摘要： 目的 报告1 例原位和转移灶激素表达差异的垂体癌患者的临床诊断与治疗经过，以提高对该病的认识。方法与结果 女性患者，50 岁。临床主要表现为垂体腺瘤切除术后4 个月眼部胀痛不适。MRI 显示颅内多发异常信号，垂体形态欠规则，鞍区呈异常信号和强化影；PET-CT 显示多发高摄取病灶。首次术后HE 染色，肿瘤细胞弥漫性分布，呈圆形或多边形伴轻度异形，胞质中等量、嗜酸性，胞核圆形、染色质较细、核仁不明显，核分裂象易见，无坏死；免疫组织化学染色，肿瘤细胞分别表达P53、嗜铬素A，个别表达生长激素，Ki-67 抗原标记指数约为80%，病理诊断为非典型垂体腺瘤。肿瘤复发转移后顶叶肿瘤活检术可见肿瘤浸润脑实质，肿瘤细胞弥漫表达生长激素，Ki-67 抗原标记指数约为75%，病理诊断为转移性垂体癌。结论 垂体癌为临床罕见的恶性垂体肿瘤，需结合影像学和术后组织病理学明确诊断。首选外科手术切除肿瘤灶，辅助术后放射治疗或药物化疗，患者多预后不良。

关键词: 垂体肿瘤, 激素类, 体层摄影术, 发射型计算机, 免疫组织化学, 病理学

Abstract: Objective To introduce the experience of diagnosing and treating one case of pituitary carcinoma with distinct hormone expressions in primary and metastatic lesions and to improve understanding of this disease.  Methods  Retrospective study was performed to analyze the clinical manifestations, imaging characteristics, histopathologic findings, and treatment information of the patient. Immunohistochemical staining was done to both primary and metastatic lesions.  Results  The patient presented with eye pain and discomfort 4 months posterior to pituitary adenoma surgery. Head MRI showed multiple abnormal intracranial signals, irregular pituitary contour, and abnormal enhancements of the sellar region. PET-CT scan showed multiple hypermetabolic lesions. After the first surgery, histological study of the pituitary tumor showed disseminated tumor cells. The cells were round-shaped or polygonal, with mild atypia, moderate amount of eosinophilic plasma and round-shaped nuclei with fine chromatin and unconspicuous nucleoli; mitosis was abundant, while necrosis was absent. The tumor cells expressed P53, chromogranin A (CgA), with scattered expression for growth hormone (GH) and a Ki-67 index of 80% by immunohistochemistry. The first pathologic diagnosis was atypical pituitary adenoma. The parietal tumor cells infiltrated parenchymal after the tumor recurrence. Immunohistochemistry findings were different from the first one. The tumor cells expressed GH diffusely, with a decreased Ki-67 index of 75%. The second pathologic diagnosis was metastatic pituitary carcinoma.  Conclusions  Pituitary carcinoma is a rare malignant pituitary tumor. Diagnosis relies on radiology and pathology. Surgical resection and radiochemotherapy are the current treatment of choice but yield poor response. General prognosis of the disease is poor.

Key words: Pituitary neoplasms, Hormones, Tomography, emission-computed, Immunohistochemistry, Pathology