原発性下垂体癌の2剖検例

TWO AUTOPSY CASES OF PRIMARY PITUITARY CARCINOMA

　抄録　我々は下垂体癌の2剖検列を経験したので報告する。症例1は45歳，女性，右同名半盲を主訴として入院し，下垂体腺腫の診断で腫瘍切除術を受けたが，術後消化管出血を併発して死亡した。剖検では左視床下部，乳頭体，視神経，第5脳神経，中脳，蝶形骨に浸潤する腫瘍で，頭蓋外転移はない。組織学的に中等度異型性を有する下垂体癌と診断した。症例2は44歳，女性，末端肥大，頭痛を主訴として入院，下垂体腺腫と診断され，腫瘍亜全摘と4,500radの放射線照射を受けた。その後状態は安定していたが，7年後に右聴力障害，構音障害，失調性歩行の急激な進展のため，腺腫再発の診断のもとに再び腫瘍の亜全摘が行なわれた。しかし術後に敗血症を併発して死亡した。剖検では残存下垂体腺部から橋腹側，右小脳橋角，右小脳実質内に連続進展する腫瘍で，頭蓋外転移はない。組織学的に構造，細胞異型の高度な腺癌で，一部に多形膠芽腫との鑑別が極めて困難な部分を有していた。しかしその部分も，GFAP染色，電顕などにより腺癌の一部と考えられ，下垂体癌と診断した。

We studied two autopsy cases of primary pitui-tary carcinoma.

Case-1. A 45 year old female was admitted on Oct. 4 1978, with a complaint of right homonymous hemianopsia. And diagnosis was pituitary adenoma. Partial removal of pituitary tumor was performed on Oct. 23 1978. She died on Dec. 5 1978 due to bleeding of gastrointestinal tract. Autopsy dis-closed a pitutary carcinoma invading the left hy-pothalamus, mamillary body, optic and V cranial nerves, and mid brain as well as sphenoid bone. No extracranial metastasis was noted.

Case-2. A 44 year old female with a history of acromegaly for 6 years was admitted with a com-plaint of headache on May 8 1976. She was diag-nosed as having pituitary adenoma. The subtotalremoval of pituitary tumor was performed on May 21 1976 and followed by 4500 rad irradiation. At this time, pathological diagnosis was eosinophilic adenoma. Seven years later, she complained of progressive right hearing disturbance, dysarthria and ataxic gait 1983. The second subtotal removal of pituitary tumor was performed with a diagnosis of recurrence of pituitary adenoma on Oct. 7 1983. After the operation, she complicated sepsis and died on Jan. 14 1984. An autopsy disclosed a pi-tuitary carcinoma from residual pituitary gland, continuously extending to the subarachnoid space of the pons, and invading right cerebello-pontine angle and cerebellum. The histological examina-tion revealed pituitary carcinoma with high pleo-morphism and glioblastoma multiform-like feature were within the tumor. The glioblastoma multi-form-like cells were, however, negative for GFAP and S-100 protein immunohistochemically, but were shown ultrastructurally to have a small num-ber of secretory granules within the cytoplasm sug-gesting pituitary cell origin. No extracranial meta-stasis was noted.