Difference between revisions of "Pituitary gland"

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Pituitary gland (view source)

Revision as of 11:20, 16 January 2019

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→‎gangliocytoma: update according WHO2017
(→‎Images: fibrosis)
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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 (cortocotrophs).
*Basophilic cells (corticotrophs).
*Eosinophilic cells(somatotrophs).
*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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*SF1: stains gonadotrophs.
*SF1: stains gonadotrophs.
*Chromogranin A +ve
*Chromogranin A +ve
*Synaptophysin +ve
*Synaptophysin strongly +ve (except lactotrophs)
*CAM5.2: fibrous bodies in sparsely granulated somatotroph adenoma, Ring-like staining in Crooke cell adenoma.
*CAM5.2: fibrous bodies in sparsely granulated somatotroph adenoma, Ring-like staining in Crooke cell adenoma.
*MIB-1: Usu less than 3%.
*MIB-1: Usu less than 3%.
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*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>
*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>
*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==
==Pituitary carcinoma==
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{{Main|Craniopharyngioma}}
{{Main|Craniopharyngioma}}


==gangliocytoma==
==Gangliocytoma==
AKA: ganglioneuroma, pituitary adenoma with neuronal choristoma (PANCH)
* Neuronal cells in abundant neuropil.
* Neuronal cells in abundant neuropil.
* Associated with pituitary adenoma.
* S-100, Synaptophysin +ve.
* S-100, Synaptophysin +ve.
* Isolated sellar cases are very rare.


Image: [[https://twitter.com/sty_md/status/664676241111252992]]
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==
==Pituicytoma==
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