除程度为次全切除的患者占比均高于肿瘤无进展组(χ^(2)/P=5.608/0.018、4.631/0.031、6.334/0.042)。多因素非条件Logistic回归分析结果显示,肿瘤质地为硬韧、肿瘤Knosp分级为3~4级均为影响巨大侵袭性垂体腺瘤患者肿瘤切除程度的独立危险因素[OR(95%CI)=1.441(1.042~1.991),1.592(1.040~2.436),均P<0.05];肿瘤切除程度为次全切除、病理学检查可见核分裂象均为影响巨大侵袭性垂体腺瘤患者肿瘤进展的独立危险因素[OR(95%CI)=1.675(1.141~2.455),1.422(1.074~1.882),均P<0.05]。结论肿瘤质地为硬韧、肿瘤Knosp分级为3~4级均为影响巨大侵袭性垂体腺瘤患者肿瘤切除程度的独立危险因素;肿瘤切除程度为次全切除、病理学检查可见核分裂象均为影响巨大侵袭性垂体腺瘤患者肿瘤进展的独立危险因素。

Analysis of whole genome-wide microRNA transcriptome profiling in invasive pituitary adenomas and non-invasive pituitary adenomas

Background:Dysregulation of microRNAs(miRNAs)plays a critical role during the occurrence and progress of pituitary adenomas(PAs).However,the roles of miRNAs in the invasiveness of PA are poorly understood.This study aims to more comprehensively and specific define the relationship between altered miRNA and PA invasion.Methods:The differential expression of miRNAs(DEMs)between invasive PAs(IPAs)and non-invasive PAs(NPAs)was explored by RNA sequencing and which functions were analyzed by gene ontology(GO)as well as Kyoto Encyclopedia of Genes and Genomes(KEGG).The miRNA-mRNA network was predicted with bioinformatics.Results:We identified 31 upregulated miRNAs and 24 downregulated miRNAs in IPAs compared with NPAs.GO analysis and KEGG pathway analysis showed the DEMs were mainly associated with cell proliferation and cell cycle pathway.In addition,on the count of predicted miRNA-mRNA network,two hub miRNAs were identified.Conclusions:Our results demonstrate the miRNA-mRNA network in detail,which suggest that miRNA may be a promising target in diagnosis and therapy for IPAs.

侵袭性垂体瘤治疗方法的研究进展

垂体瘤是最常见的颅内肿瘤,大多数属于良性肿瘤。少数肿瘤呈侵袭性生长,其特点为侵袭周围的解剖结构、对常规治疗抵抗、术后早期复发率高。目前,侵袭性垂体瘤的治疗仍然是一个挑战。本文从三个方面综述侵袭性垂体瘤的治疗进展:(1)标准的治疗方案为再手术治疗或放射治疗,能在一定程度降低激素分泌水平,但不能控制肿瘤进展;(2)替莫唑胺被推荐作为侵袭性垂体瘤的一线化疗药物,但只对部分患者有效;(3)肽受体放射性核素治疗、新的分子靶向药物(mTOR抑制剂和表皮生长因子受体抑制剂)和免疫检查点抑制剂已用于治疗侵袭性垂体瘤的临床研究,并且取得了一定的治疗效果,给侵袭性垂体瘤患者带来了希望。

MRI诊断侵袭性垂体腺瘤的特征分析及内镜下双鼻孔入路的手术效果观察

本研究探讨侵袭性垂体腺瘤的磁共振成像(MRI)特征及采取内镜下双鼻孔入路实施手术治疗的临床效果。选取35例侵袭性垂体腺瘤患者作为侵袭组、25例同期非侵袭性垂体腺瘤患者作为非侵袭组,对比两组的MRI影像学特征参数差异。两组患者均采用内镜下双鼻孔入路实施手术治疗,观察患者手术效果及血清生长激素、催乳素水平的变化情况。侵袭组患者主要为大腺瘤、巨大腺瘤,非侵袭组主要为微腺瘤(P<0.05)。侵袭组患者与非侵袭组患者的泌乳素(PRL)腺瘤、促肾上腺皮质激素(ACTH)腺瘤、生长激素类(GH)腺瘤、混合型腺瘤、非功能性垂体腺瘤构成情况比较,差异无统计学意义(P>0.05)。侵袭组患者主要为慢速上升型、平台型时间-信号强度曲线,非侵袭组患者主要为快速上升型时间-信号强度曲线(P<0.05)。两组患者术后1周、术后1个月的血清生长激素、催乳素水平较术前均显著降低(P<0.05)。侵袭组患者的总体临床疗效与非侵袭组患者的比较,差异无统计学意义(P>0.05)。侵袭性垂体腺瘤肿瘤病灶一般大于非侵袭性垂体腺瘤,MRI时间-信号强度曲线以慢速上升型时间-信号强度曲线、平台型时间-信号强度曲线为主,且采用内镜下双鼻孔入路实施手术治疗侵袭性垂体腺瘤、非侵袭性垂体腺瘤均具有较好的效果。

LncRNA SLC26A4-AS1在人垂体瘤组织中的表达及其意义

目的 探讨lncRNA SLC26A4-AS1在人垂体瘤中的表达情况,并分析其与垂体瘤侵袭性的关系。方法 收集经病理确诊的16例非侵袭性垂体瘤和25例侵袭性垂体瘤,利用实时荧光定量聚合酶链反应技术检测SLC26A4-AS1在人垂体瘤中的表达,并进一步分析SLC26A4-AS1与垂体瘤临床参数的相关性。结果 与非侵袭性垂体瘤相比,SLC26A4-AS1在侵袭性垂体瘤中表达降低;与无功能瘤相比,SLC26A4-AS1在泌乳素瘤、生长激素瘤和促肾上腺皮质激素瘤中表达无明显差异。与SLC26A4-AS1高表达组相比,SLC26A4-AS1低表达组中肿瘤体积≥3 cm^(3)的比例明显增加、侵袭性垂体瘤的比例明显增加,差异具有统计学意义(P<0.05)。结论 SLC26A4-AS1在侵袭性垂体瘤中表达降低,SLC26A4-AS1的低表达与肿瘤体积和侵袭性相关。

内镜经鼻入路个体化切除侵袭海绵窦垂体腺瘤

目的 初步探讨侵袭海绵窦垂体腺瘤的内镜手术策略,以提高手术安全性和肿瘤切除率。方法 回顾性分析连续收治的32例侵袭海绵窦垂体腺瘤患者的临床资料,结合患者手术前后影像学特点及术中情况,提出侵袭海绵窦垂体腺瘤的临床分型,并针对不同侵袭类型采取的手术策略及手术要点进行归纳总结。结果 32例患者术前均诊断为侵袭性垂体腺瘤,初发肿瘤21例、复发肿瘤11例,既往有放疗史6例;术前均行头颅MRI平扫+增强、导航序列、头颅三维脑窗+骨窗CT检查。根据肿瘤与颈内动脉(ICA)在海绵窦内走形的相对位置关系,将32例患者分为ICA外上型(10例)、ICA外下型(6例)和ICA外侧型(16例)3种类型。所有患者均行内镜经鼻入路手术治疗,其中全切5例(15.6%),均为ICA外下型;近全切除23例(71.9%);大部分切除4例(12.5%),均为ICA外侧型。术中见肿瘤质软21例、质地中等9例、质韧2例;肿瘤内存在纤维分隔11例。术中发生脑脊液漏10例,术后均未发生脑脊液鼻漏。术后腰大池置管6例,颅内感染2例,无死亡病例。术前19例视力下降、视野缺损患者术后均有不同程度好转,术前1例眼睑下垂患者术后症状消失;术后新增复视及外展麻痹10例,1周至1个月逐渐恢复。结论 ICA外上型、ICA外下型和ICA外侧型是侵袭海绵窦的垂体腺肿瘤常见的3种侵袭类型,针对此3种类型的不同特点,由内而外、循“肿瘤通道”按需切开海绵窦壁及瘤内分隔,沿ICA走形切除肿瘤有利于提高手术安全性和肿瘤切除率。

侵袭性垂体腺瘤中TNF-αIL-6及VEGF之间表达水平变化的相关性研究

目的:探讨肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和血管内皮生长因子(VEGF)在侵袭性垂体腺瘤组织中表达水平变化相关性研究以及意义。方法:选择承德市中心医院神经外科手术切除的56例垂体腺瘤患者,根据肿瘤侵袭性分为无功能性侵袭性垂体腺瘤(观察组,共38例)和无功能性非侵袭性垂体腺瘤患者(对照组,共18例)。采用实时定量PCR及免疫组织化学法测定观察组及对照组中TNF-α、IL-6和VEGF的表达水平,了解三者在垂体腺瘤侵袭性生长过程中所起的作用。结果:观察组TNF-α、IL-6和VEGF mRNA表达水平均高于对照组(均P<0.05),免疫组织化学染色的结果观察组TNF-α、IL-6和VEGF的表达均高于对照组,差异具有统计学意义(均P<0.05)。结论:垂体腺瘤组织中TNF-α、IL-6和VEGF的高表达可使垂体腺瘤易于侵袭性生长,低表达或无表达可导致侵袭性更低或无侵袭性,TNF-α、IL-6和VEGF可能对垂体腺瘤侵袭性生长起促进作用。

无功能性垂体腺瘤患者中COX-2和PGE_(2)的表达及与肿瘤侵袭性的关系

目的探讨环氧化酶2(COX-2)和前列腺素2(PGE_(2))在无功能性垂体腺瘤(NFPA)患者中的表达及与肿瘤侵袭性的关系。方法选取2021年1月—2022年8月于徐州医科大学附属医院和徐州市中心医院行经蝶垂体肿瘤切除术的患者共82例。根据垂体瘤有无侵袭性,将上述患者分为侵袭性NFPA组和非侵袭性NFPA组。收集患者血清及其垂体肿瘤组织,进行相关实验室检查、血清及肿瘤组织匀浆COX-2、PGE_(2)水平测定。结果单因素分析显示,侵袭性NFPA组血清COX-2、PGE_(2)均显著高于非侵袭性NFPA组(P<0.05)。多因素Logistic回归分析显示,肿瘤直径、血清COX-2和血清PGE_(2)是NFPA发生浸润侵袭的独立危险因素(P<0.05)。血清COX-2、PGE_(2)均与垂体肿瘤组织匀浆COX-2、PGE_(2)水平呈正相关(P<0.05)。ROC曲线显示,血清COX-2、PGE_(2)以及二者联合诊断NFPA侵袭性的AUC分别为0.804、0.802、0.830(P均<0.05)。此外,NFPA患者血清COX-2、PGE_(2)均与肿瘤直径、Hardy-Wilson分级和分期、Knosp分级、Ki-67指数呈正相关(P<0.05)。结论NFPA患者血清COX-2、PGE_(2)水平与其肿瘤侵袭性密切相关,血清COX-2联合PGE_(2)水平升高可作为评价NFPA侵袭性的有效指标。