探讨促肾上腺皮质激素(ACTH)免疫染色阳性和阴性的无症状性促肾上腺皮质激素腺瘤(SCAs)的不同临床特点。并探讨垂体限制性转录因子(Tpit)免疫染色对SCAs的诊断价值。
SCAs患者的临床资料,具有Tpit免疫染色阳性和ACTH免疫染色阳性/阴性的典型病理特征,回顾性分析2018年4月至2019年3月在本中心无临床特征和生化证据的库欣综合征.探讨ACTH阳性和阴性SCAs的临床特征和手术结果的差异。
共纳入105名SCA患者(94.3%为女性)。ACTH阴性的SCA为66例(66/105,62.9%),和39个ACTH阳性SCA(39/105,37.1%)。ACTH阴性SCA的病例更有可能具有较低的ACTH水平(27.5±24.0vs.54.4±58.6,P=0.011),更多多发性微囊囊肿(81.8%vs.61.5%,P=0.022)和较低水平的Ki-67表达(低表达率90.9%vs.74.4%,P=0.023)。ACTH阳性和阴性SCA患者在性别方面无统计学差异(97.0%vs.89.7%,P=0.192),年龄(50.3±10.3vs.49.0±11.2,P=0.543),手术史(16.7%vs.23.1%,P=0.419),鞍上延伸(66.7%vs.74.4%,P=0.408),蝶窦延伸(51.5%vs.56.4%,P=0.627),海绵窦侵犯(75.8%vs.66.7%,P=0.314),磁共振成像(MRI)的大囊肿(47.0%vs.61.5%,P=0.149),或总切除率(42.4%vs.51.3%,P=0.379)。
观察到ACTH阴性SCAs在临床上更沉默,并且更可能在MRI上显示多个微囊肿。SCA的患病率,尤其是ACTH阴性的SCA,事实证明被大大低估了,因此考虑到这种难治性垂体腺瘤(PA)亚型的高侵袭性,应给予足够的重视。
To investigate the different clinical characteristics of silent corticotroph adenomas (SCAs) with positive and negative adrenocorticotropic hormone (ACTH) immunostaining, and to explore the value of pituitary-restricted transcription factor (Tpit) immunostaining for diagnosing SCAs.
The clinical materials of patients with SCAs who had a typical pathological feature with positive Tpit immunostaining and positive/negative ACTH immunostaining, and without clinical features and biochemical evidence for Cushing\'s Syndrome in our center from April 2018 to March 2019 were analyzed retrospectively. The differences in clinical characteristics and surgical results between ACTH-positive and -negative SCAs were explored.
A total of one hundred and five patients (94.3% female) with SCAs were included. There were 66 SCAs with ACTH-negative (66/105, 62.9%), and 39 SCAs with ACTH-positive (39/105, 37.1%). Cases with ACTH-negative SCAs were more likely to have lower ACTH levels (27.5 ± 24.0 vs. 54.4 ± 58.6, P = 0.011), more multiple microcysts (81.8% vs. 61.5%, P = 0.022) and lower levels of Ki-67 expression (low expression rate 90.9% vs. 74.4%, P = 0.023). No statistical significant differences were observed between patients with ACTH-positive and -negative SCAs regarding gender (97.0% vs. 89.7%, P = 0.192), age (50.3 ± 10.3 vs. 49.0 ± 11.2, P = 0.543), surgical history (16.7% vs. 23.1%, P = 0.419), suprasellar extension (66.7% vs. 74.4%, P = 0.408), sphenoid sinus extension (51.5% vs. 56.4%, P = 0.627), cavernous sinus invasion (75.8% vs. 66.7%, P = 0.314), large cyst on Magnetic Resonance Imaging (MRI) (47.0% vs. 61.5%, P = 0.149), or gross total resection rate (42.4% vs. 51.3%, P = 0.379).
ACTH-negative SCAs were observed to be more clinically silent and more likely to demonstrate multiple microcysts on MRI. The prevalence of SCAs, especially ACTH-negative SCAs, proved to be substantially underestimated and thus they should be given enough attention in consideration of the high aggressiveness of this subtype of refractory pituitary adenoma (PA).