Neuroendoscopic and microscopic transsphenoidal approach for resection of nonfunctional pituitary adenomas

BACKGROUND Nonfunctional pituitary adenoma is a common type of pituitary adenoma, which can lead to headache, visual field disturbance, and cranial nerve damage due to increased tumor volume. Neuroendoscopic and microscopic transsphenoidal approaches have been widely used in the resection of nonfunctional pituitary adenomas. However, the clinical efficacy in neuroendoscopic and microscopic surgery is still controversial. AIM To explore the clinical efficacy of neuroendoscopic and microscopic transsphenoidal approach for resection of nonfunctional pituitary adenomas. METHODS We retrospectively analyzed 251 patients with nonfunctional pituitary adenomas;138 underwent neuroendoscopic surgery via transsphenoidal approach, and 113 underwent microscopic surgery via transsphenoidal approach between July 2010 and September 2015. All patients were followed up for > 6 mo. Gender, age, course of disease, tumor diameter, tumor location, and percentage of patients with headache, visual impairment, sexual dysfunction, and menstrual disorders were contrasted between the two groups to compare the difference of preoperative data. Cure rate, symptom improvement rate, recurrence rate, the postoperative hospital stay, operating time, intraoperative blood loss, and the incidence of postoperative complications were compared in order to evaluate the advantages and disadvantages of neuroendoscopic and microscopic surgery.RESULTS There was no significant difference in cure rate, symptom improvement rate, and recurrence rate between neuroendoscopy group and microscopy group (82.6% vs 85.8%, P > 0.05;90.6% vs 93.8%, P > 0.05;5.1% vs 9.7%, P > 0.05). In the neuroendoscopy group, the postoperative hospital stay was 8.4 ± 0.6 d;operating time was 167.2 ± 9.6 min;intraoperative blood loss was 83.4 ± 9.3 mL, and the rates of diabetes insipidus and electrolyte imbalance were 4.3% and 8.0%, respectively. The corresponding results in the microscopic group were 11.2 ± 0.6 d, 199.7 ± 9.3 min, 138.8 ± 13.6 mL, and 32.7% and 20.4%, respectively. There were significant differences in postoperative hospital stay, operating time, intraoperative blood loss, and the rates of diabetes insipidus and electrolyte imbalance between the two groups (P < 0.05). CONCLUSION Neuroendoscopic and microscopic transsphenoidal approaches have similar clinical efficacy for the resection of nonfunctional pituitary adenomas. Neuroendoscopic surgery reduces operating time, intraoperative bleeding, postoperative recovery, and complications.

The changes of preoperative bone mineral density of patients with nonfunctional pituitary adenoma

Objective To evaluate the bone mineral density (BMD) alteration of patients with nonfunctional pituitary adenoma in Chinese mainland and further to investigate the relevant factors of BMD changes. Methods 31 patients with nonfunctional adenoma and 255 healthy controls were enrolled in this study between December 2007 and May 2008.

Folate receptor-mediated boron-10 containing carbon nanoparticles as potential delivery vehicles for boron neutron capture therapy of nonfunctional pituitary adenomas

Invasive nonfunctional pituitary adenomas （NFPAs） are difficult to completely resect and often develop tumor recurrence after initial surgery. Currently, no medications are clinically effective in the control of NFPA. Although radiation therapy and radiosurgery are useful to prevent tumor regrowth, they are frequently withheld because of severe complications. Boron neutron capture therapy （BNCT） is a binary radiotherapy that selectively and maximally damages tumor cells without harming the surrounding normal tissue. Folate receptor （FR）-targeted boron-10 containing carbon nanoparticles is a novel boron delivery agent that can be selectively taken up by FR-expressing cells via FR-mediated endocytosis. In this study, FR-targeted boron-10 containing carbon nanoparticles were selectively taken up by NFPAs cells expressing FR but not other types of non-FR expressing pituitary adenomas. After incubation with boron-10 containing carbon nanoparticles and following irradiation with thermal neutrons, the cell viability of NFPAs was significantly decreased, while apoptotic cells were simultaneously increased. However, cells administered the same dose of FR-targeted boron-10 containing carbon nanoparticles without neutron irradiation or received the same neutron irradiation alone did not show significant decrease in cell viability or increase in apoptotic cells. The expression of Bcl-2 was down-regulated and the expression of Bax was up-regulated in NFPAs after treatment with FR-mediated BNCT. In conclusion, FR-targeted boron-10 containing carbon nanoparticles may be an ideal delivery system of boron to NFPAs ceils for BNCT. Furthermore, our study also provides a novel insight into therapeutic strategies for invasive NFPA refractory to conventional therapy, while exploring these new applications of BNCT for tumors, especially benign tumors.

Simultaneous rectal neuroendocrine tumors and pituitary adenoma:A case report and review of literature

BACKGROUND Neuroendocrine tumors(NET)are rare heterogeneous tumors that arise from neuroendocrine cells throughout the body.Acromegaly,a rare and slowly progressive disorder,usually results from a growth hormone(GH)-secreting pituitary adenoma.CASE SUMMARY We herein describe a 38-year-old patient who was initially diagnosed with diabetes.During colonoscopy,two bulges were identified and subsequently removed through endoscopic submucosal dissection.Following the surgical intervention,the excised tissue samples were examined and confirmed to be grade 2 NET.^(18)F-ALF-NOTATATE positron emission tomography-computed tomography(PET/CT)and 68Ga-DOTANOC PET/CT revealed metastases in the peri-intestinal lymph nodes,prompting laparoscopic low anterior resection with total mesorectal excision.The patient later returned to the hospital because of hyperglycemia and was found to have facial changes,namely a larger nose,thicker lips,and mandibular prognathism.Laboratory tests and magnetic resonance imaging(MRI)suggested a GH-secreting pituitary adenoma.The pituitary adenoma shrunk after treatment with octreotide and was neuroendoscopically resected via a trans-sphenoidal approach.Whole-exome sequencing analysis revealed no genetic abnormalities.The patient recovered well with no evidence of recurrence during follow-up.CONCLUSION ^(18)F-ALF-NOTATE PET/CT and MRI with pathological analysis can effectively diagnose rare cases of pituitary adenomas complicated with rectal NET.

内镜与显微镜经鼻蝶入路切除术对垂体腺瘤患者嗅觉功能、相关激素、应激反应的影响

目的 探讨内镜与显微镜经鼻蝶入路切除术在垂体腺瘤患者中的应用价值。方法 回顾性收集垂体腺瘤患者122例的临床资料,采取内镜经鼻蝶入路切除术61例,设为内镜组,采取显微镜经鼻蝶入路切除术61例,设为显微镜组。比较2组围手术期指标、相关激素[生长激素(human growth hormone,HGH)、促甲状腺素(thyrotropin,TSH)、泌乳素(prolactin,PRL)]、视觉功能[视野指数(visual field index,VFI)、视野模式标准差(pattern standard deviation,PSD)]、嗅觉功能(嗅觉识别阈)、应激反应[血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)、去甲肾上腺素(norepinephrine,NE)、肾素(renin,R)]、并发症发生情况。结果 内镜组住院时间短于显微镜组,术中出血量少于显微镜组(P<0.05)。2组血清AngⅡ、NE、R水平均呈先升高再降低趋势,内镜组变化幅度小于显微镜组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组PRL、TSH、HGH水平均呈降低趋势,且内镜组低于显微镜组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组PSD呈降低趋势,嗅觉识别阈呈先升高再降低趋势,VFI呈升高趋势,内镜组PSD、嗅觉识别阈低于显微镜组,VFI高于显微镜组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组并发症发生率差异无统计学意义(P>0.05)。结论 与显微镜比较,内镜经鼻蝶入路切除术具有手术创伤小、术后恢复快等优势,有助于促进垂体功能、视觉功能恢复,降低对嗅觉功能的影响,且具有一定安全性。

垂体催乳素瘤的临床特点及诊治要点更新--基于《2022版ICCE/AME垂体催乳素瘤临床实践共识》解读

垂体催乳素瘤是一种由垂体催乳素细胞瘤过量合成和分泌催乳素引起的神经内分泌疾病,垂体催乳素瘤的规范化诊疗对于恢复并维持患者的正常垂体功能并提高其生活质量具有重要意义。2022年1月,《欧洲内分泌杂志》发布了国际临床内分泌学分会(ICCE)与意大利临床内分泌学家协会(AME)关于垂体催乳素瘤的临床实践最新共识申明——《2022版ICCE/AME垂体催乳素瘤临床实践共识》(简称2022版ICCE/AME新共识)。2022版ICCE/AME新共识立足最新循证医学证据,对于垂体催乳素瘤的临床诊治问题进行系统性阐述、分析和建议。本文围绕2022版ICCE/AME新共识关于垂体催乳素瘤的诊断、治疗、特殊人群、多巴胺激动剂抵抗及侵袭性疾病等诊治要点更新进行解读,希望有助于全科医生及内分泌专科医生对于垂体催乳素瘤的认识,为其临床实践的规范化诊疗提供参考。

儿童垂体腺瘤诊断与治疗进展

垂体腺瘤为颅内良性肿瘤,常见于成人、偶见于儿童,根据是否存在激素分泌异常分为功能性和无功能性腺瘤,主要表现为内分泌功能紊乱、视觉障碍、颅内高压等。儿童垂体腺瘤发病率低,但对儿童生理和心理的影响较明显,临床诊疗具有其独特性,鉴别诊断较成人更复杂,如内分泌症状多见、副鼻窦气化不良、经鼻蝶手术对发育期儿童的影响、药物和放射治疗的儿童化及个体化、术后内分泌调节及后续生长发育等。本文对儿童垂体腺瘤近年临床研究进展进行综述,为神经外科医师诊断与治疗儿童垂体腺瘤提供参考。

长链非编码RNA母系表达基因3在垂体生长激素细胞肿瘤组织中的表达及其临床病理相关性分析

目的按探讨长链非编码RNA(LncRNA)母系表达基因3(MEC3)在垂体生长激素(GH)细胞肿瘤组织中的表达水平及其临床病理相关性。方法利用ChipBase v3.0数据库分析正常垂体组织中MEC3与谱系分化因子核受体亚家族5A族成员1(NR5A1)、POU1类同源盒1(POU1F1)、Tbox转录因子19(TBX19)、GH、GH受体(CHR)、CH释放激素受体(CHRHR)、胰岛素样生长因子1受体(ICF1R)、生长抑素受体2/5(SSTR2/5)基因的相关性。选取来源于唐山市人民医院神经外科的28例垂体GH细胞肿瘤患者的手术切除肿瘤标本,采用实时定量PCR法检测肿瘤组织中MEC3的表达水平,采用免疫组织化学染色方法检测肿瘤组织中CH、CHRHR和SSTR5蛋白的表达情况。采用Pearson相关性检验分析肿瘤标本中MEC3基因表达水平与CH、GHRHR和SSTR5蛋白表达水平的关系。根据MEC3基因表达水平,将患者分为MEC3高表达组(表达水平≥0.14,14例)和低表达组(表达水平<0.14,14例),分析MEC3基因表达水平与患者的临床病理特征的相关性。结果ChipBasev3.0数据库分析结果显示,31种器官中,垂体的MEC3表达水平与POU1F1、NR5A1和TBX19表达水平的相关性分别排名第1(r=0.60)、9(r=0.32)和29位(r=0.28)(均P<0.05)。31种器官的MEC3基因表达水平与GH、GHRHR和SSTR5基因表达水平的相关性中,垂体均位居第1(r值分别为0.60、0.72和0.57)(均P<0.05);MEC3表达水平与ICF1R和GHR表达水平的相关性中,垂体分别位居第4(r=0.74)、18位(r=0.28)(均P<0.05);而与SSTR2表达水平的相关性无统计学意义(P>0.05)。Pearson相关分析结果显示,MEC3基因表达水平与肿瘤组织标本中GH、GHRHR和SSTR5蛋白的免疫组织化学评分均呈正相关(r值分别为0.59、0.65和0.47,均P<0.05)。MEC3高表达组与低表达组患者的肿瘤体积和最大径的差异均无统计学意义(均P>0.05)。MEG3高表达组和低表达组的Ki-67增殖指数[M(Q_(1),Q_(3))]分别为2.0%(1.5%,2.6%)和3.0%(2.0%,6.6%),差异有统计学意义(Z=2.11,P=0.001);Ki-67增殖指数>3.0%者分别占2/14和6/14,两组的差异无统计学意义(P=0.088)。透射电镜结果显示,MEG高表达组存在细胞内大量致密圆形颗粒者的比例为10/14,MEG低表达组为3/14,差异有统计学意义(P=0.001)。结论MEG3可能促进垂体肿瘤向GH细胞肿瘤分化和合成CH,并抑制肿瘤的增殖,其表达量的高低可能影响肿瘤的激素颗粒类型.

蝶窦解剖对无功能垂体大腺瘤垂直方向生长的影响

目的探讨蝶窦相关解剖对无功能垂体大腺瘤沿垂直方向扩展的影响。方法回顾性分析65例无功能垂体大腺瘤患者影像资料,根据肿瘤鞍上扩展值(suprasellar expansion value,SEV),分为鞍上组(SEV>0)和鞍下组(SEV≤0)。比较蝶窦气化类型、蝶窦主隔偏向、蝶窦体积、蝶窦主隔最大宽度,并进行多因素Logstic回归分析,筛选出有价值的影响因素。结果与鞍下组比较,鞍上组蝶窦气化更好(P=0.016),蝶窦主隔最大宽度更宽(P=0.003),蝶窦主隔更居中(P=0.048),蝶窦体积更小(P=0.040),差异具有统计学意义。多因素Logstic回归分析显示:蝶窦主隔最大宽度(OR=6.23,P=0.013)和蝶窦体积(OR=0.72,P=0.024)是影响无功能垂体大腺瘤沿垂直方向扩展的独立预测因素。结论蝶窦体积越小、蝶窦主隔越宽,无功能垂体大腺瘤越倾向于向鞍上生长。

MRI影像组学用于垂体腺瘤研究进展

垂体腺瘤是成人第三常见原发性中枢神经系统肿瘤。影像组学可于医学影像中挖掘海量的定量特征并进行分析,现已用于精准诊疗垂体腺瘤。本文就MRI影像组学用于垂体腺瘤研究进展进行综述。

多重技术在神经内镜下经鼻蝶垂体大腺瘤切除的应用

目的探讨神经导航影像融合、假包膜外分离和术中个体化颅底修复技术在神经内镜下经鼻蝶垂体大腺瘤切除手术的应用价值。方法回顾性分析43例垂体大腺瘤的病例资料。术前行鞍区薄层CT、垂体MRI+MRA导航序列,利用神经导航影像融合重建技术进行术前评估。均行神经内镜下经蝶垂体瘤切除术,切开鞍底硬膜后,识别腺瘤周围的膜性结构,尽量沿假包膜外界面钝性分离,将假包膜与腺瘤一并切除。病人术中无脑脊液漏36例;低流量脑脊液漏4例,采用鞍底硬膜缝合、鼻外纱条支撑;术中有明显脑脊液漏2例,采用自体脂肪、阔筋膜、鞍底硬膜缝合;术中1例高流量脑脊液漏者,应用自体脂肪,可吸收人工脑膜,自体阔筋膜,带蒂鼻中隔黏膜瓣分层修补,间断缝合硬膜术后填塞瘤腔,最后予纱条支撑填塞鼻腔。结果所有病例未出现术后脑脊液鼻漏,出现一过性尿崩9例,颅内感染3例,均对症治疗后好转。肿瘤全切除39例,次全切除4例。术后3个月、6个月、1年复查MRI,39例全切病例未见复发,4例次全切病例中,3例无明显进展,1例接受再次手术,恢复良好。结论神经导航影像融合技术有助于手术医师评估肿瘤与周边结构位置关系,内镜下辨别腺瘤周围的膜性结构,颅底个体化修复技术效果确切,值得临床应用。

Hyperprolactinemia due to pituitary metastasis: A case report

BACKGROUND Pituitary metastasis is an uncommon manifestation of systemic malignant tumors.Moreover,hyperprolactinemia and overall hypopituitarism caused by metastatic spread leading to the initial symptoms are rare.CASE SUMMARY A 53-year-old male patient was admitted to our hospital with complaints of bilateral blurred vision,dizziness,polyuria,nocturia,severe fatigue and somnolence,decreased libido,and intermittent nausea and vomiting for more than 6 mo.During the last 7 d,the dizziness had worsened.Laboratory investigations revealed overall hypofunction of the pituitary gland,but the patient had an elevated serum prolactin level(703.35 mg/mL).Preoperative magnetic resonance imaging revealed a tumor in the sellar region,accompanied by intratumoral hemorrhage and calcification.Thus,transnasal subtotal resection of the lesion in the sellar region was performed.The histopathological and immunohistochemical examinations of the resected lesion revealed metastasis of lung adenocarcinoma to the pituitary gland.Oral hydrocortisone(30 mg/d)and levothyroxine(25 mg/d)were given both pre-and postoperatively.Postoperatively,the clinical symptoms were significantly improved.However,4 mo following the surgery,the patient succumbed due to multiple organ failure.CONCLUSION Hyperprolactinemia is one of the markers of poor prognosis in patients with carcinoma that metastasizes to the pituitary gland.Exogenous hormone supplementation plays a positive role in relieving the symptoms of patients and improving quality of life.

改良补救带蒂鼻中隔黏膜瓣在神经内镜经鼻蝶垂体腺瘤切除术中行脑脊液漏修补的应用

目的探讨以改良补救带蒂鼻中隔黏膜瓣为主的修补方式在神经内镜经鼻蝶垂体腺瘤切除术中行术中脑脊液漏修补的实用性。方法回顾性分析在2021年1月至2023年11月安徽医科大学附属省立医院行神经内镜经鼻蝶垂体腺瘤切除术,且术中出现脑脊液漏且行脑脊液漏修补术的患者资料,选择使用改良补救带蒂鼻中隔黏膜瓣进行修补的研究组患者共20例,用传统鼻中隔黏膜瓣进行修补的对照组患者共22例,比较2组间患者一般资料、术中情况和术后并发症。结果研究组手术用时[182.5(140.0,243.8)min]比对照组[240.0(182.8,303.5)min]短,P=0.017。研究组术后嗅觉减退(1/20)较对照组(8/22)少,P=0.036。研究组20例患者均得到良好的修补效果,无术后脑脊液漏出现;对照组中21例患者得到成功修补,仅1例患者术后出现脑脊液漏,再次行手术治疗后好转;2组修补成功率差异无统计学意义(P>0.05)。2组围术期均无感染、死亡等严重并发症,随访期内无死亡及失访病例。结论使用改良补救带蒂鼻中隔黏膜瓣安全可行,可缩短手术时间,有效减少术后患者嗅觉减退的发生率。

垂体瘤手术病人发生医院感染的病原菌分布及危险因素分析

目的 探究垂体瘤手术病人发生医院感染的病原菌分布及危险因素。方法 回顾性分析2018年6月至2022年4月南阳市中心医院279例垂体瘤病人临床资料,观察医院感染发生情况,分析病原菌分布情况,采用logistic回归分析影响垂体瘤手术病人发生医院感染的危险因素。结果 279例垂体瘤手术病人,26例发生医院感染,发生率为9.32%;分离出病原菌29株,其中革兰阴性菌占55.17%,革兰阳性菌占41.38%,真菌1株占3.45%;logistic回归分析,结果显示,肿瘤长径≥1 cm、手术时间>1 h、术后留置引流管、抗菌药物使用时间>7 d是垂体瘤手术病人发生医院感染的独立危险因素(P<0.05)。结论 垂体瘤手术病人医院感染风险高,感染病原菌以革兰阴性菌为主,肿瘤长径≥1 cm、手术时间>1 h、术后留置引流管、抗菌药物使用时间>7d是发生医院感染的独立危险因素,临床上应针对危险因素制定有效的感染防控措施,减少医院感染。

神经内镜下经鼻中隔黏膜下入路与传统经鼻蝶入路垂体腺瘤切除术的疗效比较

【目的】比较神经内镜下经鼻中隔黏膜下入路方式与传统经鼻蝶入路垂体腺瘤切除术的临床效果。【方法】回顾性分析2019年3月至2023年11月本院收治的85例垂体腺瘤患者的临床资料,根据手术入路方案不同将其分为鼻中隔黏膜下组(经鼻中隔黏膜下入路,n=45)和鼻蝶组(经鼻蝶入路,n=40)。比较两组术后并发症发生情况,手术前后嗅觉功能、鼻通气功能及激素水平。【结果】两组患者总有效率比较,差异无统计学意义(P>0.05)。鼻中隔黏膜下组的术中肿瘤切除率及脑脊液漏发生率与鼻蝶组比较,差异无统计学意义(P>0.05);鼻中隔黏膜下组的操作时间、出血量少于鼻蝶组,差异有统计学意义(P<0.05)。与术前比较,两组术后1个月、3个月、6个月嗅觉识别阈值高于术前,且鼻中隔黏膜下组低于鼻蝶组,差异有统计学意义(P<0.05)。术后3个月、6个月,两组鼻吸气阻力、呼气阻力高于术前,鼻中隔黏膜下组低于鼻蝶组,差异有统计学意义(P<0.05)。术后6个月,两组血清催乳素、生长激素、促肾上腺皮质激素水平低于术前(P<0.05),但两组术后6个月上述指标比较,差异无统计学意义(P>0.05)。鼻中隔黏膜下组术后并发症总发生率低于鼻蝶组,差异有统计学意义(P<0.05)。【结论】神经内镜下经鼻中隔黏膜下入路垂体腺瘤切除术对患者嗅觉功能损害较小,术后并发症发生率较低,具有较高的临床应用价值。

Epigenetic changes of pituitary tumor-derived transforming gene 1 in pancreatic cancer

BACKGROUND: Pancreatic cancer is a devastating disease with abnormal genetic changes. The pituitary tumor-derived transforming gene (PTTG) is considered to be implicated in the tumorigenesis of cancers when the gene is epigenetically transformed. In this study, we investigated the relationships between aberrant expression and epigenetic changes of the PTTG1 gene in pancreatic cancer. METHODS: We chose 4 cell lines (PANC-1, Colo357, T3M-4 and PancTu I) and pancreatic ductal adenocarcinoma (PDAC) tissues. After using restriction isoschizomer endonucleases (Msp I /Hpa II) to digest the DNA sequence (5'-CCGG-3'), we performed PCR reaction to amplify the product. And RT-PCR was applied to determine the gene expression. RESULTS: The mRNA expression of the PTTG1 gene was higher in pancreatic tumor than in normal tissue. The gene was also expressed in the 4 PDAC cell lines. The methylation states of the upstream regions of the PTTG1 gene were almost identical in normal, tumor pancreatic tissues and the 4 PDAC cell lines. Some (5'-CCGG-3') areas in the upstream region of PTTG1 were methylated, while some others were unmethylated. CONCLUSIONS: The oncogene PTTG1 was overexpressed in pancreatic tumor tissues and verified by RT-PCR detection. The methylation status of DNA in promoter areas was involved in the gene expression with the help of other factors in pancreatic cancer.

1例蝶窦异位垂体瘤影像学表现

患者男,56岁,枕部间断疼痛伴嗅觉减退、视远物模糊1个月,无视野缺损;既往糖尿病10余年,未规律监测血糖。前鼻镜检查未见明显异常。实验室检查:孕酮0.04ng/ml,睾酮38.67ng/dl,甲状腺素11.60μg/dl,游离甲状腺素1.80ng/dl。颅脑CT/MRI:蝶窦、斜坡处3.9cm×2.5cm×2.3cm等低混杂密度不规则团块,局部骨质破坏(图1A、1B),T1WI以等信号为主(图1C),T2WI呈不均匀高信号(图1D),增强后不均匀强化(图1E),蝶窦偏左部分呈中度强化。

Endoscopic Endonasal Surgery for Clinically Nonfunctioning Pituitary Adenomas

Background: Clinically nonfunctioning pituitary adenomas (NFPAs) are the most frequent pituitary macroadenomas, and represent approximately one-third of all pituitary adenomas. Patients often present with symptoms of mass effects, such as visual field defects, chronic headache, and hypopituitarism. Objective: The objective of this study was to retrospectively analyze the surgical results of 35 patients with non-functioning pituitary adenomas (NFPAs) operated by the endoscopic endonasal approach (EEA). Surgical outcomes including postoperative complications, recurrence and the postoperative visual and endocrine profile were assessed. Results: This retrospective study included 35 patients operated for clinically nonfunctioning pituitary adenomas (NFPAs) in Al Azhar university hospitals treated by endoscopic endonasal approach (EEA) in the last 6 years. 65.7% (n = 23) were male and 34.3% (n = 12) were female. The mean age was 41.5 (range 18 - 65) years. The most common presenting symptoms were headache, with 60% of the patients having headache. Visual disturbances were the presenting symptom in 82.9% patients and endocrinological problems (panhypopituitarism) were present in 6 (17.1%) patients. The number of patients suffering from cranial nerve deficit was 2 (5.7%). Visual acuity and visual field improved in 23 (79.3%) of 29 patients. The rate of tumor recurrence/regrowth was higher in the case of giant adenomas and cavernous sinus invasion represented 11 patients (31.4%). Conclusions: Early endoscopic endonasal approach surgery of NFPAs and effective surgical decompression reduces morbidity. Visual deficit improves in two third of cases. NFPAs represent high rate of recurrence due to invasion or incomplete resection especially with giant adenomas. The recurrence rate with growth total resection (GTR) is lower than subtotal resection (STR).

胃癌组织中KLF6和PTTG1的表达与胃癌淋巴结转移及预后的关系

目的:探讨Kruppel样因子6(KLF6)、垂体肿瘤转化基因1(PTTG1)在胃癌组织中的表达,并分析两者与胃癌淋巴结转移及预后的关系。方法:选取2018年4月—2019年10月诊治的80例胃癌患者,收集患者术中切除的癌组织及癌旁正常组织。采用免疫组织化学法对KLF6、PTTG1的表达进行检测;Spearman法分析胃癌组织中KLF6和PTTG1表达的相关性;Logistic回归分析影响淋巴结转移的因素;Kaplan-meier法分析胃癌组织中KLF6和PTTG1表达与患者预后的关系;Cox回归分析患者预后的影响因素。结果:与癌旁正常组织相比,胃癌组织中KLF6低表达率、PTTG1高表达率明显升高(P<0.05);胃癌组织中KLF6、PTTG1表达呈负相关(r=-0.502,P<0.05);胃癌淋巴结转移患者KLF6低表达、PTTG1高表达比例明显高于无淋巴结转移患者(P<0.05);KLF6是淋巴结转移的保护因素(P<0.05),PTTG1是淋巴结转移的危险因素(P<0.05)。KLF6高表达组生存率显著高于低表达组(χ^(2)=8.557,P<0.05),PTTG1低表达组生存率显著高于高表达组(χ^(2)=5.637,P<0.05);KLF6是患者预后的保护因素(P<0.05),淋巴结转移、PTTG1是患者预后的危险因素(P<0.05)。结论:胃癌组织中KLF6低表达、PTTG1高表达,均与胃癌淋巴结转移及预后有关。

表现为垂体腺瘤卒中的黄色瘤性垂体炎

目的报告1例黄色瘤性垂体炎病例,总结其临床表现、实验室、影像学和组织病理学特征。方法与结果患者为河北省人民医院2018年7月确诊并治疗的男性黄色瘤性垂体炎病例,临床表现为头痛伴恶心呕吐;头部CT显示鞍区呈软组织密度影,较饱满;MRI显示蝶鞍扩大,鞍内可见一类圆形肿物影。临床考虑为“垂体腺瘤卒中”,于神经内镜下经鼻蝶入路行垂体腺瘤切除术,术后病理学检查,组织细胞呈弥漫性片状浸润,免疫组化染色CD68和波形蛋白呈强阳性,S⁃100蛋白和CD1α呈阴性,Ki⁃67抗原标记指数为10%~20%,最终诊断为鞍区黄色瘤性垂体炎。结论黄色瘤性垂体炎临床罕见,症状及影像学表现无特异性,临床诊断极具挑战性,神经内镜活检是诊断与鉴别诊断的“金标准”,伴出血时应注意与垂体腺瘤卒中相鉴别。