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

:根据世界卫生组织垂体瘤分类,只有具有全身转移的肿瘤才可被视为癌。具有多次复发的浸润性肿瘤仅分类为浸润性肿瘤或“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,我们介绍了两名男性患者,他们患有侵袭性催乳素垂体腺瘤,有或没有转移。在病例1、5的手术,3的放射线,增加的多巴胺激动剂剂量以及替莫唑胺和卡铂-VP16的试验中,未能控制肿瘤的进展和转移的出现,从而导致发病后16年死亡。在案例2中,基于对多巴胺激动剂有抵抗力的侵略性腺瘤的初步诊断,最初对海绵体内残余物进行了伽玛刀照射。发病八年后,在多巴胺激动剂作用下,残余物保持稳定,血浆PRL正常化。从这2例病例以及文献中发现的其他病例中,我们建议将某些临床体征(男性,多巴胺耐药性高泌乳素血症),放射体征象(MRI上的浸润性大肿瘤或巨瘤)与组织学征象(血管生成,Ki- 67> 3%,p53阳性,每个高倍视野中的有丝分裂> 2,血管浸润,与浸润和增殖相关的基因上调,以及11号染色体的等位基因丢失,这可能表明其具有侵略性,并且在出现转移之前怀疑是恶性的。泌乳素垂体瘤侵袭性表型的早期检测应允许较早建立最佳的治疗策略,以结合手术和放疗来延迟或抑制转移。

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