| Objective:By collecting clinical data of patients with clinically non-functional pituitary adenoma,and conducting research and analysis on the collected clinical data in accordance with the new version of the endocrine tumors 2017 classification standard,to explore the clinical manifestations and pathology of non-functional pituitary adenoma Features,provide a reference for clinical diagnosis and treatment of nonfunctioning pituitary adenoma.Methods:In this study,the clinical data of 220 patients with clinically nonfunctional pituitary adenoma treated by neurosurgery in Tianjin Huanhu Hospital from April 16,2018 to August 31,2019 were collected(A total of 482 patients with pituitary adenoma treated in the same period).The clinical information collected mainly includes the patient’s name,age,gender,clinical symptoms,imaging results,and postoperative histopathological examination-related results.After verifying that the data obtained is correct,SPSS21.0 statistical software was used to analyze and process the data,P <0.05 had a significant difference.Results:1.Sex and age distribution: a total of 220 cases of clinically nonfunctional pituitary adenoma.There were 97 males(44.1%)and 123 females(55.9%),with a male to female ratio of 0.79: 1.The age range of the patients was 13-80 years old,and the average age was 55.25 ± 11.12 years old.The peak age of onset is 40 to 70 years old(accounting for 85.9%).2.Tumor size: The average maximum diameter of the tumor is 29.0 ± 9.8mm,including 194 cases of large adenoma(88.18%),26 cases of huge adenoma(11.81%),and no small adenoma was found.3.Clinical symptoms: The clinical manifestations of clinically nonfunctional pituitary adenoma are mainly related to the tumor mass-occupying effect,including 131 cases of visual field disturbance(59.5%),83 cases of headache(37.7%),and 9 cases of cranial nerve palsy(4.1%),serum prolactin levels increased slightly in 92 cases(41.8%),pituitary dysfunction in 71 cases(32.2%),and pituitary stroke patients in 21 cases(9.5%).4.Classification: According to the new WHO classification criteria for endocrine tumors,the proportion of pituitary adenomas of different hormone types in this study: 107 cases(48.6%)of resting gonadotropin cell adenoma and 67 cases(30.5%)of men,40 women(18.2%),the difference between men and women was significant(P <0.0001).There were 74 cases(33.6%)of resting adrenocorticotropic cell adenoma,6 cases of male(2.7%),68 cases of female(30.9%),and the difference between men and women was significant(P <0.0001).There were 23 cases(10.5%)of zero cell adenoma.There were 6 cases(2.7%)of multi-hormonal and dual-hormone cell adenoma.There were 5 cases(2.3%)of resting growth hormone cell adenoma.There were 3 cases(1.4%)of resting multihormone PIT-1 positive adenoma.A total of 1 case(0.5%)of resting thyrotropin cell adenoma.There were 1 case(0.5%)of resting prolactinoma.In this study,clinical non-functional pituitary adenoma included the following three high-risk subtypes,a total of 74 cases of resting adrenocorticotropic cell adenoma,3 cases of resting PIT-1 positive multihormone cell adenoma,and sparse granule growth There were 4 cases of hormone cell adenoma.5.Main typing characteristics: the average age of patients with resting ACTH cell adenoma is 54.2 ± 10.5 years old;the proportion of pituitary dysfunction in SGA patients is 46.7%,and the proportion of patients with pituitary dysfunction in three groups of adenoma Obvious and statistically significant(P = 0.005);adrenocorticotropic cell adenoma tumors have an average diameter of 32 ± 10 mm,and the tumor body is larger than zero cell adenoma and gonadotropin cell adenoma(P = 0.029);adrenocorticotropic tumor The proportion of large adenoma in patients with hormone cell adenoma was higher than that of zero cell adenoma and resting gonadotropin cell adenoma(P = 0.060).The average Ki-67 index of zero cell adenoma was 3.59 ± 2.1,which was higher than that of SGA and SCA(P = 0.006).6.The relationship between invasiveness and Ki-67 index: The Ki-67 index of the clinical non-functional pituitary adenoma invasion group was higher than that of the clinical non-functional pituitary adenoma non-invasive group(P = 0.001).7.Recurrence: A total of 34 patients(15.6%)in the relapse group,of which two patients had a history of postoperative radiotherapy,the clinical non-functional pituitary adenoma ki-67 index in the relapse group was higher than that in the non-relapse group-67 index.The invasiveness of the relapse group was higher than that of the non-relapse group,and the difference in invasive rate between the two groups was significant(P = 0.002).Conclusion:In this study,the incidence of clinical non-functional pituitary adenoma was 45.6%,which was more common in women(male to female ratio was 0.78: 1).The average age of onset was 55.25 ± 11.1 years,and the peak incidence was 40 to 70 years(85.9%).The most common clinical symptom of clinically nonfunctional pituitary adenoma is impaired visual field,followed by headache and cranial nerve palsy.According to the new WHO classification standard for endocrine tumors,the most non-functional pituitary adenoma in this study was resting gonadotropin cell adenoma,with a total of 107 cases(48.6%),followed by resting adrenocortic cell adenoma,with a total of 74(33.6%),zero cell adenoma,a total of 23 cases(10.5%).Clinical non-functioning pituitary adenoma This study included a total of three types of high-risk adenoma,mostly resting adrenocortical cell adenoma.Patients with resting adrenocorticotropic cell adenoma are younger and show a female advantage,and the tumor diameter is larger and the proportion of giant adenoma is higher.At the same time,the adenoma also has higher imaging invasiveness and recurrence rate.Patients with resting gonadotropin cell adenoma showed male dominance,with a higher proportion of patients with hypopituitarism.Patients with zero-cell adenoma are more aggressive and their Ki-67 index is higher.The recurrence rate,invasiveness and stroke rate of the high-risk group in clinical non-functional pituitary adenoma were higher than those in the non-high-risk group.At the same time,the Ki-67 index of invasive pituitary adenoma is significantly higher than that of the non-invasive group.Therefore,the Ki-67 index can also be used as an index to predict tumor invasion.In this study,the clinical non-functioning pituitary adenoma recurrence group had a higher Ki-67 index than the non-recurrence group,and its imaging invasive ratio was higher(P = 0.002),which suggests that the combination of multiple disciplines Methods to predict tumor prognosis. |
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