Expression Of Nonfunctioning Pituitary Adenomas Apoplexy On Residual Tumor After Operation, And Study On The Postoperative Changes Of The Pituitary Hormone

Part Ⅰ: Expression of Endothelial cell specific molecule‐1 and its clinical significance in pituitary null cell adenomas0bjective: To explore the expression of endothelial cell specific molecule‐1(ESM‐1) in pituitary null cell adenoma(NCA), and analyze the relationship between the clinical parameter and the expression of ESM‐1. And to discuss the possibility of ESM‐1 as a marker for estimate the invasiveness of pituitary NCA.Methods: 94 cases of pituitary NCA patients who undergone microscopic resection of pituitary NCA by transsphenoidal surgery from January 2010 to May 2014 in department of neurosurgery were included in this analysis. The clinical datas and pathological results of these 94 cases were collected completely. ESM‐1 was detected by immunohistochemical S‐P method in 94 cases of pituitary NCA,and the results of expression were compare with age, sex, invasive status, Ki‐67 labeling index and maximum tumor diameter.Results: The expression of ESM‐1 was observed in the endothelial cells of all the 94 cases and in the adenoma cells of 90 cases. In comparison with noninvasive pituitary NCA, the high expression of ESM‐1 of invasive pituitary NCA which was located in the endothelial cells was significantly increased(P<0.05), there was no significant relationships between high expression of ESM‐1 and age, sex, maximum tumor diameter or Ki‐67 labeling index. There was no significant relationships between the high expression of ESM‐1 of adenoma cells and age, sex, invasion, maximum tumor diameter or Ki‐67 labeling index.Conclusion:(1)The expression of ESM‐1 was observed in the endothelial cells and in the adenoma cells;(2)The high expression of ESM‐1 of NCA which was located in the adenoma cells was negatively correlated with invasive status;(3)The high expression of ESM‐1 in endothelial cells wad positively correlated with invasive status, ESM‐1 could be used as a indicator of aggressive behavior in NCA.Part Ⅱ: Effect of nonfunctioning pituitary adenoma apoplexy on residual tumor after operation0bjective:(1)To calculate the growth rate of residual tumor after undergo microscopic resection of nonfunctioning pituitary adenoma(NFPA) by transsphenoidal surgery, and to explore the effect of NFPA apoplexy on the growth rate of residual tumor;(2)To explore the expression of endothelial cell specific molecule‐1(ESM‐1), surviving and Fascin protein in NFPA, and analyze the relationship between the adenoma apoplexy and the expression of ESM‐1, surviving and Fascin protein.Methods:(1)The clinical datas, follow‐up MRI and pathological results of 57 cases with NFPA who had residual tumor after transsphenoidal operation from January 2010 to May 2014 in department of neurosurgery were analyzed retrospectively. We calcuated the tumour volume doubling time(TVDT), the rate of rapid growth and the apoplexy/tumor size ration of residual tumor. The TVDT of residual tumor were compared with the existence of adenoma apoplexy, the course of adenoma apoplexy and the apoplexy/tumor size ration.(2)ESM‐1, surviving and Fascin protein were detected by immunohistochemical S‐P method in 57 cases of pituitary NCA,and the results of expression of ESM‐1, surviving and Fascin protein were compare with the existence of adenoma apoplexy, the course of adenoma apoplexy.Results:(1)There were 30 cases with NFPA apoplexy, 27 cases without adenoma apoplexy. Postoperative follow‐up showed the residual tumor enlarged in 49 cases, shrinked in 8 cases. The mean TVDT was 1305.82±1685.32 days. The rate of rapid growth of residual tumor in NFPA apoplexy group(56.67%) was not significantly increased compared with no NFPA apoplexy group(66.67%)( P>0.05). There was significant relationship between the rate of rapid growth of subacute NFPA apoplexy group(81.82%) and the rate of chronic NFPA apoplexy group(36.84%)( P<0.05). There was not significant relationships between the rate of rapid growth of the group whose apoplexy/tumor size ration was less than 12%(40%) and the rate of rapid growth of the group whose apoplexy/tumor size ration was more than 12%(66.67%)( P>0.05).(2)The expression of ESM‐1 was observed in the endothelial cells of all the 57 cases. There was significant relationships between the expression of ESM‐1 and the existence of adenoma apoplexy( P<0.05), in comparison with subacute NFPA apoplexy, the expression of ESM‐1 of chronic NFPA apoplexy was not significantly increased( P>0.05). The expression of Fascin protein was observed in all the 57 cases with NFPA. There was significant relationships between the expression of Fascin protein and the existence of adenoma apoplexy( P<0.05), in comparison with subacute NFPA apoplexy group, the expression of Fascin protein of chronic NFPA apoplexy group was not significantly increased( P>0.05). The expression of Survivin was observed in 45 cases with NFPA. There was not significant relationships between the existence of adenoma apoplexy and the expression of Survivin( P>0.05), in comparison with subacute NFPA apoplexy group, the expression of Survivin of chronic NFPA apoplexy was not significantly increased( P>0.05).Conclusion:(1)Adenoma apoplexy can reduce the proliferation of residual tumor of NFPA after transsphenoidal operation.(2)The expression of ESM‐1 and Fascin protein were effected by NFPA apoplexy, the expression of Survivin was not effected by NFPA apoplexy.(3)For patients with NFPA apoplexy which is in subacute or chronic phase, if their symptoms are mild, they can be followed up regularly.Part Ⅲ: The study on the postoperative changes of pituitary hormone of patients with nonfunctioning pituitary adenomas0bjective:To study the characteristic changes of postoperative hormone levels of patients with nonfunctioning pituitary adenoma(NFPA) by the six kinds of pituitary hormones total pituitary hormone, and to discuss the postoperative changes of total pituitary hormone.Methods:(1)The clinical datas, follow‐up datas and pathological results of 87 patients with NFPA who underwent transsphenoidal operation from January 2010 to January 2015 in department of neurosurgery were analyzed retrospectively. According to the degree of resection, 87 patients were divided into 2 groups, including total resection(TR) group and partial resection(PR) group.(2)The perioperative(including the 1st day after operation(1DAO), the 7th day after operation(7DAO), the 4th month after operation(4MAO), the 1st year after operation(1YAO)) pituitary hormones were recorded, and total pituitary hormone were calculated.(3)According to the results of six kinds of pituitary hormones, the total pituitary hormone were caculated, the postoperative changes of total pituitary hormone and six kinds of pituitary hormones were compared between TR group and PR group.Results:(1)There were 87 cases with NFPA. There were 5 kinds of pituitary hormone in PR group, 6 kinds of pituitary hormone in TR group whose difference were statistically significant among observation points(P<0.05), after comparative analysis, the levels of these hormones in multiple observation points were significantly different(P<0.05). In both groups, the total pituitary hormone among the preoperation and 1DAO, 7DAO, 4MAO and 1YAO were statistically significant(P<0.05). In PR group, the total pituitary hormone levels of preoperation were significantly higher than that of 1DAO and 7DAO(P<0.05), the total pituitary hormone levels of 4MAO and 1YAO were significantly higher than that of 1DAO and 7DAO(P<0.05). In TR group, the total pituitary hormone levels of preoperation were significantly higher than that of 1DAO and 7DAO(P<0.05), the total pituitary hormone levels of 1YAO were significantly higher than that of 1DAO, 7DAO and 4MAO(P<0.05).(2)There were 30 cases with NCA. There were 5 kinds of pituitary hormone in TR group whose difference were statistically significant among observation points(P<0.05), There were not pituitary hormone in PR group whose difference were statistically significant among observation points.In TR group, the total pituitary hormone among the preoperation and 1DAO, 7DAO, 4MAO and 1YAO were statistically significant(P<0.05). In TR group, the total pituitary hormone levels of preoperation were significantly higher than that of 1DAO and 7DAO(P<0.05), the total pituitary hormone levels of 1YAO were significantly higher than that of 7DAO and 4MAO(P<0.05).Conclusion:(1)For patients with NFPA, postoperative the total pituitary hormone levels are significantly lower in 1DAO and 7DAO. In PR group, the pituitary hormone levels began to rise 4MAO, while In TR group, the pituitary hormone levels rose from 4MAO to 1YAO.(2)Combined with the six kinds of pituitary hormones, the total pituitary hormone can assess the preoperative and postoperative changes of pituitary function of patients with NFPA accurately, and provide a theoretical basis to predict the recovery of pituitary function after operation and hormone replacement therapy.