3%, p53 positive, mitoses >2 per high power field, vascular invasion, up-regulation of genes related to invasion and proliferation, and allelic loss of chromosome 11) might suggest aggressiveness and be suspicious of malignancy before the appearance of metastasis. The early detection of an aggressive phenotype of a prolactin pituitary tumor should permit the earlier establishment of the optimum therapeutic strategy associating surgery and radiotherapy to delay or inhibit metastasis. " />

According to the World Health Organization classification of pituitary tumors, only tumors with systemic metastasis must be considered as carcinomas. Invasive tumors with multiple recurrences are only classified as aggressive tumors or "atypical adenomas". To illustrate the problems encountered in the pathological diagnosis of pituitary carcinoma and in patient management, we present two male patients operated on for an aggressive prolactin pituitary adenoma with and without metastasis. In case 1, 5 surgeries, 3 irradiations, increased doses of dopamine agonists, and trials of temozolomide and carboplatine-VP16 failed to control tumor progression and the appearance of metastases which lead to death 16 years after onset. In case 2, based on the initial diagnosis of an aggressive-invasive adenoma that was resistant to dopamine agonists, gamma-Knife irradiation was initially performed on the intra-cavernous remnant. Eight years after onset, the remnant remained stabilized and the plasma PRL normalized under dopamine agonist. From these 2 cases alongside other cases found in the literature, we propose that the association of certain clinical signs (male sex, dopamine-resistant hyperprolactinemia), radiological signs (invasive macro or giant tumor on MRI) and histological signs (angiogenesis, Ki-67 > 3%, p53 positive, mitoses >2 per high power field, vascular invasion, up-regulation of genes related to invasion and proliferation, and allelic loss of chromosome 11) might suggest aggressiveness and be suspicious of malignancy before the appearance of metastasis. The early detection of an aggressive phenotype of a prolactin pituitary tumor should permit the earlier establishment of the optimum therapeutic strategy associating surgery and radiotherapy to delay or inhibit metastasis.

译文

根据世界卫生组织对垂体瘤的分类,只有具有全身转移的肿瘤才必须考虑为癌。多次复发的浸润性肿瘤仅被归类为侵袭性肿瘤或 “非典型腺瘤”。为了说明在垂体癌的病理诊断和患者管理中遇到的问题,我们介绍了两名因侵袭性催乳素垂体腺瘤而手术的男性患者,无论是否有转移。在病例1中,5次手术,3次照射,增加多巴胺激动剂的剂量以及替莫唑胺和carboplatine-VP16的试验未能控制肿瘤的进展和转移的出现,导致发病后16年死亡。在病例2中,基于对多巴胺激动剂具有抗性的侵袭性腺瘤的初步诊断,最初对海绵体内残留物进行伽玛刀照射。发病八年后,残余物保持稳定,血浆PRL在多巴胺激动剂下正常化。从这2例病例以及文献中发现的其他病例中,我们提出某些临床体征 (男性,多巴胺抗性高催乳素血症),放射学体征 (MRI上的侵袭性大肿瘤或巨瘤) 和组织学体征 (血管生成,Ki-67> 3%,p53阳性,每个高功率场的有丝分裂> 2,血管浸润,与侵袭和增殖相关的基因上调以及11号染色体的等位基因丢失可能提示侵袭性,并在转移出现之前怀疑恶性肿瘤。早期发现催乳素垂体瘤的侵袭性表型应允许较早建立结合手术和放疗以延迟或抑制转移的最佳治疗策略。

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