垂体细胞瘤的诊治及疗效分析
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摘要
目的目前国内外关于垂体细胞瘤的临床报道较少。文中旨在探讨垂体细胞瘤的治疗方式、病理结果及术后并发症等情况。方法回顾性分析2008年7月至2018年7月东部战区总医院神经外科收治的10例垂体细胞瘤患者临床资料。患者均行显微外科手术治疗,肿瘤全切除6例,次全切除4例。统计分析患者病理结果、术后并发症及随访结果。结果术后病理见肿瘤组织结构紧密,由伸长的双极梭形细胞构成,呈纤维束状交叉或席纹状排列;细胞梭形、卵圆形,细胞质红染嗜酸性,细胞核中等大小,圆形、卵圆形、梭形,异型性小,细胞核分裂,可见微囊形成,间质血管丰富。术后无患者死亡。术后主要并发症为尿崩8例、低钠血症4例,术后视力较术前下降、垂体功能低下、颅内感染分别为3、2、1例。随访9例患者均存活,其中1例患者术后2年复发,再次手术,截止2018年7月肿瘤未复发。结论垂体细胞瘤明确诊断需要结合病理学检查。手术切除是其主要治疗方式,术后应注意尿崩和低钠血症的防治。
Objective Reports are rarely seen on the clinical studies of pituicytomas. This article discusses the clinical diagnosis,treatment strategies,pathological features and postoperative complications of pituicytomas.Methods This retrospective study included 10 cases of pituicytomas treated in our hospital from July 2008 to July 2018. All the patients underwent microsurgery,gross total resection of the tumor in 6 cases and subtotal resection in the other 4. We analyzed the histopathological features,postoperative complications and follow-up data of the patients.Results The tumors were tightly organized morphologically,consisting of bipolar spindle-shaped cells,arranged like crosswise-woven fiber bundles or in a storiform pattern,the cytoplasm stained red and eosinophilic,the nuclei medium-sized,round,oval or spindle shaped,mildly heterotypical,with visible microencapsulation and abundant interstitial blood vessels. The main postoperative complications included insipidus in 8 cases,hyponatremia in 4,decreased visual acuity in 3,hypopituitarism in 2,and intracranial infection in 1. Of the 9 patients followed up,1 experienced recurrence at 2 years postoperatively and received another surgery,with no more recurrence hitherto.Conclusion Definite diagnosis of pituicytoma depends on pathological examination,and adequate attention should be paid to the prevention and management of such postoperative complications as insipidus and hyponatremia.
Objective Reports are rarely seen on the clinical studies of pituicytomas. This article discusses the clinical diagnosis,treatment strategies,pathological features and postoperative complications of pituicytomas.Methods This retrospective study included 10 cases of pituicytomas treated in our hospital from July 2008 to July 2018. All the patients underwent microsurgery,gross total resection of the tumor in 6 cases and subtotal resection in the other 4. We analyzed the histopathological features,postoperative complications and follow-up data of the patients.Results The tumors were tightly organized morphologically,consisting of bipolar spindle-shaped cells,arranged like crosswise-woven fiber bundles or in a storiform pattern,the cytoplasm stained red and eosinophilic,the nuclei medium-sized,round,oval or spindle shaped,mildly heterotypical,with visible microencapsulation and abundant interstitial blood vessels. The main postoperative complications included insipidus in 8 cases,hyponatremia in 4,decreased visual acuity in 3,hypopituitarism in 2,and intracranial infection in 1. Of the 9 patients followed up,1 experienced recurrence at 2 years postoperatively and received another surgery,with no more recurrence hitherto.Conclusion Definite diagnosis of pituicytoma depends on pathological examination,and adequate attention should be paid to the prevention and management of such postoperative complications as insipidus and hyponatremia.
引文
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[4]蒋小飞,周惠芳,周伯如,等.SD大鼠腺垂体细胞体外分离方法的比较[J].医学研究生学报,2017,30(12):1272-1276.
[5]李储忠,张亚卓.2017版who垂体肿瘤分类解读[J].中华神经外科杂志,2018,34(1):1-5.
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[7]杨来华,唐忠民,李建瑞,等.垂体细胞瘤7例的MRI特征分析[J].江苏医药,2014,40(10):1184-1186.
[8]吴燕妮,何燕,李南云,等.鞍区垂体细胞瘤10例临床病理分析[J].临床与实验病理学杂志,2015,31(6):662-665.
[9]熊先,苗彦明,关树森,等.垂体细胞瘤的临床特征和治疗策略(附11例报告)[J].中华神经外科杂志,2016,32(3):270-273.
[10]Salge-Arrieta FJ,Carrasco-Moro R,Rodríguez-Berrocal V,et al.Clinical features,diagnosis and therapy of pituicytoma:an update[J].J Endocrinol Invest,2018,20(7):1-14
[11]邓伟,祝迎锋.垂体细胞瘤3例临床病理观察[J].诊断病理学杂志,2016,23(10):761-763.
[12]司海鹏,王剑蓉,章宜芬,等.垂体细胞瘤及其罕见室管膜样亚型的临床病理分析[J].临床与实验病理学杂志,2018,34(3):284-288.
[13]薛凤麟,潘国庆,何波,等.鞍上垂体细胞瘤1例并文献复习[J].临床与实验病理学杂志,2016,32(1):93-95.
[14]杜军,沈倩,黄亮亮,等.垂体细胞瘤5例并文献复习[J].临床与实验病理学杂志,2015,31(5):589-591.
[15]李杰,王汉东,杭春华,等.术中磁共振成像在大型侵袭性垂体瘤手术的应用[J].医学研究生学报,2013,26(1):49-51.
[16]Teti C,Castelletti L,Allegretti L,et al.Pituitary image:pituicytoma[J].Pituitary,2015,18(5):592-597.
[2]Thurnher MM.2007 World Health Organization classification of tumours of the central nervous system[J].Cancer Imaging.2009,9 Spec No A:S1-3.
[3]杨晓宇,刘晓亮,李文森,等.垂体细胞瘤2例并文献复习[J].中国肿瘤临床,2015,42(21):1075-1076.
[4]蒋小飞,周惠芳,周伯如,等.SD大鼠腺垂体细胞体外分离方法的比较[J].医学研究生学报,2017,30(12):1272-1276.
[5]李储忠,张亚卓.2017版who垂体肿瘤分类解读[J].中华神经外科杂志,2018,34(1):1-5.
[6]Gibbs WN,Monuki ES,Linskey ME,et al.Pituicytoma:diagnostic features on selective carotid angiography and MR imaging[J].AJNR Am J Neuroradiol,2006,27(8):1639-1642.
[7]杨来华,唐忠民,李建瑞,等.垂体细胞瘤7例的MRI特征分析[J].江苏医药,2014,40(10):1184-1186.
[8]吴燕妮,何燕,李南云,等.鞍区垂体细胞瘤10例临床病理分析[J].临床与实验病理学杂志,2015,31(6):662-665.
[9]熊先,苗彦明,关树森,等.垂体细胞瘤的临床特征和治疗策略(附11例报告)[J].中华神经外科杂志,2016,32(3):270-273.
[10]Salge-Arrieta FJ,Carrasco-Moro R,Rodríguez-Berrocal V,et al.Clinical features,diagnosis and therapy of pituicytoma:an update[J].J Endocrinol Invest,2018,20(7):1-14
[11]邓伟,祝迎锋.垂体细胞瘤3例临床病理观察[J].诊断病理学杂志,2016,23(10):761-763.
[12]司海鹏,王剑蓉,章宜芬,等.垂体细胞瘤及其罕见室管膜样亚型的临床病理分析[J].临床与实验病理学杂志,2018,34(3):284-288.
[13]薛凤麟,潘国庆,何波,等.鞍上垂体细胞瘤1例并文献复习[J].临床与实验病理学杂志,2016,32(1):93-95.
[14]杜军,沈倩,黄亮亮,等.垂体细胞瘤5例并文献复习[J].临床与实验病理学杂志,2015,31(5):589-591.
[15]李杰,王汉东,杭春华,等.术中磁共振成像在大型侵袭性垂体瘤手术的应用[J].医学研究生学报,2013,26(1):49-51.
[16]Teti C,Castelletti L,Allegretti L,et al.Pituitary image:pituicytoma[J].Pituitary,2015,18(5):592-597.