Lach B, Rippstein P, Benott B G, Staines W
Department of Laboratory Medicine, Ottawa Civic Hospital, Ontario, Canada.
J Neurosurg. 1996 Nov;85(5):953-60. doi: 10.3171/jns.1996.85.5.0953.
The authors report the case of a 40-year-old woman with a 12-year history of irregular menses, amenorrhea, infertility, galactorrhea, a slightly elevated prolactin level, and a slowly growing pituitary adenoma. She developed recent onset of visual symptoms, prompting craniotomy for removal of an intrasellar tumor. Following surgery, her vision and prolactin levels returned to normal. Light microscopic and immunohistochemical examination of the tumor revealed it to be a neuroblastoma, which was immunohistochemically positive for synaptophysin, S-100 protein, and oxytocin. The neoplasm contained prolactin-positive neuroblastic and pituitary epithelial cells. No other pituitary hormones were found. Electron microscopy demonstrated two cell types: one with frequent neuritic processes containing neurosecretory granules and showing synaptic specialization, and another one compatible with epithelial adenohypophyseal cells. A few cells had ultrastructural features that were transitional between neuronal cells and granulated epithelial cells. Agranular folliculostellate cells were also identified. Immunoelectron microscopy demonstrated prolactin granules in the cytoplasm of the epithelial cells, in a few transitional cells, and in scattered neuritic processes. Ultrastructural and immunohistochemical features of the tumor suggested a transformation of pituitary epithelium to neuroblastic cells. Hyperprolactinemia and associated clinical symptoms may in part be attributed to selective prolactin secretion by neoplastic cells that were differentiating into adenomatous pituitary cells and, to a lesser extent, to cells differentiating into a neuroblastic line. Compression of pituitary stalk might also have been a contributory factor to the increased prolactin levels. Moreover, the oxytocin produced by the neuroblastic cells was considered an additional stimulus for prolactin secretion by neoplastic cells or by the normal pituitary.
作者报告了一例40岁女性病例，该患者有12年月经不规律、闭经、不孕、溢乳、催乳素水平轻度升高及垂体腺瘤缓慢生长的病史。她近期出现视觉症状，促使进行开颅手术以切除鞍内肿瘤。术后，她的视力和催乳素水平恢复正常。对肿瘤进行光镜和免疫组化检查发现其为神经母细胞瘤，免疫组化显示突触素、S-100蛋白和催产素呈阳性。肿瘤包含催乳素阳性的神经母细胞和垂体上皮细胞。未发现其他垂体激素。电镜显示有两种细胞类型：一种有频繁的神经突起，含有神经分泌颗粒并显示突触特化，另一种与腺垂体上皮细胞相符。少数细胞具有介于神经元细胞和颗粒状上皮细胞之间的超微结构特征。还鉴定出无颗粒的滤泡星形细胞。免疫电镜显示上皮细胞、少数过渡细胞及散在神经突起的细胞质中有催乳素颗粒。肿瘤的超微结构和免疫组化特征提示垂体上皮向神经母细胞转化。高催乳素血症及相关临床症状部分可能归因于正在分化为垂体腺瘤细胞的肿瘤细胞选择性分泌催乳素，在较小程度上也归因于分化为神经母细胞系的细胞。垂体柄受压也可能是催乳素水平升高的一个促成因素。此外，神经母细胞产生的催产素被认为是肿瘤细胞或正常垂体分泌催乳素的额外刺激因素。
