图7 Syn

图8 CgA

图9 CK

图10Ki67

图11GFAP

This is a case of pituitary adenoma (adenohypophyseal adenoma) and the histology and immunohistochemistry are all very characteristic. Pituitary adenomas are usually very cellular (except in cases receiving presurgical hormonal antagonist treatment) and epithelial. Neoplastic cells have a tendency to be arranged in papillary architecture with rich blood supply. Though cellular, mitotic figures are very rarely found and cytologic atypia is minimal if any. An occasional giant cell with hyperchromatic nuclei may be seen sporadically, but this is considereddegenerative rather than true anaplasia. Features of malignancy (large nucleoli, irregular nuclear membranes, brisk mitotic activity, nuclear pleomorphism and tumor necrosis) are never found. When they do exist, metastasis and another primary malignancy should be seriously ruled out. Pituitary carcinoma is very rare, and it may or may not show these anaplastic features. Like many endocrine neoplasms in other organs, the histology and cytology of endocrine neoplasms do not predict biological behavior. In other words, an occasional case of histologically benign pituitary adenoma may invade local surrounding structures and recur rapidly after initial surgery, so-called "invasive" pituitary adenoma. Though this is not diagnostic of carcinoma, it is difficult to treat for obvious reasons.

这是一例 垂体腺瘤（腺垂体腺瘤），其组织学和免疫组化都很典型。垂体腺瘤通常细胞丰富（接受术前抗激素治疗的病例除外）。肿瘤细胞往往形成乳头结构，血管丰富。尽管富于细胞，核分裂象少见，细胞不典型性即使有也很轻微。偶见散在巨细胞，核浓染，被认为是退变不是真正的间变。未发现恶性特征：如 大核仁、不规则核膜、核分裂活跃、核异质性以及肿瘤性坏死。如果有上述恶性特征，应该排除转移和其它原发恶性肿瘤的存在。垂体癌很少见，它可以显示或者不显示间变特征。象其它器官内分泌肿瘤一样，内分泌肿瘤的组织学、细胞学不能提示其生物学行为。也就是说，有时组织学良性的垂体腺瘤可以侵犯局部周围组织结构，术后很快复发－－所谓的“侵袭性垂体腺瘤”。尽管不能诊断为癌，治疗困难。（liguoxia71试译）

垂体腺瘤组织学形态可以多样，瘤细胞弥漫成片或排列成索、巢状、窦隙样、腺样、假腺样或乳头状结构，IHC：除表达 ACTH、TSH、FSH、LH、GH、PRL 其中之一或数种同时表达外，尚可表达Syn、CgA、Cam5.2，本例组织学形态以腺样及乳头状结构为主。诊断时需要与转移性腺癌鉴别。

 谢谢 楼上老师们的指教，

最后报告：  垂体腺瘤。

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 垂体腺瘤

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