Difference between revisions of "Pituitary gland"

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Pituitary gland (view source)

Revision as of 11:30, 30 September 2022

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→‎Pituitary carcinoma: Update
(→‎IHC: LMWCK)
 
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=DDx for sella turcica lesions=
=DDx for sella turcica lesions=
*[[Pituitary adenoma]].
*[[Pituitary adenoma|PitNET]].
*[[Rathke cleft cyst]].
*[[Rathke cleft cyst]].
*[[Craniopharyngioma]].
*[[Craniopharyngioma]].
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=Specific entities=
=Specific entities=
==Pituitary adenoma==
==Pituitary neuroendocrine tumor (PitNET)==
Old terminology '''Pituitary adenoma''' is depreceated.
The WHO 2022 Classification of tumours of endocrine organs recoginizes following tumours:<ref>{{cite journal |vauthors=Asa SL, Mete O, Perry A, Osamura RY |title=Overview of the 2022 WHO Classification of Pituitary Tumors |journal=Endocr Pathol |volume=33 |issue=1 |pages=6–26 |date=March 2022 |pmid=35291028 |doi=10.1007/s12022-022-09703-7 |url=}}</ref>
 
 
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
! PitNET lineage
! PitNET type
! subtypes
! Hormone IHC
! Transcription factor IHC
|-
| PIT1
| Somatotroph tumor
| Densely and sparsely granulated tumor
| GH, a-subunit+/-, CK+
| PIT1
|-
| PIT1
| Lactotroph tumor
| Densely and sparsely granulated tumor
| PRL, CK-ve or weak
| PIT1, [[Estrogen receptor|ER]]
|-
| PIT1
| Mammosomatotroph tumor
|
| GH, PRL (usu. less), CK perinuclear +ve
| PIT1, [[Estrogen receptor|ER]]
|-
| PIT1
| Thyrotroph tumor
|
| TSH, CK-ve or weak
| PIT1, GATA3
|-
| PIT1
| Mature plurihormonal PIT1 lineage tumor
|
| GH, PRL, TSH, a-subunit +/-ve, CK perinuclear
| PIT1, [[Estrogen receptor|ER]], GATA3
|-
| PIT1
| Immature PIT1 lineage tumor
|
| Only focal GH, PRL, TSH, a-subunit +/-ve, CK variable
| PIT1, [[Estrogen receptor|ER]] +/-ve, GATA3 +/-ve
|-
| PIT1
| Acidophilic stem cell tumor
|
| PRL, GH (focal/variable), CK fibrous bodies
| PIT1, [[Estrogen receptor|ER]]
|-
| PIT1
| Mixed somatotroph and lactotroph tumor
|
| PRL, GH (in separate cells)
| PIT1, [[Estrogen receptor|ER]] (only in lactotroph component) 
|-
| TPIT
| Corticotroph tumor
| Densely and sparsely granulated tumors, Crooke cell adenoma
| ACTH,CK+ve
| TPIT
|-
| SF1
| Gonadotroph tumor
|
| FSH, LH, a-Subunit or none
| SF1, ER, GATA3, CK+/-ve
|-
| None
| Plurihormonal tumor
|
| All combinations possible
| All combinations possible, CK+/-ve
|-
| None
| Null cell adenoma
|
| None (adenohypophyseal?)
| None
|}
 
Other tumours may be classified as plurhormonal or double adenomas or as adenomas with unusual IHC combination.
 
===General===
===General===
*Clinical:<ref>{{Ref PBoD8|1100}}</ref>
*Clinical:<ref>{{Ref PBoD8|1100}}</ref>
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**Tumor of adults.
**Tumor of adults.


Classification:
Morphologic Classification:
#Microadenoma <= 1 cm.
#Microtumor <= 1 cm.
#Macroadenoma 1-4 cm.
#Macrotumor 1-4 cm.
#Giant adenoma > 4cm.
#Giant tumor > 4cm.


May be classified by what they secrete.  
May be classified by what they secrete.  
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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).
*Extensive fibrosis often seen in TSH-producing tumors.


Notes:
Notes:
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Crooke_HE_40x.jpg | Crooke cell adenoma, HE (WC/Marvin101)
Crooke_HE_40x.jpg | Crooke cell adenoma, HE (WC/Marvin101)
File:Crooke Cytokeratins.jpg | Crooke cell adenoma, panCK (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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*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>
*Immature PIT-1 lineage tumors 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>
===Molecular===
*GNAS mutations frequently in densely granulated somatotroph tumors.
==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==
* ICD-O: 8272/3
* Depreceated in the WHO2022 classification.  
* Requires presence of cerebrospinal or systemic metastasis.
* It is acknowledged that PitNETs can be invasive or spread to other sites.
* 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==
==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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