acp

Best Practice No 172

Pituitary gland pathology

J W Ironside

Correspondence to:
Correspondence to:
Professor J W Ironside, Division of Pathology, School of Clinical and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK;
j.w.ironside{at}ed.ac.uk

This article reviews published evidence on the diagnosis and classification of pituitary gland tumours and the relevance of histological and genetic features to prognosis. Much of the literature is devoted to the histological, ultrastructural, and immunocytochemical classification of pituitary adenomas (extensively supported by multicentre studies), with little consensus on the identification of prognostic features in adenomas, particularly in relation to invasion. There is a lack of correspondence between clinical and pathological criteria to identify and classify invasion, and a need to reassess the nomenclature and diagnostic criteria for invasive adenomas and carcinomas. Recent cytogenetic, genetic, and molecular biological studies have identified no consistent abnormalities in relation to pituitary tumour progression, although many genes are likely to be involved. In light of these uncertainties, an approach to the diagnosis and classification of pituitary adenomas is suggested, based on robust criteria from earlier studies and incorporating provisional data that require reassessment in large prospective studies with an adequate clinicopathological database.

Keywords: pituitary adenoma; intraoperative diagnosis; invasion; immunocytochemistry; genetics

Abbreviations: ACTH, adrenocorticotrophic hormone; CI, computerised tomography; FGF, fibroblast growth factor; GH, growth hormone; MEN-1, multiple endocrine neoplasia type 1; MRI, magnetic resonance imaging; PRL, prolactin; ptd-FGFR-4, pituitary tumour derived N terminally truncated isoform of fibroblast growth factor receptor-4; PTTG, pituitary tumour transforming gene; TSH, thyroid stimulating hormone

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