Silent Corticogonadotroph Adenomas: Clinical and Cellular Characteristics and Long-Term Outcomes
Silent Corticogonadotroph Adenomas: Clinical and Cellular Characteristics and Long-Term Outcomes
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DOI：
10.1007/s12672-010-0014-x
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发表时间：
2010-04-01
影响因子：
3
通讯作者：
Melmed, Shlomo
中科院分区：
文献类型：
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作者：
Cooper, Odelia;Ben-Shlomo, Anat;Melmed, Shlomo
无症状促肾上腺皮质激素腺瘤（SCA）临床上无症状，不分泌，但免疫染色阳性ACTH。我们假设SCA包括促肾上腺皮质激素和促性腺激素的特性。1994-2008年的队列分析，随访时间范围为1-15年，在三级转诊中心进行。我们比较了109例术前诊断为无功能垂体腺瘤的连续患者中25例SCA和84例无功能腺瘤的术前和术后临床结果和肿瘤细胞发生。临床结局为放射学和激素测量。病理结果为相关垂体激素、组织特异性转录因子和电子显微镜特征的表达。术前SCA表现与无功能腺瘤相似。然而，SCA术后复发的中位数为3年，而无功能腺瘤为8年（p < 0.0001）。54%的SCA患者术后新发垂体功能减退，而无功能腺瘤患者为17%（p < 0.025）。SCA（n=18）的ACTH、胞浆和胞核SF-1、NeuroD 1、DAX-1免疫阳性，肿瘤ACTH的α-与SF-1或LH一起检测。相反，功能性促肾上腺皮质激素腺瘤（n=11）免疫阳性ACTH，核SF-1，NeuroD 1，和Tpit，但阴性DAX-1，促性腺激素细胞转录因子。促性腺激素腺瘤（n=23）ACTH和Tpit免疫阴性，但核SF-1，NeuroD 1和DAX-1阳性。SCA电子显微镜显示的超微结构特征与促肾上腺皮质激素细胞和促性腺激素细胞一致。由于SCA表现出与促肾上腺皮质激素和促性腺激素细胞学起源一致的特征，我们提出了SCA的病理和临床不同分类为沉默性促肾上腺皮质激素腺瘤。
Silent corticotrophins adenomas (SCAs) are clinically silent and non-secreting but immunostain positively for ACTH. We hypothesize that SCAs comprise both corticotroph and gonadotroph characteristics. Cohort analysis from 1994-2008 with follow-up time ranging from 1-15 years in a tertiary referral center. We compared preoperative and postoperative clinical results and tumor cytogenesis in 25 SCAs and 84 nonfunctioning adenomas in 109 consecutive patients diagnosed pre-operatively with nonfunctioning pituitary adenomas. Clinical outcomes were radiologic and hormonal measures. Pathologic outcomes were expression of relevant pituitary hormones, tissue-specific transcription factors, and electron microscopy features. Preoperative SCA presentation was similar to that observed for nonfunctioning adenomas. However, SCAs recurred postoperatively at a median of 3 years vs. 8 years for nonfunctioning adenomas (p < 0.0001). Fifty-four percent of patients with SCAs had new onset postoperative hypopituitarism vs. 17% of nonfunctioning adenomas (p < 0.025). SCAs (n=18) were immunopositive for ACTH, cytoplasmic and nuclear SF-1, NeuroD1, DAX-1, and alpha-of tumor ACTH with either SF-1 or LH was detected. In contrast, functional corticotroph adenomas (n=11) were immunopositive for ACTH, nuclear SF-1, NeuroD1, and Tpit, but negative for DAX-1, a gonadotroph cell transcription factor. Gonadotroph adenomas (n=23) were immuno-negative for ACTH and Tpit but positive for nuclear SF-1, NeuroD1, and DAX-1. SCA electron microscopy demonstrated ultrastructural features consistent with corticotroph and gonadotroph cells. As SCAs exhibit features consistent with both corticotroph and gonadotroph cytologic origin, we propose a pathologic and clinically distinct classification of SCAs as silent corticogonadotroph adenomas.