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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: | ||
# | #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. | ||
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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 ( | *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==== | ||
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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> | *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== | ==Pituitary blastoma== | ||
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==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== | ||
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{{Main|Craniopharyngioma}} | {{Main|Craniopharyngioma}} | ||
== | ==Gangliocytoma== | ||
* Neuronal cells in abundant neuropil. | * Neuronal cells in abundant neuropil. | ||
* 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== |