Spertini F, Deruaz J P, Perentes E, Pelet B, Gomez F
J Clin Endocrinol Metab. 1986 May;62(5):849-54. doi: 10.1210/jcem-62-5-849.
A pituitary tumor was diagnosed in a prepubertal 13-yr-old girl, who had elevated plasma LH (58 mIU/ml) and PRL (93 ng/ml) levels; decreased GH, ACTH, and FSH secretion; and diabetes insipidus. After surgery, plasma LH and PRL declined, but not to normal levels. Conventional external radiotherapy to the pituitary was immediately followed by a decrease in LH to prepubertal values (0.7 mIU/ml), while PRL levels became normal only after a long course of bromocriptine therapy. The pituitary tumor was composed of two distinct cell types: small polygonal cells, which were PRL positive by immunohistochemistry, and clusters of pleomorphic large frequently mitotic polynucleated cells, which were LH positive, some of them also being positive for the alpha-subunit or beta LH but not for beta FSH. Four years after surgery and radiotherapy, the patient deteriorated neurologically. Computed tomographic scan showed widespread frontal and periventricular tumor, which had the histological features of a poorly differentiated carcinoma. No PRL, LH, or alpha- or beta-subunits were detectable on immunocytochemistry. While the PRL-positive cells of the pituitary tumor displayed the histological and clinical features of PRL adenomas, the morphological characteristics of LH cells and the sharp decline of plasma LH levels after radiotherapy were suggestive of malignant transformation. In this context, the later brain tumor could have been the result of subependymal spread of the pituitary tumor after it lost its hormone-secreting capacity.
一名13岁青春期前女孩被诊断出患有垂体瘤，其血浆促黄体生成素（LH）水平升高（58 mIU/ml），催乳素（PRL）水平升高（93 ng/ml）；生长激素、促肾上腺皮质激素和促卵泡激素分泌减少；并患有尿崩症。手术后，血浆LH和PRL下降，但未降至正常水平。垂体接受常规外照射放疗后，LH立即降至青春期前水平（0.7 mIU/ml），而PRL水平仅在长期服用溴隐亭治疗后才恢复正常。垂体瘤由两种不同的细胞类型组成：小的多边形细胞，免疫组化显示PRL阳性；以及多形性大的、频繁有丝分裂的多核细胞簇，LH阳性，其中一些α亚基或β-LH也呈阳性，但β-FSH呈阴性。手术和放疗四年后，患者神经功能恶化。计算机断层扫描显示广泛的额叶和脑室周围肿瘤，具有低分化癌的组织学特征。免疫细胞化学检测未发现PRL、LH或α或β亚基。虽然垂体瘤中PRL阳性细胞表现出PRL腺瘤的组织学和临床特征，但LH细胞的形态特征以及放疗后血浆LH水平的急剧下降提示发生了恶性转化。在这种情况下，后来的脑肿瘤可能是垂体瘤失去激素分泌能力后经室管膜下播散的结果。
