摘要：

目的 报道1 例垂体转移性肺非典型类癌患者的临床资料，总结此类肿瘤的临床病理学特征及诊断与鉴别诊断要点。 方法与结果 女性患者，81 岁，临床表现为头痛，突然失明；头部MRI 提示鞍区占位性病变。遂行经鼻蝶入路鞍区占位性病变切除术，术中可见肿瘤位于鞍内，呈灰红色，直径 约2 cm，质地柔软，血运不丰富，无包膜，边界欠清晰，沿边缘手术全切除肿瘤。组织学形态观察，肿瘤组织由形态较单一、大小较一致的小圆形细胞构成，呈巢片状弥漫性分布，可见核分裂象和灶性坏死。免疫组织化学染色，肿瘤细胞弥漫性表达突触素、CD56，部分表达甲状腺转录因子?1、广谱细胞角蛋白、P53，不表达生长激素、泌乳素、促肾上腺皮质激素、卵泡刺激素、促甲状腺激素、黄体生成素、S?100 蛋白、甲状腺球蛋白、降钙素，Ki-67 抗原标记指数约为33%。 结论 垂体转移瘤临床少见，垂体转移性肺非典型类癌更为罕见，明确诊断依靠临床病史、组织学形态和免疫表型。

关键词: 肺肿瘤, 类癌瘤, 肿瘤转移, 垂体, 免疫组织化学, 病理学

Abstract:

Objective  To study clinicopathological features, diagnosis and differential diagnosis of atypical lung carcinoid metastasis to the pituitary gland based on clinical data of one patient.  Methods and Results  A 81-year-old female presented headache and sudden blindness, and head MRI showed that there was a lesion at the saddle area. The tumor was detected at intrasellar and in grayish red during surgery. The diameter of tumor was 2 cm. The tumor was soft with no envelop at and well-defined margins, and insufficiency in blood supply. The tumor was removed completely along its edge. Under optical microscopy, the tumor was consisted of small round cells of the same size. Tumor cells were distributed around blood vessels in a nest manner or diffuse manner with brisk mitotic activity and focal necrosis. By using immunohistochemical staining, the tumor cells were diffusely positive for synaptophysin (Syn), CD56 and thyoid transcription factor - 1 (TTF - 1), focal positive for cytokeratin (CK) and P53, and negative for growth hormone (GH), prolactin (PRL), adrenocorticotropic hormone (ACTH), follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), luteinizing hormone (LH), S-100 protein (S-100), thyroglobulin (TG) and calcitonin. Ki?67 labeling index was about 33%. Conclusions  Pituitary metastasis is a rare tumor, and only a few cases of atypical lung carcinoid metastasis to the pituitary gland have been reported. Definite diagnosis could be made by history, typical histopathological characteristics and immunohistochemical expressions.

Key words: Lung neoplasms, Carcinoid tumor, Neoplasm metastasis, Pituitary gland, Immunohistochemistry, Pathology