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Brain and Nerve No to Shinkei Volume 34, Issue 9 （September 1982）

Brain and Nerve 脳と神経 34巻9号（1982年9月発行）

Japanese English

原著

下垂体腺腫の境界に関して—手術所見と病理組織学的所見の対比 THE CIANICO-PATHOLOGICAL STUDY ON THE BOUNDARY OF PITUITARY ADENOMAS 寺本明 ¹ , 高倉公朋 ¹ , 福島孝徳 ² Akira Teramoto ¹ , Kintomo Takakura ¹ , Takanori Fukushima ² ¹東京大学神経外科 ²三井記念病院脳神経外科 ¹Department of Neurosurgery, Faculty of Medicine University of Tokyo ²Department of Neurosurgery, Mitsui Memorial Hospitial pp.887-894

発行日 1982年9月1日 Published Date 1982/9/1

DOI https://doi.org/10.11477/mf.1406204999

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Abstract 文献概要
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　抄録　下垂体腺腫と前葉組織は術中どこまで正確に鑑別し得るか，又腺腫と前葉，下垂体硬膜との境界は組織学的にどうであるか，の2点を各ホルモン産生腺腫に関して検討した。前者の目的には41例の手術症例について「腺腫」「前葉」「境界部」と考えられる部位を採取した。後者に関しては，38例で腺腫・前葉境界部を，61例で下垂体硬膜への浸潤を主に免疫染色を用いて検索した。その結果，腺腫および前葉のいずれも手術所見の正確度は89％であった。多くの場合，腺腫は黄白色で柔かく，前葉はより赤色調で硬いが，腺腫がfibrousで硬い場合は前葉と鑑別することが困難であつた。腺腫・前葉境界部に関する紅織学的検索では，PRL産生腺腫およびACTH産生腺腫（特にNelson症候群）が高率に不規則な境界を呈した。下垂体硬膜への浸潤は，他の腺腫に比し，PRL産生腺腫が断然高率（75％）であった。以上より，　PRL産生腺腫やACTH産生腺腫においては，徒来のselective adenomectomyのみでは腺腫摘出が不充分であり，より根治的な手術が必要であることを論じた。

In order to confirm the accuracy of surgeon's impressions for the adenoma tissue and the resi-dual gland during the pituitary surgery, the ope-rative findings on 68 specimens taken from 41 pituitary operations were compared with the pathological results. The accuracy of the opera-tive findings for each tissue was obtained as follows: the adenoma tissue 33)37 (89%), the residual gland 8/9 (89%), the boundary between the adenoma and the gland 17/22 (77%). In most instances, the adenoma was yellowish-white soft mass, while the gland was somewhat reddish firm tissue. However, in case of fibrous adenomas, it was difficult for the surgeon to clearly differen-tiate the adenoma from the gland.

Secondary, the boundary between the adenoma and the gland were histologically examined in 38 specimens (PRL 12, GH14, ACTH 7, N-F 5), using the enzyme-labeled antibody method. Both GH producing adenomas and non-functioning ones generally showed clear boundaries, while PRL producing adenomas and ACTH producing ones (especially adenomas with Nelson's syndrome) frequently demonstrated irregular borders over a wide area.

The third, the invasions of adenoma cells into the pituitary dura were studied in 61 cases (PRL 20, GH 22, ACTH 5, N-F 14). As compared with GH producing adenomas and non-functioning ones, prolactinomas showed markedly high percentage (75%) of dural invasions. Since all ACTH produc-ing adenomas belonged to the subglandular type, no dural invasions were found in them.

Our results suggested that the selective adeno-mectomy was insufficient for the surgical cure especially in prolactinomas and ACTH producing adenomas. The authors stressed that more radical resections were necessary in the operations of these adenomas.