Landolt A M
Klin Monbl Augenheilkd. 1977 Feb;170(2):303-13.
The generally accepted classification of pituitary adenomas into eosinophilic, basophilic, mixed, and chromophobe types has not been very useful since no clear correlation exists between the staining character of the tumor cells and the clinical syndrome produced. The ultrastructural examination of different adenoma types with clinically manifest endocrine activity (acromegaly, amenorrhea-galactorrhea-syndrome, Cushing's disease) shows that the type of hormone secreted can only be determined in few cases. The ultrastructure is more representative of the activity of the secretory process than of the type of the product. Histoimmunological methods achieve the specific identification of the various types of adenomas with endocrine symptomatology. The so-called "chromophobe" adenomas, which only manifest signs of a space occupying lesion with pituitary insufficiency of varying degree and compression of the visual pathways, represent a mixed group. The majority of the cases (about 60%) shows increased prolactin secretion with amenorrhea or loss of potency, but without galactorrhea or gynecomastia. A small group of cases may either produce normal hormones (growth hormone or prolactin) at a very low rate, or secrete hormone fragments or abnormal, as yet undeterminable substances. The oncocytomas, which stain with eosin in light microscopy, seem to suffer from a defective metabolism and therefore may have lost the ability of hormone production.
垂体腺瘤通常被分为嗜酸性、嗜碱性、混合型和嫌色细胞型,但这种分类方法并不是很有用,因为肿瘤细胞的染色特征与所产生的临床综合征之间没有明确的相关性。对具有临床表现的内分泌活性(肢端肥大症、闭经-溢乳综合征、库欣病)的不同腺瘤类型进行超微结构检查发现,只有少数情况下能确定所分泌激素的类型。超微结构更能代表分泌过程的活性,而非产物的类型。组织免疫学法可对各种有内分泌症状的腺瘤类型进行特异性识别。所谓的“嫌色”腺瘤,仅表现为占位性病变的体征,伴有不同程度的垂体功能减退和视路受压,它们代表了一个混合组。大多数病例(约60%)表现为催乳素分泌增加,伴有闭经或性功能丧失,但无溢乳或男性乳腺增生。一小部分病例可能以非常低的速率分泌正常激素(生长激素或催乳素),或者分泌激素片段或异常的、尚未确定的物质。在光镜下用伊红染色的嗜酸性细胞瘤,似乎存在代谢缺陷,因此可能已丧失激素产生能力。