Diagnosis, clinical and pathological analysis of pituitary adenomas based on the new World Health Organization classification

doi:10.3969/j.issn.1006-7795.2020.03.009

Abstract

Abstract: Objective To analyze the diagnosis, clinical and pathological characteristic and to investigate the value of the new World Health Organization(WHO) classification of pituitary adenomas. Method The clinical features of 134 cases diagnosed as pituitary adenomas were retrospectively reviewed. The characteristic of morphology and the result of immunohistochemical expression were analyzed. Results The study population was composed of 134 patients (74 male and 60 female) and the median age was 51. Totally 24.6% of all pituitary adenomas were functional or hormone-secreting, while the remaining 75.4% were non-functional present with symptoms related to local mass effects. The imaging showed 7 cases with microadenomas, 120 cases with macroadenomas and 7 cases with giant adenomas. According to the 2017 WHO classification of pituitary adenomas, there were 68 (50.7%) gonadotroph adenomas, 25(18.7%) corticotroph adenomas, 17 (12.7%) somatotroph adenomas, 11 (8.2%) lactotroph adenomas, 4 (3.1%) silent Pit-1 positive pituitary adenomas, 3 (2.2%) plurihormonal adenomas, 3(2.2%) double adenmoas, 2 (1.5%) null cell adenomas, and 1 (0.7%) thyrotroph adenomas. This classification also recognizes some subtypes of pituitary adenomas as high-risk pituitary adenomas, which include 2 sparsely granulated somatotroph adenoma, 6 lactotroph adenoma in men, 2 silent corticotroph adenoma, and 3 newly introduced plurihormonal Pit-1-positive adenoma. Conclusion According to the different transcription factor, the new classification of pituitary adenomas was of important effect and significance to the clinical diagnosis and treatment.

Key words: pituitary adenomas, pathology, immunohistochemical

CLC Number:

R736.4

Gao Wei, Zhao Lihong, Wang Wei, Wang Leiming, Xu Susu, Wei Lifeng, Teng Lianghong. Diagnosis, clinical and pathological analysis of pituitary adenomas based on the new World Health Organization classification[J]. Journal of Capital Medical University, 2020, 41(3): 364-371.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2020.03.009

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2020/V41/I3/364

References

[1] Mete O, Lopes M B. Overview of the 2017 who classification of pituitary tumors[J]. Endocr Pathol, 2017, 28(3):228-243.
[2] Ezzat S, Asa S L, Couldwell W T, et al. The prevalence of pituitary adenomas:A systematic review[J]. Cancer, 2004, 101(3):613-619.
[3] Al-Shraim M, Asa S L. The 2004 world health organization classification of pituitary tumors:What is new?[J]. Acta Neuropathol, 2006, 111(1):1-7.
[4] Nishioka H, Inoshita N, Mete O, et al. The complementary role of transcription factors in the accurate diagnosis of clinically nonfunctioning pituitary adenomas[J]. Endocr Pathol, 2015, 26(4):349-355.
[5] Tjornstrand A, Gunnarsson K, Evert M, et al. The incidence rate of pituitary adenomas in western sweden for the period 2001-2011[J]. Eur J Endocrinol, 2014, 171(4):519-526.
[6] Daly A F, Rixhon M, Adam C, et al. High prevalence of pituitary adenomas:A cross-sectional study in the province of liege, belgium[J]. J Clin Endocrinol Metab, 2006, 91(12):4769-4775.
[7] Yamada S, Ohyama K, Taguchi M, et al. A study of the correlation between morphological findings and biological activities in clinically nonfunctioning pituitary adenomas[J]. Neurosurgery, 2007, 61(3):580-584; discussion 584-585.
[8] Mete O, Asa S L. Clinicopathological correlations in pituitary adenomas[J]. Brain Pathol, 2012, 22(4):443-453.
[9] Melmed S. Pituitary medicine from discovery to patient-focused outcomes[J]. J Clin Endocrinol Metab, 2016, 101(3):769-777.
[10] Saeger W, Ludecke D K, Buchfelder M, et al. Pathohistological classification of pituitary tumors:10 years of experience with the german pituitary tumor registry[J]. Eur J Endocrinol, 2007, 156(2):203-216.
[11] Beck-Peccoz P, Lania A, Beckers A, et al. 2013 european thyroid association guidelines for the diagnosis and treatment of thyrotropin-secreting pituitary tumors[J]. Eur Thyroid J, 2013, 2(2):76-82.
[12] Yamada S, Fukuhara N, Horiguchi K, et al. Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas:A single-center study of 90 cases[J]. J Neurosurg, 2014, 121(6):1462-1473.
[13] van Varsseveld N C, Bisschop P H, Biermasz N R, et al. A long-term follow-up study of eighteen patients with thyrotrophin-secreting pituitary adenomas[J]. Clin Endocrinol (Oxf), 2014, 80(3):395-402.
[14] Cossu G, Daniel R T, Pierzchala K, et al. Thyrotropin-secreting pituitary adenomas:A systematic review and meta-analysis of postoperative outcomes and management[J]. Pituitary, 2019, 22(1):79-88.
[15] Capraru O M, Gaillard C, Vasiljevic A, et al. Diagnosis, pathology, and management of tsh-secreting pituitary tumors. A single-center retrospective study of 20 patients from 1981 to 2014[J]. Ann Endocrinol (Paris), 2019, 80(4):216-224.
[16] Puig Domingo M. Treatment of acromegaly in the era of personalized and predictive medicine[J]. Clin Endocrinol (Oxf), 2015, 83(1):3-14.
[17] Cuevas-Ramos D, Carmichael J D, Cooper O, et al. A structural and functional acromegaly classification[J]. J Clin Endocrinol Metab, 2015, 100(1):122-131.
[18] Colao A, Sarno A D, Cappabianca P, et al. Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia[J]. Eur J Endocrinol, 2003, 148(3):325-331.
[19] Cho H Y, Cho S W, Kim S W, et al. Silent corticotroph adenomas have unique recurrence characteristics compared with other nonfunctioning pituitary adenomas[J]. Clin Endocrinol (Oxf), 2010, 72(5):648-653.
[20] Alahmadi H, Lee D, Wilson J R, et al. Clinical features of silent corticotroph adenomas[J]. Acta Neurochir (Wien), 2012, 154(8):1493-1498.
[21] Osamura R Y, Kajiya H, Takei M, et al. Pathology of the human pituitary adenomas[J]. Histochem Cell Biol, 2008, 130(3):495-507.
[22] Mete O, Gomez-Hernandez K, Kucharczyk W, et al. Silent subtype 3 pituitary adenomas are not always silent and represent poorly differentiated monomorphous plurihormonal pit-1 lineage adenomas[J]. Mod Pathol, 2016, 29(2):131-142.
[23] Erickson D, Scheithauer B, Atkinson J, et al. Silent subtype 3 pituitary adenoma:A clinicopathologic analysis of the mayo clinic experience[J]. Clin Endocrinol (Oxf), 2009, 71(1):92-99.