| Part I Correlation Analysis of Peripheral Blood Cells and Globulin Changes in Patients with Nonfunctioning Pituitary AdenomasObjectives:To compare the difference of peripheral blood cells and some blood biochemical indexes between patients with nonfunctioning pituitary adenomas(NPA),normal populations and meningiomas,explore the characteristics of peripheral blood-related changes in NPA patients.Methods:Clinical and laboratory data were continuously collected in NPA and meningioma patients who diagnosed in neurosurgery between July 2011 and October 2016,and the data of healthy examiners in the same period.Cases with complete records and corresponding criteria were included in the study.Compare the differences of average levels in their peripheral blood cell counts and its proportions and some blood biochemical indicators likes to creatinine(Cr),uric acid(Ua),total protein(TP),albumin(ALB),globulin(GLB),A/G,and cholinesterase(CHE)etal.between the NPA group(n=233),meningioma group(n=53),and the normal control group(n=98).The mean values of the normal control group were used as base values(denominator),the mean values of the NPA and meningioma group were as comparative values(molecule),the average ratio of each index was calculated and plotted to explore the characteristics of the overall peripheral blood index related change in NPA patients.The indicators with significant differences in the mean values between the NPA group and meningioma group were further compared to the difference of the abnormal cases number.Results:There was no significant difference in average age among the three groups,and in gender between NPA group(132 males,101 females)and normal group(52 males,46 females),but between meningiomas(10 males,42 females)and NPA group or normal control group(p<0.05).Those indexes likes to white blood cells(WBC),neutrophils(N)and its percentage(N%),lymphocyte percentage(L%),red blood cells(RBC),hemoglobin(HGB),platelets(PLT),TP,GLB,has a statistically significant difference among the three groups(p<0.05).Furthermore,WBC,N%,N,Plt were increased,but L%,RBC,HGB were decreased significantly in NPA group and meningioma group compared with normal control group(p<0.05);The levels of TP and GLB in NPA group were higher than normal control group,but PLT level was lower compared with meningiomas group,the difference have statistically significant(p<0.05).There are 11.16%patients PLT increased and 14.59%patients HGB decreased in NPA group,compared with meningioma patients(PLT increased 22.64%,HGB decreased 5.66%),has statistically significant differences(p<0.05).Conclusions:The peripheral blood of NPA patients had a significant change compared with the normal population,with the presence of WBC,N%,N,PLT,TP levels increased,and L%,RBC,HGB levels decreased.Male NPA patients may be more susceptible to anemia than normal and meningiomas.Part Ⅱ Preliminary Investigate of Relationship between Hypophysis Hormone Levels and Peripheral Blood Cells in Patients with Nonfunctioning Pituitary AdenomasObjectives:To investigate the characteristics of changes in hormone levels and the relationship bettween with the peripheral blood cells and partially peripheral blood biochemical indexes in NPA patientsMethods:Peripheral blood test data of NPA patients diagnosed by neurosurgery between July 2011 and October 2016 were collected continuously,and included cases with intact hormone test,blood routine,and blood biochemical test were analyzed.According to the corresponding normal reference range,the patient’s hormone levels are evaluated according to their text results;Single hormone index(normal,low,and high)and various hormone indicators(Normal,Simply inferior,Simply increase,Both high and low)were evaluated and grouped by their levels.All patients were divided into groups by:gender,age(youth,middle,and old)and their individual and various hormones.The peripheral blood cell counts and their proportions,and partially biochemical indexes were compared among the groups.Results:In this study,201(86.27%)had at least one abnormal hormone index and 172(73.82%)had at least one low hormone level among the overall 233 NPA patients(male 132 and female 101).According to the level of single hormone levels,the following hormones were found to be lower in patients with NPA:T(51.50%),E2(22.75%),C(22.75%),FT4(24,46%),LH(17.60%),FT3(16.31%)),T3(14.16%),ACTH(12.02%);26.61%with PRL increased and 6.87%with ACTH increased in the 233 patients.The levels of HGB,TP,and CHE have significantly difference between the groups of various hormone indicators(p<0.05).There has a significant difference average levels among WBC,N,L,M,RBC,HGB,Cr,Ua,A/G,PLT between males and females(p<0.05).The levels of peripheral blood in each individual hormone showed that T3,TSH,PRL,ACTH,C were related to WBC(N,L,and proportion)(p<0.05);T3,FT3,FT4,TSH,PRL,C,E2,LH,FSH,T were related to RBC and HGB(p<0.05);FT3,E2,T,GH were associated with Cr(p<0.05);T4,FT4,C,E2 were associated with UA(p<0.05);T3,FT3,FT4,TSH,FSH,GH were associated with CHE(p<0.05).Conclusions:Patients with NPA are easyly likely to merger exists sex hormones,thyroid hormones,and cortisol deficiency.NPA patients have different levels of changes in peripheral blood indicators among different hormone levels.Part III The Study on MRI Features and Invasiveness of Cystic Nonfunctioning Pituitary AdenomaObjectives:To analyze the related MRI features of cystic degeneration in NPAs and to explore the relationship between cystic degeneration and invasiveness.Methods:The complete clinical,imaging,and pathological data of NPAs patients diagnosed by neurosurgery between July 2011 and October 2016 were collected continuously;the preoperative MRI features of NPAs were assessed,including:the tumor size,presence of cystic degeneration(The cystic degeneration is defined as the MRI on T2WI fluid signal>5 mm),growth pattern,tumor morphology,parasellar extension grade(Based on the modified Knosp-Steiner classification,definitions 3B and 4 are invasive),and the number of cystic cysts,cyst size,fluid level,and the location of the cyst,etc.among cystic NPA.Based on the presence or absence of cystic changes(cystic NPAs,solid NPAs),cyst size(<10mm,10-20mm,>20mm),number of cysts(single,2-6,≥7),fluid level,tumor morphological classification(vertical,cystic,lateral extension,deviated,under-sinus,lobular,isolated,and mixed),combined with intraoperative conditions such as tumor texture,blood supply,and presence or absence of invasiveness(according to the improved Wolfsberger criteria,the relevant intraoperative performance is considered as invasive),respectively,to explore the differences between the MRI characteristics of the groups,the intraoperative conditions,.The MRI features and differences in intraoperative conditions between the groups were explored respectively.Results:The 203 cases of NPA(cystic/solid:99/104)tumors were maximally caliber 10.3mm～88.3mm.The average cystic NPA size(36.9±13.2mm)was significantly larger than solid NPA(30.0±10.9mm).The ratio of giant NPA which size>40mm in cystic NPA(38.38%)was statistically higher than that in solid NPA(19.23%),(p<0.05);Both the proportion of high-grade(Grade 3B and 4)and intraoperative invasion in cystic NPA was significant higher than solid NPA(p<0.05).There was no significant difference in the age,gender,tumor texture and blood supply between the cystic and solid NPA(p>0.05).The maximal diameter and the ratio of giant type in cystic NPA with multicystic cavity was larger than single cystic cavity(p<0.05).The difference in paranasal stenosis grade and intraoperative invasion,as well as cystic size,tumor texture and blood supply between multicystic cavity and single cavity cystic NPA is not statistically different(p>0.05).The cystic NPA without liquid level were statistically higher at paraspinal expansion classfication and intraoperative invasion than the cystic NPAs with liquid level,(p<0.05).The location of the cysts mostly occurred in the upper part of the tumor(70.11%),higher than the sum of the second half and the middle part(29.89%)(p<0.05).There was no significant difference in the left and right,front and rear azimuths(p>0.05).From the morphological classification of the tumor,several types with higher proportion of cystic lesions were:mixed type 69.23%(9/13),lateral extension type 68.42%(13/19),vertical and cystic type 64.29%(36/56)and under-sinus type 46.67%(7/15).Conclusions:The NPA with large diameter,irregular shape,high grade of parasellar extension,and sinusoidal extension along the midline may be susceptible to cystic changes;NPA cystic lesions tend to occur in the upper part of the tumor;Cystic NPA is more likely to be an aggressive adenoma compared to the solid NPA.Part Ⅳ The Effect of Transsphenoidal Surgery and Short-term Follow-up of Cystic Nonfunctioning Pituitary AdenomasObjectives:To explore the effect of transsphenoidal microsurgical treatment of cystic NPAs and short-term follow-up.Methods:The 203 cases of NPA patients diagnosised during from July 2011 to October 2016 in neurosurgery were followed-up and their medical history was traced retrospectively.Combined with clinical,surgical,and radiographic data,analyze the total surgical resection rate between cystic and solid NPA,and the possible influencing factors(likes to tumor size,texture,blood supply,intraoperative invasive performance,cyst size,cysts number,fluid level);We defined tumor recurrence as tumor reappearance after total resection or residual tumor regrowth.Assessed the tumor recurrence rate and the interval from surgery to recurrence in follow-up patients,and compare the differences between cystic and solid NPA.Results:There were 140 cases NPA patients(cystic/solid:75/65)aged from 18 to 76 years old(average age 49.3±11.6 years)were effectively followed 1～88 months(mean 18.2±19.9 months),the median period was 10 months.The average preoperative size of NPA was 33.6±12.0mm.The gross-total resection(GTR)rate of NPA was 57.86%(81/140),122 cases among them were transsphenoidal microsurgery with 61.48%of GTR;The difference of GTR between cystic NPA(49.33%)and solid NPA(67.69%)was statistically significant.The NPA between non-total and total resection groups had a significant difference in the tumor size,Cystic NPA ratio,proportions of giant type and intraoperative invasion(p<0.05).The GTR of NPA with multiple cysts(≥2)was significantly lower(36.36%)than the NPA with a single cysticer(59.52%),p<0.05.Fifteen patients(10.71%)were found to have residual regrowth or recurrence during follow-up,8 were cystic NPA,and 7 were solid NPA.In these NPA,the time from surgery to "recurrence" was detected.The cystic NPA was 14.2±14.5 mean months,which was significantly shorter than that of solid NPA 40.0 ±21.3 months,,the difference was statistically significant(p<0.05).Conclusions:Cystic NPA has a lower GTR rate and a higher residual rate than solid NPA because of the larger tumor size,cystic degeneration and intraoperative invasion.Compared with solid NPA,cystic NPA may have residual regrowth or recurrence earlyer after surgery. |
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