Institute of Neuropathology, University of Hamburg, UKE, Martinistraße 52, 20246, Hamburg, Germany.
Clinic of Neurosurgery, University of Hamburg, UKE, 20246, Hamburg, Germany.
Hormones (Athens). 2022 Dec;21(4):653-663. doi: 10.1007/s42000-022-00392-9. Epub 2022 Aug 10.
PURPOSE/OBJECTIVE: Multiple tumorous lesions in one pituitary gland are rare and mostly described in case reports. Their incidences and combinations are defined in larger collectives. Therefore, we analyzed our large collection for double tumors and combinations of tumors, cysts, and inflammation.
The German Registry of Pituitary Tumors, including cases from 1990 to 2018, served as the database. Our collection comprises a total of 16,283 cases up until the end of 2018. Of these cases, 12,673 originated from surgical and 3,610 from autopsy material. All specimens were fixed in formalin and embedded in paraffin. The sections were stained with hematoxylin-eosin and PAS. Monoclonal (prolactin, TSH, FSH, LH, and α subunit) or polyclonal (GH and ACTH) antibodies were used to detect pituitary hormones in the lesions. Since 2017, antibodies against the transcription factors Pit-1, T-Pit, and SF-1 have been used in difficult cases. The criteria of the 2017 WHO classification have been basic principles for classification since 2018 (Osamura et al. 2017). For differentiation of other sellar tumors, such as meningiomas, chordomas, or metastases, the use of additional antibodies was necessary. For these cases, it was possible to use a broad antibody spectrum. Autopsy pituitaries were generally studied by H&E and PAS sections. If any lesions were demonstrated in these specimens, additional immunostaining was performed.
Multiple tumorous lesions with more than one pituitary neuroendocrine tumor (PitNET) respectively adenoma make up 1.4% (232 cases) in our collection. Within the selected cases, synchronous multiple pituitary neuroendocrine tumors (PitNETs) account for 17.3%, PANCH cases (pituitary adenoma with neuronal choristoma) for 14.7%, PitNETs and posterior lobe tumors for 2.2%, PitNETs and metastases for 5.2%, PitNETs and mesenchymal tumors for 2.6%, PitNETs and cysts for 52.2%, and PitNETs and primary inflammation for 6.0%. The mean patient age was 53.8 years, with a standard deviation of 18.5 years. A total of 55.3% of the patients were female and 44.7% were male. From 1990 to 2018, there was a continuous increase in the number of multiple tumorous lesions.
From our studies, we conclude that considering possible tumorous double lesions during surgeries and in preoperative X-ray analyses is recommended.
目的/目标：一个垂体中出现多个肿瘤性病变较为罕见，大多见于病例报告。这些病变的发生率和组合在更大的集合中进行了定义。因此，我们分析了我们的大型数据库中涉及双肿瘤以及肿瘤、囊肿和炎症组合的病例。
德国垂体瘤登记处的数据库包括 1990 年至 2018 年的病例。我们的数据库包括截至 2018 年底共 16283 例手术和 3610 例尸检材料。所有标本均用福尔马林固定并石蜡包埋。切片用苏木精-伊红和 PAS 染色。使用单克隆（催乳素、TSH、FSH、LH 和 α 亚单位）或多克隆（GH 和 ACTH）抗体检测病变中的垂体激素。自 2017 年以来，在困难病例中使用了针对转录因子 Pit-1、T-Pit 和 SF-1 的抗体。2017 年世界卫生组织分类标准是自 2018 年以来分类的基本原则（Osamura 等人，2017 年）。为了区分其他鞍区肿瘤，如脑膜瘤、脊索瘤或转移瘤，有必要使用其他抗体。对于这些病例，可以使用广泛的抗体谱。尸检垂体一般通过 H&E 和 PAS 切片进行研究。如果在这些标本中发现任何病变，则进行额外的免疫染色。
在我们的数据库中，具有多种垂体神经内分泌肿瘤（PitNET）和腺瘤的多瘤性病变占 1.4%（232 例）。在所选病例中，同步多发性垂体神经内分泌肿瘤（PitNET）占 17.3%，Panch 病例（伴有神经元神经嵴瘤的垂体腺瘤）占 14.7%，PitNET 和后叶肿瘤占 2.2%，PitNET 和转移瘤占 5.2%，PitNET 和间充质肿瘤占 2.6%，PitNET 和囊肿占 52.2%，PitNET 和原发性炎症占 6.0%。患者平均年龄为 53.8 岁，标准差为 18.5 岁。女性患者占 55.3%，男性患者占 44.7%。从 1990 年到 2018 年，多发性肿瘤病变的数量持续增加。
从我们的研究中可以得出结论，建议在手术中和术前 X 射线分析中考虑可能的双肿瘤病变。
