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→Pituitary carcinoma: Update
Jensflorian (talk | contribs) |
Jensflorian (talk | contribs) (→Pituitary carcinoma: Update) |
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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]]. | ||
| Line 97: | Line 97: | ||
! PitNET type | ! PitNET type | ||
! subtypes | ! subtypes | ||
! Hormone | ! Hormone IHC | ||
! Transcription factor | ! Transcription factor IHC | ||
|- | |- | ||
| PIT1 | | PIT1 | ||
| Line 140: | Line 140: | ||
| | | | ||
| PRL, GH (focal/variable), CK fibrous bodies | | PRL, GH (focal/variable), CK fibrous bodies | ||
| PIT1, [[Estrogen receptor|ER]] | | PIT1, [[Estrogen receptor|ER]] | ||
|- | |||
| PIT1 | |||
| Mixed somatotroph and lactotroph tumor | |||
| | |||
| PRL, GH (in separate cells) | |||
| PIT1, [[Estrogen receptor|ER]] (only in lactotroph component) | |||
|- | |- | ||
| TPIT | | 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 | | None | ||
| Null cell adenoma | |||
| | |||
| None (adenohypophyseal?) | |||
| None | | None | ||
|} | |} | ||
| Line 170: | Line 182: | ||
Morphologic Classification: | Morphologic Classification: | ||
# | #Microtumor <= 1 cm. | ||
# | #Macrotumor 1-4 cm. | ||
#Giant | #Giant tumor > 4cm. | ||
May be classified by what they secrete. | May be classified by what they secrete. | ||
| Line 221: | Line 233: | ||
*Basophilic cells (corticotrophs). | *Basophilic cells (corticotrophs). | ||
*Eosinophilic cells(somatotrophs). | *Eosinophilic cells(somatotrophs). | ||
*Extensive fibrosis often seen in TSH-producing tumors. | |||
Notes: | Notes: | ||
*Smears very well.<ref>MUN. 24 November 2010.</ref> | *Smears very well.<ref>MUN. 24 November 2010.</ref> | ||
====Images==== | ====Images==== | ||
| Line 277: | Line 288: | ||
*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> | *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> | * 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== | ==Pituitary blastoma== | ||
| Line 286: | Line 300: | ||
==Pituitary carcinoma== | ==Pituitary carcinoma== | ||
* | * Depreceated in the WHO2022 classification. | ||
* It is acknowledged that PitNETs can be invasive or spread to other sites. | |||
* | |||
==Rathke cleft cyst== | ==Rathke cleft cyst== | ||