Granulomatous and lymphocytic hypophysitis – are they immunologically distinct?
Granulomatous and lymphocytic hypophysitis – are they immunologically distinct?
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肉芽肿性和淋巴细胞性垂体炎——它们在免疫学上有区别吗？
DOI：
10.1111/apm.12603
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
J. Saini
中科院分区：
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作者：
Shilpa Rao;A. Mahadevan;T. Maiti;M. Ranjan;S. Shwetha;A. Arivazhagan;J. Saini
垂体炎包括三种组织病理学上不同的实体-肉芽肿、淋巴细胞和黄色瘤形式。发病机制和免疫学的差异，这些是没有很好的特点。本研究旨在探讨肉芽肿性和淋巴细胞性垂体炎的免疫发病机制。本文对33例经病理证实的垂体炎的人口学、临床、内分泌功能及影像学特点进行了回顾性分析。13/33例进行了炎性成分的免疫表型。常见的临床症状为视力障碍（46%）、头痛（36%）、多尿多饮（6%）、月经紊乱（6%）和溢乳（6%）。在11/18例评价病例（61%）中观察到内分泌异常。甲状腺功能减退是最常见的内分泌异常（33.33%），其次是高泌乳素血症（22%）和低皮质醇血症（16.66%）。在神经影像学上，观察到鞍区肿块伴不同程度的增强。组织学上，肉芽肿性垂体炎（GH）较淋巴细胞性垂体炎（LH）多见（84.84%，15.15%）。在GH中，浸润具有几乎相等比例的CD 3 + T细胞和CD 68+组织细胞。细胞毒性T细胞（CD 8+）占优势[CD 4：CD 8 < 1]。CD 20 + B细胞成分范围为<5%至50%。纤维化、坏死和巨细胞增生。相反，LH具有CD 4 + T辅助细胞优势[CD 4：CD 8> 1]。CD 68+组织细胞<20%，CD 20 + B细胞5-40%。总之，GH显示细胞毒性T细胞和组织细胞丰富的浸润，而LH中以CD 4 + T细胞为主，表明这两种形式在进化中具有不同的免疫机制，LH中的自身免疫过程和GH中的IV型超敏反应。
Hypophysitis includes three histopathologically distinct entities – granulomatous, lymphocytic and xanthomatous forms. Etiopathogenesis and the immunological differences among these is not well characterized. This study aims to explore the immunopathogenesis of granulomatous and lymphocytic forms of hypophysitis. Demographic, clinical, endocrine function and radiological features of 33 histologically confirmed cases of hypophysitis were reviewed. Immunophenotyping of inflammatory component was performed in 13/33 cases. Visual disturbances (46%), headache (36%), polyuria/polydipsia (6%), menstrual disturbance (6%) and galactorrhoea (6%) were the frequent presenting symptoms. Endocrine abnormalities were noted in 11/18 cases evaluated (61%). Hypothyroidism was the most common endocrine abnormality (33.33%) followed by hyperprolactinaemia (22%) and hypocortisolism (16.66%). On neuroimaging, sellar mass with variable contrast enhancement was observed. On histology, granulomatous hypophysitis (GH) was more common (84.84%) than lymphocytic hypophysitis (LH) (15.15%). In GH, the infiltrate had almost equal proportions of CD3+ T cells and CD68+ histiocytes. Cytotoxic T cells (CD8+) predominated [CD4:CD8 < 1]. CD20+ B cell component ranged from <5% to 50%. Fibrosis, necrosis and giant cells accompanied GH. LH in contrast, had CD4+ T‐helper cell predominance [CD4: CD8 > 1]. CD68+ histiocytes constituted <20% and CD20+ B cells, 5–40% of the infiltrates. In conclusion, GH revealed cytotoxic T cell and histiocyte rich infiltrate in contrast to CD4+ T‐cell predominance in LH suggesting that the two forms have distinct immunological mechanisms in evolution, an autoimmune process in LH and type IV hypersensitivity response in GH.
Tanaka S、Tatsumi K、Takano T、Murakami Y、Takao T、Yamakita N、Tahara S、Teramoto A、Hashimoto K、Kato Y、Amino N：“垂体疾病中的抗α烯醇化酶抗体。”Endocr J. 50，
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