Division of Neurosurgery, University Health Network, TWH 399 Bathurst Street, Toronto, ON, M5T2S8, Canada,
Endocr Pathol. 2015 Mar;26(1):63-70. doi: 10.1007/s12022-014-9347-2.
The aim of the study was to establish if the null cell adenoma (NCA) forms a distinct subgroup with unique clinicopathological characteristics within the nonfunctioning pituitary adenoma group particularly in relation to the silent gonadotroph adenomas (SGAs). We identified 31 patients with the pathological diagnosis of NCA verified by routine histology and immunohistochemistry with distinct differentiation from SGAs by an established negative testing for SF-1 at the Toronto Western Hospital between December 2004 and August 2010. We reviewed their demographic data, clinical features, magnetic resonance imaging, and the histologic variables: MIB-1, FGFR4, and P27. We compared these to 63 SGAs identified within the same period. All the NCAs were macroadenomas with diameter ranging from 15-57 mm and tumor volumes between 1.95-53.5 mm(3). Preoperative cavernous sinus tumor growth was able to predict the presence of a residual after surgery (p = 0.023). Furthermore, preoperative cavernous sinus extension (p = 0.002) and negative P27 expression (p = 0.035) were able to independently predict the subsequent growth of the postoperative tumor residual. Comparing the NCA to SGA, we found that MIB-1 was higher in NCA (mean ± SD = 3.43 ± 2.76 %) compared to SGAs (mean ± SD = 2.49 ± 1.41 %) (p = 0.044). The preoperative and postoperative tumor volume doubling times (TVDTs) displayed a negative correlation in the SGA (r = -0.855, p = 0.002) while in the NCA, a positive correlation was evident (r = 0.718, p = 0.029). Our study suggests that the NCAs are a distinct group with differing behavioral characteristics from the SGAs. It also appears that the finding of cavernous sinus extension on preoperative imaging and a negative P27 expression on immunohistochemistry in NCAs may be valuable tools in predicting residual tumor growth which may impact on postoperative care.
研究目的在于确定无功能性垂体腺瘤（NCA）是否在非功能性垂体腺瘤组中形成具有独特临床病理特征的明确亚组，特别是与静默促性腺激素腺瘤（SGA）相关。我们在 2004 年 12 月至 2010 年 8 月期间在多伦多西部医院通过常规组织学和免疫组织化学证实了 31 例 NCA 的病理诊断，并通过 SF-1 的已建立的阴性检测将其与 SGA 明确区分开来。我们回顾了他们的人口统计学数据、临床特征、磁共振成像以及组织学变量：MIB-1、FGFR4 和 P27。我们将这些与同一时期内确定的 63 个 SGA 进行了比较。所有的 NCA 都是直径为 15-57 毫米的大腺瘤，肿瘤体积为 1.95-53.5 毫米 3。术前海绵窦肿瘤生长能够预测术后残留肿瘤的存在（p=0.023）。此外，术前海绵窦延伸（p=0.002）和 P27 表达阴性（p=0.035）能够独立预测术后肿瘤残留的后续生长。将 NCA 与 SGA 进行比较，我们发现 NCA 的 MIB-1 高于 SGA（平均值±标准差=3.43±2.76%）（p=0.044）。SGA 的术前和术后肿瘤倍增时间（TVDT）呈负相关（r=-0.855，p=0.002），而 NCA 则呈正相关（r=0.718，p=0.029）。我们的研究表明，NCA 是一组与 SGA 具有不同行为特征的明确亚组。此外，在 NCA 中，术前影像学上发现海绵窦延伸和免疫组织化学上 P27 表达阴性可能是预测残留肿瘤生长的有价值工具，这可能会影响术后护理。
