The Blood Supply And Micro-angioarchitecture Of Pituitary Adenomas Consistent With Different Histological Conformation Based On MRI

Background and Objective Pituitary adenomas is a common intracranial t?mors,one of the major treatment is transsphenoidal surgery,but the surgical treatment effect is not very satisfied,how to improve the effect of the treatment is still a current research hot spot and the difficulty of neurosurgeons.In clinical work we found that pituitary adenomas tissue conformation is not the same,some is parenchyma,or cystic change,at the same time,also found special image features such as pituitary adenomas like spongy change,cordage change.The clinical features,characteristics of blood supply and the possibility of the pathological mechanism in these different histological conformation of pituitary adenomas are not satisfactory explained in current.To further study the clinical features of these histological conformation types and internal mechanism,can provide some useful reference value for preoperative evaluation of pituitary adenoma,operation strategy formulation,etc.Studied in this paper is divided into three parts,from the clinical and imaging features,blood supply to microvasculature in different histological conformation of pituitary adenomas: 1)image analyzing the relationship between the different histological conformation of pituitary adenomas,in image signs,growth behavior,invasion characteristics,pathological type,to explain the inner relationship between the clinical characteristics of pituitary adenomas and histological conformation;2)To evaluate the blood supply in different areas of the solid pituitary adenomas and comparing lack blood supply region with cystic position of the adenomas at the same time,to explore the characteristics of blood supply of pituitary adenoma and the relationship between different histological conformation;3)analyzing the micro-angioarchitecture of the different histological conformation of pituitary adenomas,to explore the relationship between the microvasculature and histological conformation as well as the influencing factors of regulating the micro-angioarchitecture of pituitary adenomas.Methods 1)We have analyzed the clinical data about preoperative images,operation findings and pathological tests in patients with pituitary adenoma who were admitted to our hospital department of neurosurgery From May 2014 to October 2016.According to the different histological conformation those patients was divided into four groups: parenchyma group(n = 68),cystic group(n = 44),cordage group(n = 12),sponge group(n = 5),analysis clinical features of these four type of hitological conformation of pituitary adenomas.2)We have consecutively collected 79 cases of patients with pituitary adenoma from May 2015 to May 2016.These patients were divided into parenchyma group(n=40)and cystic group(n = 39)according to the presence of cystic change.We conducted dynamic enhanced MR scanning in parenchyma group,then we calculated the steepest slopes(SSmax)in different areas of the pituitary adenomas.The location of cystic change of the pituitary adenoma was recorded and analyzed for the cystic change group.3)Collecting the pathological specimen paraffin blocks of 74 patients with pituitary adenomas who were admitted to our hospital from October 2015 to October 2016.Their pathological specimen paraffin blocks were immunohistochemically stained for detecting vascular endothelial cell to showed that t?mor microvascular information,and then these immunohistochemical staining slides were photographed.Finally photos were taken into Image J for microvascular information extraction and analysis.Results 1.The clinical characteristics of different histological conformation of pituitary adenomas There are 12 cases of cordage type and 5cases of sponge type in 129 cases of pituitary adenomas,these cases are adenomas of large type or huge type with average maxim?m t?mor diameter for(3.65 + 1.01)cm and(3.02 + 1.43)cm respectively.68 cases of pituitary adenoma are in parenchyma group,its average maxim?m t?mor diameter for(2.27 ± 1.06)cm;44 cases of pituitary adenoma are in cystic group,its average maxim?m t?mor diameter for(2.84 ± 1.12)cm;The largest diameter are difference between those types of t?mor(P < 0.05).Pituitary adenomas of cordage type is significantly greater than parenchyma and cystic type for largest diameter(P < 0.05).Comparing the different group in t?mor's growth direction,we found that t?mor spreading degree toward the cavernous sinus have no statistical significance between these four types of adenomas(P > 0.05);pituitary adenomas of cordage type comparing with parenchyma and cystic type are more likely to grow upward to the saddle or downward to the sphenoid sinus(P < 0.05).There are 109 cases in the 129 cases of pituitary adenomas negatively expression CD34,Comparing CD34 expression between the groups of different histological conformations has no difference(P > 0.05).Investigating the expression of Ki67,expression >3% has 27 cases(20.9%),comparing the expression of Ki67 in different histological conformation the difference has no statistical significance(P > 0.05).Comparing t?mor invasion in different histological conformation,we found that there is no statistically significant difference between them(P > 0.05).Different histological conformation of pituitary adenomas expression of immunohistochemical hormone has no statistically significant difference(P > 0.05).2.Analyzing the blood supply of different histological conformation of pituitary adenoma with dynamic enhanced MR.The parenchyma group showed an upper SSmax of 2.52 ± 1.18,a lower SSmax of 2.89 ± 1.46,a left SSmax of 2.71 ± 1.31,and a right SSmax of 2.66 ± 1.29.There was significant difference between the upper and lower SSmax(p<0.001);The location of cystic change of the pituitary adenoma is mainly in the upper region,accounting for 48.7% of cases.The t?mor largest diameter is not correlated with upper SSmax in parenchyma group(r = 0.124,P = 0.124).The t?mor largest diameter is not correlated with lower SSmax in parenchyma group(r = 0.269,P = 0.269);the t?mor largest diameter is statistically correlate with difference value of SSmax of upper and lower region in pituitary adenomas(r = 0.463,P = 0.463).3.Analyzing the microvasculature architecture between different histological conformations of pituitary adenomas.Comparing difference of the microvascular density in different of histological conformation of pituitary adenoma are statically significant(P < 0.05),the microvascular density of the cordage type of the pituitary adenoma is statistically lower than parenchyma type(P < 0.05);the difference of microvascular density between parenchyma and cystic type is not statistically significant(P > 0.05);the perimeter of cystic type of pituitary adenoma is longer than parenchyma type and cordage type(P < 0.05);circularity of microvascular is statistically difference between different histological conformation and circularity of cystic type is lowest one in those three types of pituitary adenomas(P < 0.05).The difference of microvascular density in different hormone types of pituitary adenomas is statistically significant(P < 0.05),as well as the difference of average area,perimeter and circularity of microvascular is statistically significant(P < 0.05);microvascular density of FSH type is higher than null cell type,perimeter is longer,circularity is lower than null cell type(P < 0.05);multiple hormone type has higher microvascular density than null cell type and has lower circularity than null cell type(P < 0.05);comparing the parameters of microvascular between FSH and PRL type of pituitary adenomas is not statistically significant(P > 0.05).The largest diameter of pituitary adenomas is not correlated with microvascular density of t?mor(Pearson's correlation coefficient r = 0.104,P = 0.377).The largest diameter of pituitary adenomas is not correlated with average area,perimeter and circularity of microvascular(P > 0.05).the difference of expression of Ki – 67(divided with 3% to two group)of these two group is not statistically significant in microvascular parameters(P > 0.05);Comparing microvasculature architecture between invasive and noninvasive t?mor of pituitary,the difference is no statistically significant(P > 0.05).Conclusion 1.Different histological conformation of pituitary adenomas have different the largest t?mor diameter,reflecting that the different histological conformation of pituitary adenoma may has different speed of t?mor cell proliferation and cell metabolic features.2.The different histological conformation of pituitary adenomas trends to toward different direction of expansion.Cordage group of pituitary adenomas is likely to grow upward to the saddle or downward to the sphenoid sinus,but they relatively less extend to bilateral cavernous sinuses.3.Analyzing blood supply in the different region of parenchyma of pituitary adenomas by dynamic enhanced magnetic resonance imaging techniques,we found that t?mor's blood supply is not grow with the increasing of t?mor size;T?mor blood supply polarization of upper and lower part of adenomas is more and more obvious with the increase of the largest t?mor diameter,of regional differentiation,lower part of upper t?mor blood supply is commonly weak than lower part of t?mor.The superior part of t?mor becomes a "trigger point" for infarction of pituitary adenoma.This may be the reason why pituitary adenomas cystic change often appear in the upper part of the t?mor.4.The different histological conformation of pituitary adenomas are difference in microvascular architecture.Although cystic type of pituitary adenomas has no obvious difference with parenchyma type of t?mor in microvascular density,but its morphological vascular is differences,which may be the micro vessels in remaining part of t?mor which had cystic change adaptively adjust its morphology to increase blood supply for residual part of t?mor.Cordage type of pituitary adenomas has the lowest microvascular density,but its micro vessels are relatively neat,it suggests that cordage type of pituitary adenomas has not rich blood supply,the appearance of this type of pituitary adenoma can be used as a reference for surgery strategy.5.Different hormone types of pituitary adenomas has different microvasculature,they are not only different in vascular density,but also in the morphological vessels.Reviewing the findings in previous literatures,we suppose that regulation of angiogenesis in the pituitary adenomas which may be different from those intracranial t?mors,it is mainly through hormones to angiogenesis of pituitary adenomas,these hormones not only affect the density of t?mor vessels,also affect the shape.