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The Assessment of the Value of Pathologic Immunohistochemical Staining Method of the Six Pituitary Hormones for the Diagnosis with Pituitary Adenoma

Author: DuYanPing
Tutor: HuRenMing；LiYiMing；YeHongYing
School: Fudan University
Course: Internal Medicine
Keywords: Growth hormone adenoma Prolactinomas Thyroid stimulating hormone adenoma Gonadotropin adenoma Pathological immunohistochemical staining Diagnosis
CLC: R736.4
Type: Master's thesis
Year: 2008
Downloads: 320
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Abstract

Purposes: 1. Pituitary tumor six kinds of hormones (growth hormone, prolactin, adrenocorticotropic hormone, thyroid stimulating hormone, follicle stimulating hormone, luteinizing hormone) immunohistochemical staining results with serum hormone levels and clinical symptoms Analysis of the correlation. 2 for further analysis of immunohistochemical staining results with the corresponding serum hormone levels and clinical symptoms of patients with inconsistent approach to explore the reasons for the inconsistency diagnosis. 3 further pathological immunohistochemical method to assess the value of the diagnosis of pituitary tumor types. Aimed at improving the understanding of the various types of diagnosis of pituitary tumors. Method: 1. Neurosurgery, Huashan Hospital from January 2006 to December 2007 in the pituitary tumor surgery patients for the study. All patients with imaging studies (CT or MRI), found that the presence of pituitary lesions. After removal of tissues were HE staining and immunohistochemical examination. 2 of these patients with a history of data consolidation, entry, including the patient's age, sex, clinical symptoms, signs, preoperative and postoperative pituitary hormone levels, imaging findings, pathological diagnosis. 3, respectively, to analyze the the six hormones pituitary tumor pathology immunohistochemical staining results and corresponding serum hormone levels and clinical symptoms relevance. Immunohistochemical staining results with the corresponding serum hormone levels and clinical symptoms inconsistent patient follow-up and pathological specimens again slice immunohistochemical staining to investigate the causes of the diagnostic inconsistencies. Results: 1.GH tumor (1) in the diagnosis of pathological immunohistochemical staining for the GH tumor patients, 86.7% of patients meet the clinical diagnostic criteria. In all found in the the GH tumor clinical diagnostic criteria of patients, 85.2% of patients with pathological diagnosis of GH is also a tumor. The consistency of the clinical diagnosis and pathological immunohistochemical staining for diagnosis of 97.2%. (2) comply with the GH tumor clinical diagnostic criteria GH immunohistochemical staining negative for 18 patients, 16 pathological immunohistochemical staining for hormone tumor, called PRL tumors, these patients are given the typical acromegaly symptoms and elevated serum GH, the majority of patients with serum GH decreased symptoms improved. ③ 16 GH immunohistochemical staining positive does not meet the the GH tumor clinical diagnostic criteria for patients 12 is elevated serum GH but no acromegaly symptoms, three symptoms of acromegaly, serum GH liters , one is neither elevated serum GH nor symptoms of acromegaly. Tumor 2.PRL serum PRL> 150ng/ml clinical diagnostic criteria: (1) in the diagnosis of pathological immunohistochemical staining for PRL tumor patients, 70.9% of patients meet the clinical diagnostic criteria. PRL tumor clinical diagnostic criteria for patients, 89.1% of patients with pathological diagnosis is also PRL tumors. The consistency of the clinical diagnosis and pathological immunohistochemical staining diagnosis was 91.2%. (2) comply with the clinical diagnosis and PRL immunohistochemical staining was negative in 25 patients, 100% of patients with pituitary adenoma, 56.5% of patients have symptoms of oppression, serum PRL / tumor diameter significantly less than 8.88 the PRL diagnosed group 19.18 (P <0.01). ③ pathological immunohistochemical staining but do not meet the diagnostic criteria for clinical diagnosis of PRL tumors of 84 patients, and has a similar level of serum PRL PRL immunohistochemistry into negative elevated PRL group of patients compared to the proportion of large adenomas and compression symptoms of a smaller proportion (P <0.01), serum PRL / tumor diameter 9.7 elevated PRL group was significantly greater than 2.08 (P <0.01). Serum PRL> 90ng/ml clinical diagnostic criteria: (1) in the diagnosis of pathological immunohistochemical staining for PRL tumor patients, 83.7% of patients meet the clinical diagnostic criteria. PRL tumor clinical diagnostic criteria for patients, 79.6% of patients with pathological diagnosis is also PRL tumors. The consistency of the clinical diagnosis and pathological immunohistochemical staining diagnosis was 91.0%. (2) comply with the clinical diagnosis PRL immunohistochemical staining was negative in 62 patients, 100% of patients with pituitary adenoma, 59.7% of patients have symptoms of oppression, serum PRL / tumor diameter was 7.48 significantly less than the PRL diagnosed group 17.73 (P <0.01). ③ pathological immunohistochemical staining but do not meet the diagnostic criteria for clinical diagnosis of PRL tumors of 47 patients, and has a similar level of serum PRL PRL immunohistochemistry into negative elevated PRL group of patients compared to the proportion of large adenomas and compression symptoms of a smaller proportion (P <0.01), the serum PRL / tumor diameter was 4.9 elevated PRL group was significantly greater than 1.96 (P <0.01). Pathological diagnosis as the gold standard, the line of the ROC curve of serum PRL, as diagnostic criteria when serum PRL> 100.06ng/ml the area under the curve, sensitivity and specificity were 82.2% and 84%, clinical diagnosis and pathological diagnosis rate was the highest. 3.TSH tumor (1) in the diagnosis of pathological immunohistochemical staining for TSH tumor patients, 21.6% of patients with elevated serum TSH. And in all serum TSH patients, 20.5% of patients with pathological diagnosis of TSH is also a tumor. ② 31 patients with serum TSH increased pathological TSH immunohistochemical staining was negative, of which 11 were thyroid dysfunction in patients, one from central hyperthyroidism, 19 patients with serum FT3, FT4 normal. (3) of 29 patients with pathological TSH immunohistochemical staining positive serum TSH is not elevated serum FT3, FT4 are within the normal range. Gonadotropin (FSH / LH) tumor (1) in the diagnosis of pathological immunohistochemical staining for FSH / LH tumor patients, 20.9% of patients with serum FSH / LH rise. In serum FSH / LH increased in patients, 48.3% of patients with pathological diagnosis is also FSH / LH tumor. 30 (2) serum FSH / LH elevated FSH / LH immune histochemical staining for negative patients, 26 pathological diagnosis of hormone-free tumors, named GH tumor, called PRL tumors, 100% of patients adenoma. (3) serum FSH / LH and FSH / LH immunohistochemical staining positive for 106 patients, in terms of age, sex, clinical symptoms, a large proportion of adenomas compared with no hormones tumor group, no difference (P> 0.05 ). Conclusions: 1. Prompted for the imaging of patients with pituitary tumors, serum PRL> 100ng/ml as the cutoff value, immunohistochemical staining and pathological diagnosis in line with the highest rate. 2 is recommended that all rows pituitary tumor surgery in patients with postoperative specimens should be the pathological immunohistochemical staining diagnosis, especially in patients with elevated serum PRL in patients with elevated serum 6 pituitary hormone neither. For patients with elevated serum PRL, in addition to PRL, FSH do, LH pathological immunohistochemical staining is also very important; For patients with elevated serum six pituitary hormones neither pathological FSH, LH immune group staining detection is very important.

The Assessment of the Value of Pathologic Immunohistochemical Staining Method of the Six Pituitary Hormones for the Diagnosis with Pituitary Adenoma

Abstract

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