Martinez A J
Semin Diagn Pathol. 1986 Feb;3(1):83-94.
The nonfunctional adenomas also known as undifferentiated, null cells, or nonsecretory adenomas are endocrinologically silent neoplasms of the anterior lobe of the pituitary gland. They constitute 50% of all pituitary adenomas in the present report. Most tumors are large, often growing beyond the confines of the sella turcica and characterized anatomically by displacement and compression of the adjacent sellar structures including the optic chiasm, hypothalamus, and third ventricle. Others may be truly invasive when they locally or diffusely infiltrate the adjacent structures. They may grow through the dura and the bone into the cranial cavity and/or the sphenoidal sinus and the nasopharynx or infiltrate one or both cavernous sinuses. Seventy-six adenomas were divided into 48 nononcocytic adenomas and 28 oncocytic adenomas or oncocytomas occurring in older patients. By light microscopy using conventional histologic stains, the majority of nononcocytic tumors were chromophobic. The oncocytomas were slightly acidophilic with a large granular cytoplasm. With the peroxidase-anti-peroxidase (PAP) method with anti-sera for the anterior pituitary hormones, the adenoma cells show no immunostaining. Ultrastructurally, the nononcocytic tumors possess a modest number of small secretory granules but no specific ultrastructural features. The oncocytic tumors are characterized by an excessive number of mitochondria in their cytoplasm. With the PAP method using cytochrome C oxidase antiserum, specific identification of mitochondria can be made. As the nonfunctional adenomas are devoid of anterior pituitary hormones they have been called "null cell" adenomas. However, most of the null-cell adenomas are positive for chromogranin. The diagnosis of nonfunctional adenoma can be suspected clinically when in the absence of signs of hypersecretion of pituitary hormones, there is radiologic evidence of ballooning of the sella and bulging of its diaphragm. An invasive adenoma can be detected by radiologic signs of destruction of the sella turcica and its boundaries or by neurosurgical intervention when there are findings of invasion of the dura, the parasellar, and suprasellar structures.
无功能腺瘤也被称为未分化型、无颗粒细胞型或无分泌型腺瘤，是垂体前叶的内分泌静止性肿瘤。在本报告中，它们占所有垂体腺瘤的50%。大多数肿瘤体积较大，常生长超出蝶鞍范围，其解剖学特征为压迫和移位相邻的蝶鞍结构，包括视交叉、下丘脑和第三脑室。其他肿瘤若局部或弥漫性浸润相邻结构，则可能具有真正的侵袭性。它们可穿过硬脑膜和骨质进入颅腔及/或蝶窦和鼻咽部，或浸润一侧或双侧海绵窦。76例腺瘤分为48例非嗜酸性细胞瘤和28例嗜酸性细胞瘤或嗜酸性细胞腺瘤，后者发生于老年患者。使用传统组织学染色的光镜检查显示，大多数非嗜酸性细胞瘤为嫌色性。嗜酸性细胞腺瘤呈轻度嗜酸性，细胞质内有大量颗粒。采用抗垂体前叶激素抗血清的过氧化物酶-抗过氧化物酶（PAP）法，腺瘤细胞无免疫染色。超微结构上，非嗜酸性细胞瘤有少量小分泌颗粒，但无特异性超微结构特征。嗜酸性细胞瘤的特征是细胞质内线粒体数量过多。采用细胞色素C氧化酶抗血清的PAP法可对线粒体进行特异性识别。由于无功能腺瘤缺乏垂体前叶激素，故被称为“无颗粒细胞”腺瘤。然而，大多数无颗粒细胞腺瘤嗜铬粒蛋白呈阳性。当临床上在无垂体激素分泌过多体征的情况下，有蝶鞍扩大及其鞍隔膨出的影像学证据时，可怀疑为无功能腺瘤。侵袭性腺瘤可通过蝶鞍及其边界破坏的影像学征象检测到，或在神经外科手术中发现硬脑膜及鞍旁和鞍上结构受侵时得以诊断。
