重新评估多激素垂体腺瘤/垂体网状细胞瘤。

IF 4.5 1区 医学 Q1 PATHOLOGY
B K Kleinschmidt-DeMasters, Christie G Turin
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引用次数: 0

摘要

多激素垂体腺瘤/神经内分泌肿瘤表达多种垂体激素和/或转录因子,由免疫组化(IHC)确定。根据世界卫生组织 2022 年内分泌分类法,目前存在三种类型:成熟的多激素性垂体腺瘤 PIT1(垂体特异性 POU 类同源染色体因子-1)、未成熟的 PIT1 系肿瘤,以及第三种垂体激素和/或转录因子异常组合的类型。然而,从那时起,具有PIT1/SF1(类固醇生成因子1)共表达的 "体细胞营养"/"多线型 "肿瘤被描述出来,可能混淆了这一分类。我们对2018年至2023年的数据库进行了搜索,以识别和重新分类肿瘤,并与发病时的神经影像学和内分泌学特征相关联。我们确定了 22 个病例:男9:女13,手术时平均年龄(51±16)岁。初诊时最常见的症状是头痛和/或视力改变(6/22)和肢端肥大症(5/22)。所有肿瘤均为大腺瘤,平均直径(25±17)毫米;11/22(50%)有海绵窦侵犯。超过70%的肿瘤在临床上至少分泌一种激素,27%的肿瘤至少分泌两种不同的激素。四名患者接受了一次以上的手术治疗。通过IHC重新分类,几乎只发现两种类型:未成熟的PIT1系肿瘤(9/22)和PIT1/SF1共表达的 "嗜体细胞"/"多系肿瘤"(12/22),后者取代了成熟的多激素肿瘤。发现了一个真正不寻常的多荷尔蒙肿瘤。生长激素、催乳素、促甲状腺激素、PIT1和SF1 IHC的表达程度各不相同,但卵泡刺激素和/或黄体生成素的免疫阳性几乎仅限于共表达者,从而将这些肿瘤与未成熟的PIT1系肿瘤区分开来。总之,肿瘤大小、侵袭性和内分泌病变并不能在术前将PIT1/SF1共表达肿瘤与未成熟的PIT1系肿瘤区分开来;只有通过全面的IHC垂体检查才能将两者区分开来。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Reassessment of Plurihormonal Pituitary Adenomas/PitNETs.

Plurihormonal pituitary adenomas/neuroendocrine tumors express multiple pituitary hormones and/or transcription factors, as determined by immunohistochemistry (IHC). Three types exist based on Endocrine WHO 2022 classification: mature plurihormonal PIT1 (pituitary-specific POU-class homeodomain factor-1), immature PIT1-lineage tumors, and a third type with unusual combinations of pituitary hormones and/or transcription factors. However, since then, "somatogonatotroph"/"multilineage" tumors with PIT1/SF1 (steroidogenic factor 1) co-expression have been described, possibly confounding this classification. We performed a database search, from 2018 to 2023, to identify and reclassify tumors, correlating with neuroimaging and endocrinological features at presentation. We identified 22 cases: M 9:F 13, mean age at surgery 51±16 years. The most common symptoms at initial presentation were headaches and/or vision changes (6/22) and acromegaly (5/22). All tumors were macroadenomas, mean diameter of 25±17mm; 11/22 (50%) had cavernous sinus invasion. More than 70% of tumors clinically secreted at least 1 hormone, and 27% tumors secreted at least 2 different hormones. Four patients underwent >1 surgical intervention. Reclassification by IHC yielded almost exclusively 2 types: immature PIT1-lineage (9/22) and "somatogonadotroph"/"multilineage tumors" with PIT1/SF1 co-expression (12/22), the latter replacing mature plurihormonal tumors. One true unusual plurihormonal tumor was identified. The extent of growth hormone, prolactin, thyroid stimulating hormone, PIT1, and SF1 IHC was variable, but immunopositivity for follicle-stimulating hormone and/or luteinizing hormone was nearly confined to co-expressors, distinguishing these from immature PIT1-lineage tumors. In conclusion, tumor size, invasiveness, and endocrinopathies do not distinguish PIT1/SF1 co-expressing tumors from immature PIT1-lineage tumors preoperatively; only full IHC pituitary workup allows distinction.

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来源期刊
CiteScore
10.30
自引率
5.40%
发文量
295
审稿时长
1 months
期刊介绍: The American Journal of Surgical Pathology has achieved worldwide recognition for its outstanding coverage of the state of the art in human surgical pathology. In each monthly issue, experts present original articles, review articles, detailed case reports, and special features, enhanced by superb illustrations. Coverage encompasses technical methods, diagnostic aids, and frozen-section diagnosis, in addition to detailed pathologic studies of a wide range of disease entities. Official Journal of The Arthur Purdy Stout Society of Surgical Pathologists and The Gastrointestinal Pathology Society.
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