摘要： 研究背景 垂体转移癌临床罕见，诊断难度较大, 容易误诊，本文拟对其临床表现和组织病理学特征进行探讨。方法 报告1 例垂体转移性肺低分化腺癌患者的临床表现、组织病理学特征和免疫表型，并复习相关文献。结果 女性患者，47岁。临床主要表现为头晕、头痛伴视物模糊，头部CT检查显示鞍上池软组织密度结节影。术中可见肿瘤位于鞍区，大小约为2 cm× 1 cm× 1 cm。光学显微镜观察垂体结构破坏，肿瘤组织由明显异型性的圆形、卵圆形细胞组成，呈巢团状或腺样排列；肿瘤细胞表达上皮膜抗原、广谱细胞角蛋白、甲状腺转录因子-1 和细胞角蛋白7 ，不表达嗜铬素A 、癌胚抗原、人绒毛膜促性腺激素、胎盘碱性磷酸酶、CD117 、白细胞共同抗原、CD30和间变性淋巴瘤激酶1 ，Ki-67抗原标记指数约为15% 。术后辅助左甲状腺素钠和伽玛刀治疗，4 个月后死亡。结论 垂体转移癌可通过组织病理学和免疫组织化学检测明确诊断，同时寻找原发灶。术后需辅助综合治疗。

关键词: 垂体肿瘤, 腺癌, 肿瘤转移, 肺肿瘤, 免疫组织化学

Abstract: Background As a kind of rare tumor, metastatic pituitary carcinoma is very difficult to diagnose clinically and is easy to be misdiagnosed. This article aims to discuss the clinical manifestations and histopathological features of this tumor. Methods The clinical presentations, histopathological features and immunophenotype were studied in one case of poorly differentiated lung adenocarcinoma metastatic to pituitary gland, and related literature was reviewed. Results A 47-year-old woman mainly presented with faint, headache and blurred vision. CT scan demonstrated abnormal signals in suprasellar cistern. During the resection, the tumor could be seen locating in sellar region, the size of which was about 2 cm × 1 cm × 1 cm. Histopathological examination revealed that the structure of pituitary gland was damaged and the tumor was composed of atypical round or oval cells arranged in nest or glandular patterns, in which a number of enlarged plump tumor cells contained abundant eosinophilic cytoplasm with eccentrical caryogenesis. The immunohistochemistry showed that epithelial membrane antigen (EMA), pan cytokeratin (PCK), thyroid transcription factor-1 (TTF-1) and cytokeratin 7 (CK7) were positive in tumor cells with Ki-67 labeling index being 15%, but chromogranin (CgA), cancer embryo antigen (CEA), human chorionic gonadotropin (hCG), placental alkaline phosphatase (PLAP), CD117, leukocyte common antigen (LCA), CD30, anaplastic lymphoma kinase-1 (ALK-1) were negative in tumor cells. After operation the patient received treatment with levothyroxine sodium and γ knife, but died 4 months later. Conclusion Histopathological examination and immunohistochemistry can confirm the diagnosis of metastatic pituitary carcinoma and locate the primary lesion. Postoperative comprehensive therapy is necessary.

Key words: Pituitary neoplasms, Adenocarcinoma, Neoplasm metastasis, Lung neoplasms, Immunohistochemistry