Zaidi Hasan A, Cote David J, Dunn Ian F, Laws Edward R
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, United States.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, United States.
J Clin Neurosci. 2016 Dec;34:246-251. doi: 10.1016/j.jocn.2016.09.014. Epub 2016 Oct 17.
Despite formal pathological criteria, not all atypical pituitary adenomas display clinically aggressive behavior. We set out to determine which factors predict a clinically aggressive phenotype among a cohort of atypical pituitary adenomas. Medical records were retrospectively reviewed from April 2008 to July 2015. Of 569 pituitary adenomas, 47 (8.3%) patients were surgically treated for atypical adenomas as defined by the WHO criteria. Clinically aggressive adenomas were defined as occurring in those patients who necessitated additional therapeutic intervention after the index (first) surgery, including additional surgery, medical therapy, or radiosurgery. Forty-seven patients with histopathological and immunohistochemical confirmation of atypical adenomas were identified and of these, 23 were noted to have a clinically aggressive course. Among the remaining 24 patients, the disease remained quiescent after the index surgery. On univariate analysis, clinically aggressive lesions were more likely to have a larger axial diameter on MRI (2.9±1.9cm vs. 1.9±0.7cm, p=0.02), greater incidence of cavernous sinus invasion (65.2% vs. 20.8%, p<0.01), and greater incidence of clival extension (60.9% vs. 0, p<0.01) on preoperative imaging. The two groups were equivalent with regard to immunohistochemical staining for ACTH, HGH, LH, FSH, PRL, and TSH. Clinically aggressive lesions, however, trended towards a greater average MIB-1 proliferative index (7.5%±4.9 vs. 6.0%±3.6, p=0.03). On multivariate analysis, the MIB-1 proliferative index trended towards statistical significance (p=0.06) as an independent predictor of clinical aggressiveness. Atypical pituitary adenomas are defined by a rigid set of immunohistochemical markers, but not all necessarily demonstrate an aggressive clinical phenotype.
尽管有正式的病理学标准，但并非所有非典型垂体腺瘤都表现出临床侵袭性行为。我们着手确定在一组非典型垂体腺瘤中哪些因素可预测临床侵袭性表型。对2008年4月至2015年7月的病历进行了回顾性研究。在569例垂体腺瘤中，47例（8.3%）患者因符合世界卫生组织标准定义的非典型腺瘤接受了手术治疗。临床侵袭性腺瘤定义为那些在初次（首次）手术后需要额外治疗干预的患者，包括再次手术、药物治疗或放射外科治疗。确定了47例经组织病理学和免疫组化证实为非典型腺瘤的患者，其中23例病程呈临床侵袭性。在其余24例患者中，初次手术后疾病保持静止。单因素分析显示，临床侵袭性病变在MRI上更可能具有更大的轴径（2.9±1.9cm对1.9±0.7cm，p=0.02），海绵窦侵犯的发生率更高（65.2%对20.8%，p<0.01），术前影像学上斜坡延伸的发生率更高（60.9%对0，p<0.01）。两组在促肾上腺皮质激素（ACTH）、生长激素（HGH）、促黄体生成素（LH）、促卵泡生成素（FSH）、催乳素（PRL）和促甲状腺激素（TSH）的免疫组化染色方面相当。然而，临床侵袭性病变的平均MIB-1增殖指数有更高的趋势（7.5%±4.9对6.0%±3.6，p=0.03）。多因素分析显示，MIB-1增殖指数作为临床侵袭性的独立预测因素有统计学意义的趋势（p=0.06）。非典型垂体腺瘤由一组严格的免疫组化标志物定义，但并非所有都必然表现出侵袭性临床表型。
