Research And Analysis Of Anterior Pituitary Hormones Expression In Craniopharyngiomas

BackgroundWith unknown etiology, craniopharyngioma is a kind of most commoncongenital intracranial tumor and was ever reported for familial disease but withoutdefinite evidence of genetic predisposition. From discovering of craniopharyngiomaon, continuous disputation was focused on the denomination of the tumor byresearchers and the very reason is just its unidentified pathological origin. In history,the name "craniopharyngioma" generally acknowledged up to now was introduced byCushing in 1932.There are two main viewpoints in the pathological origin of craniopharyngiomanow, the embryonic vestige theory was proposed by Erdheim in 1904 and the otherone is pituitary metaplasia theory. In Erdheim's theory, craniopharyngioma isdeveloped just by the remnant ectoderm cells originated from the primitivecraniopharyngeal duct and adenohypophysis. However, in pituitary metaplasia theory,craniopharyngioma may be originated by the histological metaplasia of matureanterior pituitary cells. The latter viewpoint was supported by a series of surprisingautopsy findings since Luse and Kernohan in 1955. Besides the above-mentioned two theories, there are still many other arguments,for example, the closely associated relationship between craniopharyngioma andepidermoid cyst may be puzzled, the association of adamantinoumouscraniopharyngioma and jaw bone tumors is still controversial.On the whole, craniopharyngioma is a kind of tumor always situated in anteriorpituitary and infundibulum in sellar region, its histological genesis problem is stillsuspending.In recent years, more and more evidendce indicated that craniopharyngioma mayhave intimate association with endocrine system, craniopharyngioma may be not justsimple epithelial tumor. Therefore, investigating the relationship ofcraniopharyngioma and anterior pituitary hormones (PRL,GH,ACTH,TSH,FSH,LH) may be helpful to identify the histological genesis problem.Objectives(1) To research the anterior pituitary hormones (PRL,GH,ACTH,TSH,FSH,LH) expression in craniopharyngiomas.(2) To discuss the significance of anterior pituitary hormones expression intumor tissue in craniopharyngiomas histological origin problem.MethodsCollecting the clinic data of 45 craniopharyngiomas, including gender, age,tumor type, cystic/solid, disease recurrence, calcification and Qi's score by MRI/CTscan preoperatively and operation video. Using SABC immunohistochemistry todetect the expression of PRL,GH,ACTH,TSH,FSH,LH in 45craniopharyngiomas. Formalin-fixed paraffin-embedded tissue section from 45craniopharyngiomas were immunostained by a manual method using monoclonal antibodies against PRL,GH,ACTH,TSH,FSH,LH. Immunoreactivity wassemiquantitatively scored based on stain intensity and positive cell, and results wereanalyzed with pathological type, primary/recrurrence, macroscopic pattern,calcification and Qi's score ect by SPSS13.0.Results19 cases of 45 craniopharyngiomas had positive expression in at least oneanterior pituitary hormone (42.2%), 33.3% in adamantinomatous type, and 60.0% insquamous papillary type. Scatterded cell groups with mild to moderate positivity forat least one anterior pituitary hormone (PRL,GH,ACTH,TSH,FSH,LH) werefound. Among 19 cases had positive expression in at least one anterior pituitaryhormone, 57.9% had only one hormone positive expression and 42.1% had more than2 hormones positive expression. The most frequent reaction was found against PRL,which is followed by TSH and ACTH, but GH, FSH and LH was found only in scarcecase. Statistical studies demonstrate significant association between immunostainingof anterior pituitary hormone (ACTH,TSH) and pathological type of tumors (P＜0.05), that means more positive expression of anterior pituitary hormone (ACTH,TSH) was observed in squamous papillary type than in adamantinoumous type.Statistical studies also showed positive correlation between TSH and calcification (P＜0.05), Qi's score and pathological type of tumors (P＜0.05),and negativecorrelation between anterior pituitary hormone and primary/recurrent tumor (P＞0.05). Cystic, solid and mixed tumors had significant difference in expression ofACTH,TSH and Qi'score (P＜0.05). Conclusions(1) Anterior pituitary hormone (PRL,GH,ACTH,TSH,FSH,LH) canbe positively expressed in some craniopharyngiomas, which hinted thepossible homology of craniopharyngiomas and adenohypophysis.Beside the hypothalamic-hypophyseal lesion, it might explain theendocrinological disturbances accompanying the patients suffering fromcraniopharyngiomas.(2) Different characteristic of positive expression of anterior pituitaryhormone was observed in two pathological type, and it may suggest thatdifferent histological origin may exist between adamantinoumouscraniopharyngiomas and squamous papillary craniopharyngiomas.