Komor Jan, Reubi Jean Claude, Christ Emanuel R
, Bühlstrasse 5, 3012, Bern, Switzerland.
Pituitary. 2014 Jun;17(3):227-31. doi: 10.1007/s11102-013-0494-0.
Non-functioning pituitary adenoma (NFPA) with higher proliferation index (WHO II) are often a therapeutical challenge. Low somatostatin receptor expression in these tumors usually prevents a treatment with somatostatin analogs. In 1996, a 55-year-old patient was referred due to right-sided headache. A pituitary macroadenoma with infiltration into the right cavernous sinus was diagnosed. There was no visual field deficit and the clinical and biochemical work up was consistent with a NFPA. The patient underwent transsphenoidal surgery. Residual adenoma remained in the right cavernous sinus. Histologically, a null-cell adenoma with a high proliferation index was documented (MIB-1: 11.6%, WHO II). Somatostatin receptor autoradiography was performed in the surgical specimen showing a homogenous expression of sst2 receptors. Radiosurgery was completed with stable disease for 8 years. In 2004, the patient was diagnosed with an incomplete palsy of the right oculomotorius nerve and a significant increase in the volume of the adenoma in the right cavernous sinus. After a positive Octreoscan(®) the patient consented to an experimental therapy approach using Lutetium DOTATOC (3 × 200 mCi). The palsy of the oculomotorius nerve improved and remained stable until today (March 2013), the follow-up MRI scans demonstrated stable disease. This is the first case of a patient with a NFPA (WHO II) in whom PRRT successfully improved the local complications of the tumor for more than 8 years after ineffective surgery and gamma knife therapy. The determination of sst2 in vitro using autoradiography and in vivo by Octreoscan was instrumental to administer this therapy in a challenging situation.
增殖指数较高（世界卫生组织II级）的无功能垂体腺瘤（NFPA）通常是治疗上的难题。这些肿瘤中生长抑素受体表达较低，通常无法用生长抑素类似物进行治疗。1996年，一名55岁患者因右侧头痛前来就诊。诊断为垂体大腺瘤并侵犯右侧海绵窦。无视野缺损，临床和生化检查结果与NFPA相符。患者接受了经蝶窦手术。右侧海绵窦仍残留腺瘤。组织学检查显示为增殖指数较高的无功能细胞腺瘤（MIB-1：11.6%，世界卫生组织II级）。对手术标本进行了生长抑素受体放射自显影，显示sst2受体呈均匀表达。立体定向放射外科治疗后病情稳定8年。2004年，患者被诊断为右侧动眼神经不完全麻痹，右侧海绵窦内腺瘤体积显著增大。奥曲肽扫描（®）结果呈阳性后，患者同意采用镥-奥曲肽（3×200毫居里）进行实验性治疗。动眼神经麻痹得到改善且至今（2013年3月）保持稳定，后续MRI扫描显示病情稳定。这是首例NFPA（世界卫生组织II级）患者，在手术和伽玛刀治疗无效后，肽受体放射性核素治疗（PRRT）成功改善肿瘤局部并发症超过8年。通过放射自显影体外测定sst2以及通过奥曲肽扫描体内测定sst2，有助于在这种具有挑战性的情况下实施该治疗。
