CHANGES IN THE IMMUNOPHENOTYPE OF RECURRENT PITUITARY-ADENOMAS
CHANGES IN THE IMMUNOPHENOTYPE OF RECURRENT PITUITARY-ADENOMAS
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DOI：
10.1227/00006123-199407000-00006
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发表时间：
1994-07-01
期刊：
影响因子：
4.8
通讯作者：
WILSON, CB
中科院分区：
文献类型：
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作者：
MINDERMANN, T;KOVACS, K;WILSON, CB
仅有两例垂体腺瘤在初次切除和复发之间发生表型改变的病例被报道。为了确定此类病例在我们的患者中的频率，我们检查了这些肿瘤的临床病程，并描述了任何类型。我们回顾了1984年至1992年间在加州大学旧金山分校接受手术的1023名垂体腺瘤患者的病历。在65名接受手术或有临床证据表明肿瘤复发的患者中，有5名(7.7%)的肿瘤表型发生了变化。男女之比为4：1，起病年龄为33.2±15.3岁(平均+/-标准差)。在6.4+/-3.4年后，激素的产生和释放发生了变化。在某种程度上，所有五个肿瘤都是侵袭性的，其中四个是大腺瘤。2例因肿瘤复发而多次手术，3例静止性或症状性垂体卒中，3例在表型改变前接受鞍区放射治疗。因此，这些肿瘤的行为似乎是侵袭性的，我们还不知道垂体腺瘤的表型变化是否有任何治疗意义。因此，我们主张对原发和复发的垂体腺瘤进行完整的免疫染色，以便收集有关其临床病程的更多数据。
Only two cases have been reported of a pituitary adenoma that changed phenotype between its initial resection and recurrence. To determine the frequency of such cases among our patients, we examined the clinical course of these tumors and characterized any patterns. We reviewed the charts of 1023 patients with pituitary adenomas who underwent surgery between 1984 and 1992 at the University of California at San Francisco. Of the 65 patients (6.4%) who had operations for or clinical evidence of tumor recurrence, five (7.7%) had tumors that changed phenotype. The female-to-male ratio was 4:1, and age at the onset of symptoms was 33.2 +/- 15.3 years (mean +/- standard deviation). Changes occurred in hormone production and hormone release after 6.4 +/- 3.4 years. At some point, all five tumors were invasive and four were macroadenomas. Two patients had more than one operation for tumor recurrence; three had silent or symptomatic pituitary apoplexy; and three had undergone sellar irradiation before the changes in phenotype occurred. The behavior of these tumors therefore seems to be aggressive, We do not yet know whether phenotypic changes in pituitary adenomas have any treatment implications. Therefore, we advocate the complete immunostaining of primary and recurrent pituitary adenomas so that additional data about their clinical course can be collected.