Reuss W A, Saeger W, Lüdecke D K
Department of Pathology, Marienkrankenhaus Hamburg, Federal Republic of Germany.
Virchows Arch A Pathol Anat Histopathol. 1991;419(5):395-401. doi: 10.1007/BF01605073.
Adrenocorticotrophic hormone (ACTH)-secreting adenomas of patients with Cushing's disease (undifferentiated and well-differentiated ACTH-cell adenomas) were studied ultrastructurally and analysed morphometrically by a computer-supported quantitative image-analysing system. They were compared with identically prepared ACTH tumours (undifferentiated and well-differentiated ACTH-cell adenomas) of pituitaries from bilateral adrenalectomised patients with Nelson's syndrome. The aim of our study was to look for significant differences in ultrastructure and to evaluate these findings statistically regarding adenoma types and clinical syndromes. Clinical syndromes aside, more secretory granules and larger-sized prosecretory granules were measured in the well-differentiated ACTH-cell adenomas. The undifferentiated adenomas showed a greater content of nucleoli and prosecretory granules. Within the adenoma types, comparison of well-differentiated ACTH-cell adenomas showed that the clinical group of Cushing's disease contained larger areas of cytofilaments, whereas the clinical group of Nelson's syndrome had a larger tumour size and more lysosomes. Comparing the undifferentiated adenomas of both clinical groups the adenomas in Cushing's disease contained larger nuclei and more lysosomes, whereas the adenomas in Nelson's syndrome were larger in tumour size and contained larger prosecretory granules. Comparison of well-differentiated and undifferentiated adenomas in Cushing's disease showed more secretory granules and bigger prosecretory granules in well-differentiated adenomas whereas in undifferentiated adenomas the total area of the nuclei is larger, the nucleoli increase in number and size and the lysosomes are more frequent. Comparison of well-differentiated and undifferentiated adenomas in Nelson's syndrome demonstrated more lysosomes in well-differentiated adenomas and a larger total area of the nuclei in undifferentiated adenomas. The differences between the well-differentiated adenomas (mainly more secretory granules and larger prosecretory granules) and undifferentiated adenomas (mainly more and larger nuclei and nucleoli and more prosecretory granules) prove the clear separability between the adenoma types, not demonstrated in the literature up to now. The significant differences between adenomas in Cushing's disease (mainly more cytofilaments) and Nelson's syndrome (mainly more ribosomes and larger prosecretory granules) may be interpreted as different cell reactions due to the hypercortisolism present in Cushing's disease and lacking in Nelson's syndrome following adrenalectomy. Despite the fact that both clinical syndromes are based on the same adenoma types, indistinguishable by light microscopy, significant morphometrical findings in ultrastructure allow a clear discrimination of both clinical types.
对库欣病患者（未分化型和高分化型促肾上腺皮质激素细胞腺瘤）分泌促肾上腺皮质激素（ACTH）的腺瘤进行了超微结构研究，并通过计算机辅助定量图像分析系统进行形态计量分析。将它们与双侧肾上腺切除术后患纳尔逊综合征患者垂体中同样制备的ACTH肿瘤（未分化型和高分化型促肾上腺皮质激素细胞腺瘤）进行比较。我们研究的目的是寻找超微结构中的显著差异，并根据腺瘤类型和临床综合征对这些发现进行统计学评估。除临床综合征外，在高分化型促肾上腺皮质激素细胞腺瘤中检测到更多的分泌颗粒和更大尺寸的前分泌颗粒。未分化腺瘤显示核仁和前分泌颗粒含量更高。在腺瘤类型中，对高分化型促肾上腺皮质激素细胞腺瘤的比较表明，库欣病临床组的细胞丝面积更大，而纳尔逊综合征临床组的肿瘤尺寸更大且溶酶体更多。比较两个临床组的未分化腺瘤，库欣病中的腺瘤细胞核更大且溶酶体更多，而纳尔逊综合征中的腺瘤肿瘤尺寸更大且含有更大的前分泌颗粒。比较库欣病中高分化型和未分化型腺瘤，高分化型腺瘤中分泌颗粒更多且前分泌颗粒更大，而未分化腺瘤中细胞核总面积更大，核仁数量和大小增加且溶酶体更常见。比较纳尔逊综合征中高分化型和未分化型腺瘤，高分化型腺瘤中溶酶体更多，未分化腺瘤中细胞核总面积更大。高分化型腺瘤（主要是更多的分泌颗粒和更大的前分泌颗粒）与未分化腺瘤（主要是更多更大的细胞核和核仁以及更多的前分泌颗粒）之间的差异证明了腺瘤类型之间的明显可分离性，这在以往文献中尚未得到证实。库欣病腺瘤（主要是更多的细胞丝）与纳尔逊综合征腺瘤（主要是更多的核糖体和更大的前分泌颗粒）之间的显著差异可能被解释为由于库欣病中存在高皮质醇血症而纳尔逊综合征肾上腺切除术后不存在，从而导致不同的细胞反应。尽管这两种临床综合征都基于相同的腺瘤类型，在光镜下无法区分，但超微结构中显著的形态计量学发现允许对两种临床类型进行清晰的区分。
