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Jensflorian (talk | contribs) (→Specific entities: SCO, Pituicytoma and GCT added.) |
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Divisions:<ref>[http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo.html http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo.html]</ref> | Divisions:<ref>[http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo.html http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo.html]</ref> | ||
*Anterior pituitary ([[AKA]] adenohypophysis). | *Anterior pituitary ([[AKA]] adenohypophysis, pars distalis). | ||
*Posterior pituitary (AKA neurohypophysis, neural pituitary). | *Posterior pituitary (AKA neurohypophysis, neural pituitary, pars nervosa). | ||
=Function= | =Function= | ||
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Mnemonic: "Go Look For The Adenoma Please" = GH, LH, FSH, TSH, ACTH, PRL. | Mnemonic: "Go Look For The Adenoma Please" = GH, LH, FSH, TSH, ACTH, PRL. | ||
===Intermedia=== | |||
* Originates from the posterior wall of the Rathke’s pouch. | |||
* Hormones: MSH, ACTH precursor. | |||
* Contains colloid cysts. | |||
===Posterior=== | ===Posterior=== | ||
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*Less cellular. | *Less cellular. | ||
**Usually more cellular in perivascular location. | **Usually more cellular in perivascular location. | ||
Image: [http://www.ouhsc.edu/histology/Glass%20slides/38_09.jpg Herring bodies (ouhsc.edu)]. | |||
<gallery> | |||
File:Pituitary gland histology 2014.jpg | Pituitary gland, low magnification (WC/Athikhun.suw) | |||
</gallery> | |||
=DDx for sella turcica lesions= | =DDx for sella turcica lesions= | ||
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**Classically: visual field defects (bitemporal hemianopsia). | **Classically: visual field defects (bitemporal hemianopsia). | ||
**Others (increased intracranial pressure): headache, nausea, vomiting. | **Others (increased intracranial pressure): headache, nausea, vomiting. | ||
**Tumor of adults. | |||
Classification: | Classification: | ||
#Microadenoma <= 1 cm. | #Microadenoma <= 1 cm. | ||
#Macroadenoma | #Macroadenoma 1-4 cm. | ||
#Giant adenoma > 4cm. | |||
May be classified by what they secrete. | |||
#Functional (endocrine hyperfunction). | |||
#*Acromegaly/giantism. | |||
#*Hyperprolactinemia. | |||
#*Cushing disease. | |||
#*Hyperthyroidism. | |||
#*Significant elevation of FSH/LH. | |||
#Clinically nonfunctioning. | |||
Notes: | Notes: | ||
''Cushing disease'' is due to pituitary gland hypersecretion of ACTH (due to a pituitary adenoma ''or'' CRH hypersecretion from the hypothalamus).<ref name=Ref_PBoD8_1148>{{Ref PBoD8|1148}}</ref> [[Cushing syndrome]] is hypercortisolism ''not'' due to pituitary gland pathology. | |||
Imaging: | |||
*Sellar enlargement. | |||
*Bone erosion, invasive growth esp. cavernous sinus (35-45%). | |||
*Inhomogenous signal in T1w MRI. | |||
====Familial pituitary adenomas==== | ====Familial pituitary adenomas==== | ||
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*Loss of fibrous stroma. | *Loss of fibrous stroma. | ||
**The cells of a normal (anterior) pituitary are nested. | **The cells of a normal (anterior) pituitary are nested. | ||
*Basophilic cells (corticotrophs). | |||
*Eosinophilic cells(somatotrophs). | |||
Notes: | Notes: | ||
*Smears very well.<ref>MUN. 24 November 2010.</ref> | *Smears very well.<ref>MUN. 24 November 2010.</ref> | ||
The WHO 2017 Classification of tumours of endocrine organs recoginizes following tumours:<ref>{{Cite journal | last1 = Lopes | first1 = MBS. | title = The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. | journal = Acta Neuropathol | volume = 134 | issue = 4 | pages = 521-535 | month = Oct | year = 2017 | doi = 10.1007/s00401-017-1769-8 | PMID = 28821944 }}</ref> | |||
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto" | |||
! Adenoma type | |||
! subtypes | |||
! Hormone secretion | |||
! Transcription factor | |||
|- | |||
| Somatotroph adenoma | |||
| Densely and sparsely granulated adenoma, Mammosomatotroph adenoma, Mixed GH and PRL adenoma | |||
| GH +/- PRL | |||
| PIT1 | |||
|- | |||
| Lactotroph adenoma | |||
| Densely and sparsely granulated adenoma, Acidophilic stem cell adenoma | |||
| PRL | |||
| PIT1, [[Estrogen receptor|ER]] | |||
|- | |||
| Thyrotroph adenoma | |||
| | |||
| TSH | |||
| PIT1, [[Estrogen receptor|ER]] | |||
|- | |||
| Corticotroph adenoma | |||
| Densely and sparsely granulated adenoma, Crooke cell adenoma | |||
| ACTH,CAM 5.2 | |||
| TPIT | |||
|- | |||
| Gonadotroph adenoma | |||
| Sparsely granulated adenoma | |||
| FSH, LH or a-Subunit | |||
| SF1, [[Estrogen receptor|ER]], GATA2 | |||
|- | |||
| Null cell adenoma | |||
| | |||
| None | |||
| None | |||
|} | |||
Other tumours may be classified as plurhormonal or double adenomas or as adenomas with unusual IHC combination. | |||
====Images==== | ====Images==== | ||
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File:ACTHoma-PAS-O-G.jpg | Pituitary adenoma , ACTH producing. PAS-O-G stain showing basophilic adenoma cells (WC/jensflorian) | File:ACTHoma-PAS-O-G.jpg | Pituitary adenoma , ACTH producing. PAS-O-G stain showing basophilic adenoma cells (WC/jensflorian) | ||
File:ACTHoma-IHC.jpg | Pituitary adenoma , ACTH producing. Strong ACTH IHC in this basophilic adenoma (WC/jensflorian) | File:ACTHoma-IHC.jpg | Pituitary adenoma , ACTH producing. Strong ACTH IHC in this basophilic adenoma (WC/jensflorian) | ||
File:Pituitary_adenoma-nonfunctioning.jpg |Pituitary adenoma with vascular pseudorosettes, nonfunctioning (WC/jensflorian) | File:Pituitary_adenoma-nonfunctioning.jpg |Pituitary adenoma with vascular pseudorosettes, nonfunctioning (WC/jensflorian) | ||
Crooke_HE_40x.jpg | Crooke cell adenoma, HE (WC/Marvin101) | |||
File:Crooke Cytokeratins.jpg | Crooke cell adenoma, panCK (WC/Marvin101) | |||
HE_fibrosis_pituitary_adenoma.jpg | Fibrosis in pituitary adenoma. | |||
</gallery> | </gallery> | ||
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*LH. | *LH. | ||
*FSH. | *FSH. | ||
*TSH | *TSH - [[Hyperthyroidism]] | ||
*GH. | *GH - [[Acromegaly]]. | ||
*Prolactin. | *Prolactin -Galactorrhea, Amenorrhea, Gynecomastia. Golgi staining pattern in sparsely granulated cases. | ||
*ACTH - Cushing | *ACTH - [[Cushing syndrome]]. | ||
*PIT-1: stains somatotrophs, lactotrophs and thyrothrops. | |||
*TPIT: stains corticotrophs. | |||
*SF1: stains gonadotrophs. | |||
*Chromogranin A +ve | |||
*Synaptophysin strongly +ve (except lactotrophs) | |||
*CAM5.2: fibrous bodies in sparsely granulated somatotroph adenoma, Ring-like staining in Crooke cell adenoma. | |||
*MIB-1: Usu less than 3%. | |||
Note: | |||
Null-cell adenoma must be hormone immunonegative and negative for transcription factors. | |||
===Variants=== | |||
*Corticotroph adenomas exhibiting Crooke's hyaline change: agressive course.<ref>{{Cite journal | last1 = George | first1 = DH. | last2 = Scheithauer | first2 = BW. | last3 = Kovacs | first3 = K. | last4 = Horvath | first4 = E. | last5 = Young | first5 = WF. | last6 = Lloyd | first6 = RV. | last7 = Meyer | first7 = FB. | title = Crooke's cell adenoma of the pituitary: an aggressive variant of corticotroph adenoma. | journal = Am J Surg Pathol | volume = 27 | issue = 10 | pages = 1330-6 | month = Oct | year = 2003 | doi = | PMID = 14508394 }}</ref> | |||
*Acidophilic stem cell adenomas: large, locally invasive adenoma with low GH activity. <ref>{{Cite journal | last1 = Horvath | first1 = E. | last2 = Kovacs | first2 = K. | last3 = Singer | first3 = W. | last4 = Smyth | first4 = HS. | last5 = Killinger | first5 = DW. | last6 = Erzin | first6 = C. | last7 = Weiss | first7 = MH. | title = Acidophil stem cell adenoma of the human pituitary: clinicopathologic analysis of 15 cases. | journal = Cancer | volume = 47 | issue = 4 | pages = 761-71 | month = Feb | year = 1981 | doi = | PMID = 6261917 }}</ref> | |||
*Sparsely granulated somatotroph adenomas are more invasive than other variants and respond less to medical treatment. <ref>{{Cite journal | last1 = Kato | first1 = M. | last2 = Inoshita | first2 = N. | last3 = Sugiyama | first3 = T. | last4 = Tani | first4 = Y. | last5 = Shichiri | first5 = M. | last6 = Sano | first6 = T. | last7 = Yamada | first7 = S. | last8 = Hirata | first8 = Y. | title = Differential expression of genes related to drug responsiveness between sparsely and densely granulated somatotroph adenomas. | journal = Endocr J | volume = 59 | issue = 3 | pages = 221-8 | month = | year = 2012 | doi = | PMID = 22200580 }}</ref> | |||
* Lactotroph adenomas in men may show aggressive clinical behavior. <ref>{{Cite journal | last1 = Delgrange | first1 = E. | last2 = Vasiljevic | first2 = A. | last3 = Wierinckx | first3 = A. | last4 = François | first4 = P. | last5 = Jouanneau | first5 = E. | last6 = Raverot | first6 = G. | last7 = Trouillas | first7 = J. | title = Expression of estrogen receptor alpha is associated with prolactin pituitary tumor prognosis and supports the sex-related difference in tumor growth. | journal = Eur J Endocrinol | volume = 172 | issue = 6 | pages = 791-801 | month = Jun | year = 2015 | doi = 10.1530/EJE-14-0990 | PMID = 25792376 }}</ref> | |||
*Poorly differentiated PIT-1 positive adenomas may show aggresive growth. <ref> {{Cite journal | last1 = Mete | first1 = O. | last2 = Gomez-Hernandez | first2 = K. | last3 = Kucharczyk | first3 = W. | last4 = Ridout | first4 = R. | last5 = Zadeh | first5 = G. | last6 = Gentili | first6 = F. | last7 = Ezzat | first7 = S. | last8 = Asa | first8 = SL. | title = Silent subtype 3 pituitary adenomas are not always silent and represent poorly differentiated monomorphous plurihormonal Pit-1 lineage adenomas. | journal = Mod Pathol | volume = 29 | issue = 2 | pages = 131-42 | month = Feb | year = 2016 | doi = 10.1038/modpathol.2015.151 | PMID = 26743473 }}</ref> | |||
==Pituitary blastoma== | |||
* New entity introduced in 2017<ref>{{Cite journal | last1 = Lopes | first1 = MBS. | title = The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. | journal = Acta Neuropathol | volume = 134 | issue = 4 | pages = 521-535 | month = Oct | year = 2017 | doi = 10.1007/s00401-017-1769-8 | PMID = 28821944 }}</ref> | |||
* Epithelial glands with rosette-like formations resembling immature Rathke epithelium. | |||
* Synaptophysin +ve, usu. ACTH+ve | |||
* DICER1 mutations<ref>{{Cite journal | last1 = de Kock | first1 = L. | last2 = Sabbaghian | first2 = N. | last3 = Plourde | first3 = F. | last4 = Srivastava | first4 = A. | last5 = Weber | first5 = E. | last6 = Bouron-Dal Soglio | first6 = D. | last7 = Hamel | first7 = N. | last8 = Choi | first8 = JH. | last9 = Park | first9 = SH. | title = Pituitary blastoma: a pathognomonic feature of germ-line DICER1 mutations. | journal = Acta Neuropathol | volume = 128 | issue = 1 | pages = 111-22 | month = Jul | year = 2014 | doi = 10.1007/s00401-014-1285-z | PMID = 24839956 }}</ref> | |||
==Pituitary carcinoma== | |||
* ICD-O: 8272/3 | |||
* Requires presence of cerebrospinal or systemic metastasis. | |||
* Very rare. | |||
* 75% are hormonally active (mostly PRL or ACTH). | |||
* IHC: Synaptophysin, Chromogranin +ve | |||
==Rathke cleft cyst== | ==Rathke cleft cyst== | ||
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{{Main|Craniopharyngioma}} | {{Main|Craniopharyngioma}} | ||
== | ==Gangliocytoma== | ||
* Neuronal cells in abundant neuropil. | |||
* S-100, Synaptophysin +ve. | |||
* Isolated sellar cases are very rare. | |||
Image: [[https://twitter.com/sty_md/status/664676241111252992]] | |||
==Mixed Gangliocytoma-adenoma== | |||
AKA: ganglioneuroma, pituitary adenoma with neuronal choristoma (PANCH) | |||
*Neuronal cells mixed with pituitary adenoma cells. | |||
* Approx. 0.25% of all pituitary adenomas. | |||
* Association with somatotroph adenomas (acromegaly). | |||
==Pituicytoma== | |||
{{Main|Pituicytoma}} | {{Main|Pituicytoma}} | ||
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*Polygonal cells with abundant granular cytoplasm. | *Polygonal cells with abundant granular cytoplasm. | ||
*CD68+ve, S-100+/-ve, GFAP+/-ve, TTF1+ve. | *CD68+ve, S-100+/-ve, GFAP+/-ve, TTF1+ve. | ||
<gallery> | |||
File:Granular_cell_tumor_pituitary.jpg | Granular cell tumor of the sellar region (HE). | |||
</gallery> | |||
==Autoimmune hypophysitis== | ==Autoimmune hypophysitis== | ||
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*Rare. | *Rare. | ||
*Autoantigens are unknown. | *Autoantigens are unknown. | ||
*May occur in pregnancy. | |||
*May be misdiagnosed as a nonsecreting adenoma. | *May be misdiagnosed as a nonsecreting adenoma. | ||
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Features:<ref name=pmid18388197>{{cite journal |author=Tzou SC, Lupi I, Landek M, ''et al.'' |title=Autoimmune hypophysitis of SJL mice: clinical insights from a new animal model |journal=Endocrinology |volume=149 |issue=7 |pages=3461–9 |year=2008 |month=July |pmid=18388197 |pmc=2453094 |doi=10.1210/en.2007-1692 |url=}}</ref> | Features:<ref name=pmid18388197>{{cite journal |author=Tzou SC, Lupi I, Landek M, ''et al.'' |title=Autoimmune hypophysitis of SJL mice: clinical insights from a new animal model |journal=Endocrinology |volume=149 |issue=7 |pages=3461–9 |year=2008 |month=July |pmid=18388197 |pmc=2453094 |doi=10.1210/en.2007-1692 |url=}}</ref> | ||
*Lymphocytic infiltration. | *Lymphocytic infiltration. | ||
<gallery> | |||
File:Lymphocytic_hypophysitis_CD3.jpg | Lymphocytic hypophysitis, CD3 IHC. (WC/jensflorian) | |||
</gallery> | |||
=See also= | =See also= |