Watanobe H, Kudo K, Okushima T, Fukita Y, Takebe K
Third Department of Internal Medicine, Hirosaki University School of Medicine, Aomori, Japan.
Acta Endocrinol (Copenh). 1991 Dec;125(6):700-4. doi: 10.1530/acta.0.1250700.
We report an extremely unusual case of prolactinoma which emerged at recurrence as a null cell adenoma. A 53-year-old woman sought medical attention for progressive visual loss and headache. A pituitary tumour was detected by a computed tomographic scan, and hyperprolactinemia was noted. The tumour, removed by a transfrontal surgery, was a chromophobe adenoma, and immunohistochemically the adenoma cells were selectively positive for PRL, which indicated a prolactinoma. Postoperatively, her plasma PRL level was normalized. Seven years later, she noted blurred vision and again sought medical attention. A CT scan demonstrated recurrence of a pituitary tumour. On this occasion, however, she was not hyperprolactinemic. She underwent again a transfrontal resection of the pituitary tumour. Its histology was again a chromophobe adenoma, but the adenoma cells showed no positive immunostaining for any anterior pituitary hormone including PRL, which indicated a null cell adenoma. We have no clear explanation of the pathogenesis underlying her very unusual course. However, null cells (assuming that the original tumour was a mixed adenoma) left behind at the first surgery, or unidentified hypothalamic and/or pituitary derangements might possibly have been responsible for the recurrence. We learned from this patient that recurrent pituitary adenomas may not necessarily have the same endocrine features as did the original tumours. This information appears to make a valid clinical point, because if hormone levels alone are followed after pituitary surgery, recurrent pituitary tumours may be overlooked.
我们报告了一例极其罕见的催乳素瘤病例，复发时表现为空细胞腺瘤。一名53岁女性因进行性视力丧失和头痛就医。计算机断层扫描发现垂体肿瘤，并检测到高催乳素血症。经额手术切除的肿瘤为嫌色性腺瘤，免疫组化显示腺瘤细胞PRL选择性阳性，提示为催乳素瘤。术后，她的血浆PRL水平恢复正常。7年后，她出现视力模糊，再次就医。CT扫描显示垂体肿瘤复发。然而，此次她没有高催乳素血症。她再次接受了经额垂体肿瘤切除术。其组织学检查再次显示为嫌色性腺瘤，但腺瘤细胞对包括PRL在内的任何垂体前叶激素均无阳性免疫染色，提示为空细胞腺瘤。对于她这种非常不寻常病程的发病机制，我们尚无明确解释。然而，第一次手术时残留的空细胞（假设原肿瘤为混合性腺瘤），或不明的下丘脑和/或垂体紊乱可能是复发的原因。我们从该患者身上了解到，复发性垂体腺瘤不一定具有与原发肿瘤相同的内分泌特征。这一信息似乎具有重要的临床意义，因为如果垂体手术后仅监测激素水平，复发性垂体肿瘤可能会被忽视。
