Carcinoma of the pituitary gland
Carcinoma of the pituitary gland
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垂体癌
作者：
V. S. D'abrera;W. Burke;K. Bleasel;L. Bader
嫌色细胞通常被认为是无功能的，但鉴于前叶细胞中有丝分裂的罕见性，这三种类型细胞分布的变化是由于嫌色细胞转化为嗜酸性粒细胞或嗜碱性粒细胞，嫌色细胞倾向于成为最未分化的类型。嫌色细胞腺瘤是嫌色细胞的肿瘤，占所有垂体肿瘤的近70%。虽然垂体的恶性肿瘤可能是由嫌色细胞或嗜色细胞引起的，但关于什么是恶性肿瘤的确切定义似乎存在一些争议，因为垂体的恶性肿瘤大多含有缺乏特异性颗粒的细胞。这一争论似乎是由于一些作者将"癌“和“恶性腺瘤“这两个术语用于侵袭性和广泛性垂体瘤而引起的。Bailey和Cutler（1940）、Jefferson（1940）和Newton、Burhenne和Palubinskas（1962）认为所有破裂包膜并直接侵入邻近结构的生长都是恶性的。另一方面，Evans（1966）认为只有当垂体外结构浸润而非侵蚀的证据明确时，病变才被认为是恶性的。尽管Cohen和Dible（1936）和福布斯（1947）描述了与库欣综合征相关的垂体癌能够产生颅外转移，但Winklemann、Cassel和Schlesinger（1952）认为这种传播非常罕见，以至于否认其存在。垂体肿瘤，无论是良性还是恶性，都可能是占位性病变，通过对邻近结构施加压力而产生机械性症状，或者可能伴有功能亢进或功能减退的症状。我们将要描述的病例表现为占位性病变的症状，功能影响极小。
Chromophobe cells have generally been regarded as functionless, but in view of the rarity of mitoses in cells of the anterior lobe, the shift in distribution of these three types of cell is due to transformation of chromophobes into either acidophils or basophils, the chromophobes tending to be the most undifferentiated type. Chromophobe adenomas are tumours of the chromophobe cells, comprising nearly 70 per cent. of all pituitary neoplasms. Though malignant tumours of the pituitary gland may arise from chromophobe or chromophil elements, some controversy appears to exist concerning the definition of what exactly constitutes malignancy, because malignant neoplasms of this gland mostly contain cells that lack specific granules. This controversy appears to have been engendered by the terms ‘‘ carcinoma ” and “ malignant adenoma ” applied by some authors to aggressive and generally extensive pituitary tumours. Bailey and Cutler (1940), Jefferson (1940) and Newton, Burhenne and Palubinskas (1962) consider as malignant all growths that burst their capsules and directly invade the adjacent structures. Evans (1966) on the other hand, believes that only when demonstrable evidence of infiltration, not erosion, of extrapituitary structures has been obtained can the lesion be considered as malignant. Even though Cohen and Dible (1936) and Forbes (1947) described carcinomas of the pituitary associated with Cushing’s syndrome with the capacity to produce extracranial metastases, Winklemann, Cassel and Schlesinger (1952) thought such dissemination so rare as to deny its existence. Taken in their true perspective, pituitary neoplasms, whether benign or malignant, may act as space-occupying lesions producing symptoms of a mechanical nature by exerting pressure on adjacent structures, or they may be associated with symptoms of hyperor hypo-function. The case that we are about to describe presented with symptoms of a space-occupying lesion with minimal functional effect.