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Image:Pituitary_adenoma_%281%29_GH_production.jpg | Pituitary adenoma - GH producing. (WC/KGH) |
File:HE-GHoma.jpg | Pituitary adenoma , HE. This gonadotropin producing adenoma has a papillary architecture (WC/jensflorian) |
File:FSH-GHoma.jpg | Pituitary adenoma, IHC for FSH (WC/jensflorian) |
File:LH-GHoma.jpg | Pituitary adenoma, IHC for LH (WC/jensflorian) |
File:ACTHoma-PAS-O-G.jpg | Pituitary adenoma , ACTH producing. PAS-O-G stain showing basophilic adenoma cells (WC/jensflorian) |
File:ACTHoma-IHC.jpg | Pituitary adenoma , ACTH producing. Strong ACTH IHC in this basophilic adenoma (WC/jensflorian) |
File:Pituitary_adenoma-nonfunctioning.jpg |Pituitary adenoma with vascular pseudorosettes, nonfunctioning (WC/jensflorian) |
Crooke_HE_40x.jpg | Crooke cell adenoma, HE (WC/Marvin101) |
File:Crooke Cytokeratins.jpg | Crooke cell adenoma, panCK (WC/Marvin101) |
HE_fibrosis_pituitary_adenoma.jpg | Fibrosis in pituitary adenoma. |
</gallery> |
===Stains=== |
*Reticulin - loss of reticulin between tumour cells. |
===IHC=== |
*LH. |
*FSH. |
*TSH - [[Hyperthyroidism]] |
*GH - [[Acromegaly]]. |
*Prolactin -Galactorrhea, Amenorrhea, Gynecomastia. Golgi staining pattern in sparsely granulated cases. |
*ACTH - [[Cushing syndrome]]. |
*PIT-1: stains somatotrophs, lactotrophs and thyrothrops. |
*TPIT: stains corticotrophs. |
*SF1: stains gonadotrophs. |
*Chromogranin A +ve |
*Synaptophysin strongly +ve (except lactotrophs) |
*CAM5.2: fibrous bodies in sparsely granulated somatotroph adenoma, Ring-like staining in Crooke cell adenoma. |
*MIB-1: Usu less than 3%. |
Note: |
Null-cell adenoma must be hormone immunonegative and negative for transcription factors. |
===Variants=== |
*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... |
*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 | firs... |
*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... |
* 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 ... |
*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... |
===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/s00401-017-17... |
* 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 ... |
==Pituitary carcinoma== |
* Depreceated in the WHO2022 classification. |
* It is acknowledged that PitNETs can be invasive or spread to other sites. |
==Rathke cleft cyst== |
===General=== |
*Benign counterpart of [[craniopharyngioma]]. |
*Arises from intermediate lobe of pituitary gland (''pars intermedia of pituitary gland''). |
Radiology: |
*Typically no calcifications.<ref name=emed_rcc>URL: [http://emedicine.medscape.com/article/343629-overview http://emedicine.medscape.com/article/343629-overview]. Accessed on: 14 November 2010.</ref> |
Radiologic DDx:<ref name=emed_rcc>URL: [http://emedicine.medscape.com/article/343629-overview http://emedicine.medscape.com/article/343629-overview]. Accessed on: 14 November 2010.</ref> |
*Arachnoid cyst. |
*[[Craniopharyngioma]]. |
*[[Cysticercosis]]. |
*[[Pituitary adenoma]]. |
*Epidermoid of brain. |
===Microscopic=== |
Features: |
*Lined by a layer of cuboidal ''or'' columnar epithelial with cilia. |
*+/-Goblet cells.<ref>URL: [http://www.endotext.org/neuroendo/neuroendo3/neuroendo3.html http://www.endotext.org/neuroendo/neuroendo3/neuroendo3.html]. Accessed on: 27 May 2010.</ref> |
*+/-Squamous metaplasia ~ may be several layers thick. |
**May be confused with ''[[papillary craniopharyngioma]]''.<ref name=Ref_PSNP408>{{Ref PSNP|408}}</ref> |
*Cholesterol clefts may be seen in association with rupture.<ref>URL: [http://path.upmc.edu/cases/case177/dx.html http://path.upmc.edu/cases/case177/dx.html]. Accessed on: 8 January 2012.</ref> |
DDx: |
*[[Papillary craniopharyngioma]]. |
Images: |
*[http://www.endotext.org/neuroendo/neuroendo3/figures/figure11.jpg Rathke cleft cyst (endotext.org)]. |
*[http://path.upmc.edu/cases/case177/micro.html Rathke cleft cyst (upmc.edu)]. |
==Craniopharyngioma== |
{{Main|Craniopharyngioma}} |
==Gangliocytoma== |
* Neuronal cells in abundant neuropil. |
* S-100, Synaptophysin +ve. |
* Isolated sellar cases are very rare. |
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== |
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