Wong K, Raisanen J, Taylor S L, McDermott M W, Wilson C B, Gutin P H
Department of Pathology, University of California San Francisco, USA.
Am J Surg Pathol. 1995 Aug;19(8):900-3. doi: 10.1097/00000478-199508000-00004.
Pituitary adenomas are common tumors that account for about 10% of intracranial neoplasms. Most arise from the adenohypophysis and are confined to the region of the sella turcica. Other sites may be involved as a result of extension, infiltration, or ectopic location. However, posterior extension or ectopic involvement of the clivus of the sphenoid and occipital bones is rare. Seven patients with destructive clival masses were referred to our institution with presumptive diagnoses of chordomas. In all cases, histologic workup revealed pituitary adenomas. Because they represent a subset of adenomas, the histologic features of the tumors were studied, and the clinical histories of the patients were reviewed. Five of the patients were men, aged 31 to 67 years, and two were women, aged 55 and 67 years. Four patients had extremely high plasma concentrations of prolactin (8,132-22,424 ng/ml, nl < 15). Four tumors resembled usual sellar adenomas; however, three exhibited nuclear pleomorphism, mitotic figures, and other morphologic features, suggesting alternate diagnoses. Three required immunoperoxidase stains in addition to those for pituitary hormones, and three required electron microscopy for diagnosis. Destructive invasion of the clivus by pituitary adenomas is rare, and anaplastic features of some of the tumors may lead to difficult diagnoses.
垂体腺瘤是常见肿瘤，约占颅内肿瘤的10%。大多数起源于腺垂体，局限于蝶鞍区域。由于肿瘤扩展、浸润或异位，其他部位也可能受累。然而，蝶骨和枕骨斜坡的向后扩展或异位受累很少见。7例斜坡有破坏性肿块的患者被转诊至我院，初步诊断为脊索瘤。所有病例的组织学检查均显示为垂体腺瘤。由于它们代表腺瘤的一个子集，因此对肿瘤的组织学特征进行了研究，并回顾了患者的临床病史。5例患者为男性，年龄31至67岁，2例为女性，年龄分别为55岁和67岁。4例患者血浆催乳素浓度极高（8132 - 22424 ng/ml，正常范围<15）。4个肿瘤类似于常见的蝶鞍腺瘤；然而，3个肿瘤表现出核多形性、有丝分裂象及其他形态学特征，提示可能有其他诊断。3例除了进行垂体激素染色外还需要免疫过氧化物酶染色，3例需要电子显微镜检查以明确诊断。垂体腺瘤对斜坡的破坏性侵犯很少见，部分肿瘤的间变特征可能导致诊断困难。
