The clinicopathological features of pituicytoma and the differential diagnosis of sellar glioma
The clinicopathological features of pituicytoma and the differential diagnosis of sellar glioma
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DOI：
10.1111/neup.12291
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发表时间：
2016-10-01
期刊：
影响因子：
2.3
通讯作者：
Li, Guilin
中科院分区：
文献类型：
--
作者：
Wang, Junmei;Liu, Zhaoxia;Li, Guilin
垂体细胞瘤罕见且难以诊断。本研究探讨垂体细胞瘤的临床病理特征、免疫表型及鉴别诊断。我们比较了 11 例垂体细胞瘤和 26 例鞍区神经胶质瘤（16 例毛细胞星形细胞瘤、4 例弥漫性星形细胞瘤、3 例毛细胞样星形细胞瘤和 3 例第三脑室脊索样神经胶质瘤）。这11例垂体细胞瘤病例涉及6名男性和5名女性（年龄：33-65岁）。 11名患者中，有3名因肿瘤残留而复发，其中一名患者在6个月内接受了3次手术。影像学结果显示肿瘤位于鞍内区（4 例）、鞍上区（4 例）和鞍上区（3 例）。肿瘤直径1.3~3.8 cm，术前诊断为垂体腺瘤、颅咽管瘤、脑膜瘤。肿瘤呈实性，含有梭形或稍胖的细胞，细胞排列密集，可见裂隙状或扩张的血窦结构。细胞边界模糊，细胞核圆形，染色质精细，核仁小。垂体细胞瘤的免疫组织化学染色显示甲状腺转录因子 1 (TTF-1) 和 S-100 蛋白 (S-100) 阳性表达，神经胶质 GFAP 阳性局部表达；（11 例中有 5 例），少突胶质细胞转录因子 2 (Olig2)、CD34 和神经丝表达阴性。 Ki67 指数在一种情况下为 6%，在其他情况下为 1-2%。与垂体细胞瘤不同，大多数鞍区神经胶质瘤病例表现出 GFAP 和 Olig2 表达，以及 TTF-1 表达阴性。第三脑室脊索样神经胶质瘤表达 TTF-1、GFAP 和 CD34，但 Olig2 阴性。我们的结果表明，垂体细胞瘤通常涉及密集排列的梭形细胞或略胖的细胞。形态偶尔不典型，具有室管膜瘤样或脑膜瘤样结构，偶尔表现出毛粘液样变性。丰富的血窦是出血性肿瘤的特征。致密的梭形细胞排列是一种相对特异的形态，GFAP、TTF-1、Olig2 和 CD4 染色可能有助于区分垂体细胞瘤和鞍区神经胶质瘤。
Pituicytoma is rare and difficult to diagnose. This study explored the clinicopathological features, immunophenotype and differential diagnosis of pituicytoma. We compared 11 cases of pituicytoma and 26 cases of sellar glioma (16 pilocytic astrocytomas, four diffuse astrocytomas, three pilomyxoid astrocytomas, and three third ventricle chordoid gliomas). The 11 pituicytoma cases involved six men and five women (age: 33-65 years). Three of the 11 patients experienced recurrence due to a residual tumor, and one patient underwent three surgeries during a 6-month period. Imaging findings revealed tumors were in the intrasellar region (four cases), suprasellar region (four cases) and intra-suprasellar regions (three cases). The tumor diameters were 1.3-3.8 cm, and the preoperative diagnoses were pituitary adenoma, craniopharyngioma and meningioma. The tumors were solid and contained spindle or slightly chubby cells that were densely arranged with visible cleft-like or expanded sinusoid structures. The cells had vague boundaries, circular nuclei, fine chromatin, and a small nucleolus. Immunohistochemical staining of the pituicytomas revealed positive expression of thyroid transcription factor-1 (TTF-1) and S-100 protein (S-100), positive focal expression of glial GFAP;(five of 11 cases), and negative oligodendrocyte transcription factor 2 (Olig2), CD34 and neurofilament expression. The Ki67 index was 6% in one case and 1-2% in the other cases. Unlike pituicytoma, most sellar glioma cases exhibited GFAP and Olig2 expression, and negative TTF-1 expression. Third ventricle chordoid gliomas expressed TTF-1, GFAP and CD34, and were negative for Olig2. Our results indicate that pituicytoma typically involves dense arrangements of spindle or slightly chubby cells. The morphology is occasionally atypical, with ependymoma-like or meningioma-like structures, and occasionally exhibits pilomyxoid degeneration. Abundant sinusoids are characteristic of hemorrhagic tumors. The dense spindle cell arrangement is a relatively specific morphology, and staining for GFAP, TTF-1, Olig2 and CD4 may help differentiate pituicytoma from sellar glioma.