The MRI Analysis About Orientation Of Cystic Degeneration In Pituitary Macroadenoma And Its Mechanism Research

Chapter 1 : The MRI Analysis about Orientation of Cystic Degeneration in Pituitary Macroadenoma0bjective To observe the cystic degeneration position in pituitary macroadenoma and to explore the relative position between the cystic degeneration and adenoma on MRI,and to analyze the pathological type,growth pattern,biological behavior and its mechanism of adenoma.Methods(1)The clinical,imaging and pathological data of 127 patients with pituitary macroadenoma were collected,which were operated at the Department of Neurosurgery,Fuzhou General Hospital from January 2013 to October 2015.According to the preoperative imaging data and the surgical outcomes,these patients were divided into substantive adenoma group,cystic degeneration group,hemorrhagic adenoma group,ischemic adenoma group.Regardless of hemorrhagic adenoma or ischemic adenoma,as long as the cystic diameter greater than 5mm,it was classified as cystic degeneration group.(2)Analyzed the adenomatous invasive state between substantive adenoma group and cystic degeneration group combined with preoperative MRI and intraoperative findings.(3)All date was analyzed combined with pathological results.According to the preoperative MRI image,The sagittal maximum plane of cystic degeneration was selected,and through the midpoint of the adenomatous largest diameter,then drew a line parallel to the extension line of sphenoid platform,according to this parallel line to assess if the cyst located in the top or below the adenoma.Through the adenomatous midpoint of the maximum diameter,drew a line that was perpendicular to the extension line of the sphenoid platform,which was used to evaluate if the cyst was at anterior or posterior of the adenoma.Select the coronal maximum plane of cystic degeneration,and through the midpoint of the adenomatous largest diameter,then drew a line that was perpendicular to the extension line of sphenoid platform,assessed the lateral deviation of the cyst,then analyzed the common position of the cystic degeneration.(4)In contrast,analyzed the differences among the different cystic degeneration orientation by measuring the suprasellar extension value,the adenomatous height,the the maximum diameter of the cyst and the adenomatous volume.Results(1)There were 50 cases(39.4%)with intraadenoma cystic degeneration of the 127 cases.There were 16 cases with fluid-fluid level of the 50 cases,with a total of 76 cysts,23 cysts with fluid-fluid level.(2)The differences of age,gender,adenoma height,suprasellar extension values in the sagittal/coronal among substantive adenoma group,cystic degeneration group,hemorrhagic adenoma group and ischemic adenoma group were not statistically significant(P>0.05).(3)50 cases with pituitary microadenoma postoperative immunohistochemistry showed null cell type in 16 cases(32%),prolactin type in 12 cases(24%),gonadotropin type in 9 cases(18%),multiple hormone type in 8 cases(16%),growth hormone type in 3 cases(6%),and ACTH type in 2 cases(4%).(4)Adenomas with cystic degeneration are more invassive than substantive adenoma(P<0.05).(5)Among the 50 cases with cystic egeneration,there were 35 cases with 1 cyst,7 cases with 2 cysts,8 cases with 3 cysts or more,and there were statistically significant differences in the number of cysts(P<0.05).Pituitary adenomas are more likely to appear with a single cyst.(6)In the sagittal,cystic degeneration grouping according to the above and below,divided into types of the whole cystic changes group 11(14.5%),the central type 1(1.3%),above group 43(56.6%)and the below group17(22.4%).because of the cystic degeneration volume was equal in the above and below directions,so the other 4 cysts were grouped in front and rear position,which be divided into the whole cystic changes group 12(14.5%),the central type 1(1.3%),the front group 29(38.2%),the rear group 24(31.6%),the remaining 11 cysts were grouped in the above and below position because the cystic degeneration volume was equal in the front and rear directions.In the coronal,the cyst to the right 19(25.0%),to the left 27(35.5%),no shifting 30(39.5%).The distribution of cystic degeneration in the sagittal plane was statistically different(P<0.05),and Cystic degeneration occur easily at the above and front.(7)The adenomatous suprasellar extension value and the adenoma height on the sagittal and coronal of the above group were significantly higher than lower group and whole adenoma group,and the difference was statistically significant(P<0.05).At the same time,the average age of the whole cystic changes group was significantly lower than that of other groups,the difference was statistically significant(P<0.05).The mean value of the maximum diameter of the cyst in above group was larger than that of the below group(13.2±7.3mm vs 9.4±3.8mm)(P<0.05).Compared with the above group and below group,the whole cystic changes group was more likely to have cystic degeneration with fluid-fluid levelConclusion(1)The incidence of pituitary adenomas with cystic degeneration was higher,pituitary adenoma prone to a single cystic degeneration,and the most common type of immunohistochemistry was null cell type,followed by prolactin type.(2)Cystic degeneration often occurs in the top of the Pituitary adenoma or in front.And when the cystic degeneration occurs in the top of the Pituitary adenoma,the adenomas showed higher adenoma height and suprasellar extension values.Chapter 2: The Research on Expression and Related Factors of HIF-1a in Pituitary AdenomasObjective To explore expressions of hypoxia inducible factor-1a protein(HIF-1a)in pituitary adenomas,to analyze the correlation of expression of HIF-1 a with the imaging features,clinical pathological features and biological behavior of pituitary adenomas.Methods(1)Collected the paraffin specimens of 50 patients with pituitary adenoma,operated at the Department of Neurosurgery,Fuzhou General Hospital,from October2015 to August 2016.According to preoperative imaging data and intraoperative findings were divided into substantive tumor group and cystic tumor group,invasive tumor group and non-invasive tumor group,and the tumor was subjected to SIPAP classification.(2)To observe expressions of hypoxia inducible factor-1 protein(HIF-1a)in tissue of pituitary adenoma by immunohistochemistry,and to analyze the relationship between the age,sex and adenoma invasion in the two groups.Results The expressions of HIF-1a in total 48 patients,only 2 cases of negative expression.There was no significant difference in age,sex and Ki-67 between the substantive adenoma group and cystic degeneration group(P>0.05).The expressions of HIF-1a in the cystic degeneration group(13/24)were significantly higher than the substantive adenoma group(11/26),the strong positive rates of the two groups were 54.2% and 42.3%,respectively.But there was no significant difference between the two groups(P>0.05).There was no significant difference of HIF-1a expressionsin between invasive and non-invasive pituitary adenomas(P>0.05).The SIPAP grading method is based on the scope of adenoma invasive to the sella turcica,when grade 3and above,the strong positive rate of HIF-1a expression was 78.6%(22/28),which was significantly higher than that in grade 2 and below 50%(11/22),and the difference was statistically significant(P<0.05),Spearman correlation analysis showed that there was a correlation between the staging of the pituitary adenoma and the positive expression of HIF-1a(r=0.343,P=0.015).Knosp grading was based on the degree of adenoma invasion to the cavernous sinus.There was no significant difference in the HIF-1a expressionb between different levels according to the Knosp grading(P>0.05).There was no significant difference in HIF-1? expression between sphenoid invasion(P> 0.05).Conclusions(1)HIF-1a is generally expressed in pituitary macroadenomas;(2)The high expression of HIF-1 a was related to the degree of pituitary adenoma to suprasellar expansion.The more the tumor spread to the sellar,the more likely it was to be hypoxia above the tumor pole.Chapter 3: Metabolomics Study of Pituitary Adenoma Based on Morphologic ConfigurationObjective To analyze the metabolic profile of pituitary adenomas surgical specimens with Substantial pituitary adenoma and cystic pituitary adenoma using GC-MS,Screening out the difference between the two groups of metabolites,explore the significance of differential metabolites.Methods(1)Collected the surgical specimens of 55 patients with pituitary adenoma,operated at the Department of Neurosurgery,Fuzhou General Hospital from October2015 to November 2016.They were divided into two groups according to preoperative MR images and the surgical outcomes: substantive adenoma group,cystic pituitary adenoma.(2)The small molecular metabolites in 55 cases of pituitary adenomas were detected by GC-MS.SIMCA-P software was used for principal component analysis(PCA),PLS-DA and OPLA-DA to screen for the differential metabolites.Results A total of 20 different metabolites were screened using SIMCA-P software,and the database was matched by AMDIS software.Twenty metabolites including glutamic acid,threonic acid,myristic acid,palmitoleic acid,trans-oleic acid,stearic acid,1-octadecanol,Ethanolamine,pyruvic acid,2-tearoylglycerol,2-oleoylglycerol,2-almitoylglycerol,ribose,2-hydroxybutyric acid,IMP,AMP,GMP,3-hydroxybutyric acid,s-methyl-l-cysteine,methyl phosphate.The cystic degeneration group showed significantly lower tissue contents of 7metabolites(glutamic acid,Ethanolamine,ribose,2-oleoylglycerol,3-hydroxybutyric acid,s-methyl-l-cysteine,methyl phosphate)than those substantive adenoma group(P<0.05).The contents of remaining 13 metabolites in cystic degeneration group were significantly higher than those in the substantive adenoma group(P<0.05).Conclusion(1)There is a difference in the metabolic phenotype of substantial pituitary adenomas and cystic pituitary adenomas.(2)metabolic differences mainly showed in glucose anaerobic oxidation,fat acid metabolism and amino acid metabolism.