Qiao Nidan, Cheng Haixia, Zhang Zhaoyun, Ye Hongying, Shen Ming, Shou Xuefei, Cao Xiaoyun, Chen Hong, Zhou Xiang, Wang Yongfei, Zhao Yao
Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China.
National Center for Neurological Disorders, Shanghai, China.
Endocr Connect. 2022 Jun 17;11(6):e220188. doi: 10.1530/EC-22-0188.
Most studies reporting posterior pituitary tumors (PPTs) are small case series or single cases.
Patients with a histological diagnosis of PPT from January 2010 to December 2021 in a tertiary center were identified. We reported clinical symptoms, endocrine assessments, radiological and pathological features, and surgical outcomes of PPTs.
A total of 51 patients (23 males, 51.3 ± 10.3 years old) with PPT were included in this study. Major symptoms were visual defects, headache, and hypopituitarism, while diabetes insipidus was uncommon (9.8%). The typical radiological feature was homogeneous enhancement (84.3%) of a regular-shaped mass on T1 contrast imaging without cystic change, calcification, or cavernous sinus invasion. We achieved gross total resection in 38/51 patients (74.5%). Pathologically, all tumors showed thyroid transcription factor 1 immunoreactivity. Among 29 patients with suprasellar PPTs, postoperative hemorrhage due to tumor residue was encountered in 2/15 cases in the transcranial group and 0/14 in the endoscopy group. Patients with spindle cell oncocytoma (SCO) were more likely to be surgically treated (25% vs 0%, P = 0.018), harbor a higher Ki-67 index (16.7% vs 0% > 5% P = 0.050), and present a lower 2-year recurrence-free survival rate (67.5% vs 90.9%) compared with patients with pituicytoma or granular cell tumor.
PPTs should be considered in the differential diagnosis of patients with sellar and suprasellar masses with a regular lesion with homogeneous enhancement. SCOs had high proliferation activity and risk of recurrence.
大多数报告垂体后叶肿瘤（PPTs）的研究都是小病例系列或单病例研究。
确定了2010年1月至2021年12月在一家三级中心组织学诊断为PPT的患者。我们报告了PPTs的临床症状、内分泌评估、放射学和病理学特征以及手术结果。
本研究共纳入51例PPT患者（23例男性，年龄51.3±10.3岁）。主要症状为视力缺陷、头痛和垂体功能减退，而尿崩症并不常见（9.8%）。典型的放射学特征是T1加权对比成像上规则形状肿块的均匀强化（84.3%），无囊性改变、钙化或海绵窦侵犯。51例患者中有38例（74.5%）实现了全切除。病理上，所有肿瘤均显示甲状腺转录因子1免疫反应性。在29例鞍上PPT患者中，经颅组15例中有2例因肿瘤残留出现术后出血，内镜组14例中无出血。与垂体细胞瘤或颗粒细胞瘤患者相比，梭形细胞嗜酸细胞瘤（SCO）患者更有可能接受手术治疗（25%对0%，P=0.018），具有更高的Ki-67指数（16.7%对0%>5%，P=0.050），并且2年无复发生存率较低（67.5%对90.9%）。
对于鞍区和鞍上有规则病变且均匀强化的肿块患者，鉴别诊断时应考虑PPTs。SCOs具有高增殖活性和复发风险。
