- MeSH
- Dopamine Agonists pharmacology therapeutic use MeSH
- Hyperprolactinemia diagnosis etiology blood metabolism prevention & control MeSH
- Humans MeSH
- Pituitary Neoplasms diagnosis drug therapy classification MeSH
- Prolactin analysis metabolism adverse effects MeSH
- Prolactinoma * diagnostic imaging diagnosis epidemiology drug therapy classification MeSH
- Pregnant People MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Review MeSH
AIMS: In somatotroph pituitary neuroendocrine tumours (adenomas), a pattern of cytokeratin (CK) 18 expression is used for tumour subclassification, with possible clinical implications. Rare somatotroph tumours do not express CK 18. We aimed to characterise this subset clinically and histologically. METHODS AND RESULTS: Clinical and pathological data for the study were derived from a previously published data set of a cohort of 110 patients with acromegaly. Data included serum levels of insulin-like growth factor 1 (IGF1), growth hormone (GH), prolactin and thyroid-stimulating hormone (TSH), tumour diameter, tumour invasion defined by Knosp grade and immunohistochemical data concerning the expression of Ki67, p53, E-cadherin, somatostatin receptor (SSTR)1, SSTR2A, SSTR3, SSTR5 and D2 dopamine receptor. Additional immunohistochemical analysis (AE1/3, CK 8/18, vimentin, neurofilament light chain, internexin-α) was performed. CK 18 was negative in 10 of 110 (9.1%) tumours. One of these tumours was immunoreactive with CK 8/18 antibody, while the remainder expressed only internexin-α intermediate filament in patterns similar to CK 18 (perinuclear fibrous bodies). CK-negative tumours showed no significant differences with respect to biochemical, radiological or pathological features. They showed significantly higher expression of SSTR2A compared to the sparsely granulated subtype and significantly lower expression of E-cadherin compared to the non-sparsely granulated subtypes of tumours. The tumours showed divergent morphology and hormonal expression: two corresponded to densely granulated tumours and three showed co-expression of prolactin and morphology of either mammosomatotroph or somatotroph-lactotroph tumours. Four tumours showed morphology and immunoprofile compatible with plurihormonal Pit1-positive tumours. CONCLUSIONS: CK-negative somatotroph tumours do not represent a distinct subtype of somatotroph tumours, and can be further subdivided according to their morphology and immunoprofile.
- Keywords
- resekce nádoru, makroadenom,
- MeSH
- Adrenocorticotropic Hormone physiology MeSH
- Acromegaly etiology pathology MeSH
- Dopamine Antagonists therapeutic use MeSH
- Cushing Syndrome surgery etiology pathology therapy MeSH
- Child MeSH
- Gigantism etiology MeSH
- Contraindications MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Pituitary Neoplasms * surgery diagnostic imaging classification complications pathology therapy MeSH
- Neurosurgical Procedures MeSH
- Puberty, Precocious MeSH
- Prolactinoma physiopathology pathology therapy MeSH
- Radiosurgery MeSH
- Growth Hormone physiology MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Humans MeSH
- Pituitary Neoplasms * diagnosis classification MeSH
- Adrenal Gland Neoplasms * diagnosis classification MeSH
- Parathyroid Neoplasms * classification MeSH
- Pancreatic Neoplasms * classification MeSH
- Neuroendocrine Tumors diagnosis classification MeSH
- Check Tag
- Humans MeSH
- Publication type
- Introductory Journal Article MeSH
Tumory tureckého sedla patria k problematickým oblastiam histopatologickej diagnostiky. Ďaleko najčastejšími selárnymi tumormi sú adenómy hypofýzy, ktoré sú histomorfologicky veľmi heterogénne, zároveň sa v tejto oblasti môžeme stretnúť s celým spektrom ďalších primárnych aj sekundárnych nádorov známych z humánnej patológie. Pre presnú klasifikáciu je potrebných pomerne veľa imunohistochemických vyšetrení: hypofyzárne hormóny, príslušné transkripčné faktory a niekoľko ďalších protilátok. Elektrón-mikroskopické vyšetrenie v rutinnej diagnostike adenómov hypofýzy už nie je v súčasnosti nevyhnutné. Dôležitým aspektom podrobnej klasifikácie adenómov hypofýzy je identifikácia agresívnych histologických typov. V roku 2017 vyšlo posledné vydanie WHO klasifikácie nádorov endokrinných orgánov, ktoré prinieslo viacero zmien týkajúcich sa adenómov hypofýzy, vrátane zrušenia konceptu atypického adenómu. V krátkom prehľadovom článku diskutujeme praktický prístup k diagnostike a zmeny v poslednej WHO klasifikácii adenómov hypofýzy z roku 2017.
The histopathological diagnosis of sellar tumors is a difficult area of the diagnostic surgical pathology. The most common sellar tumor is a pituitary adenoma. The histomorphology of pituitary adenomas is very heterogeneous, and in the sellar area, we can encounter practically any other tumor known from human pathology, either primary or secondary. Exact histopathological classification requires many immunohistochemical antibodies: pituitary hormones, pituitary transcription factors, and several other antibodies. At present, electron microscopy is no longer necessary for the routine diagnosis of the pituitary gland adenomas. The important aspect of the precise classification is to screen pituitary adenomas for aggressive histological types. The latest edition of the WHO classification of tumours of endocrine organs, published in 2017, involves several changes in the chapter of pituitary adenomas, including the abolition of the concept of atypical adenoma. In the short review, we discuss the practical approach to the diagnosis and the changes in the latest WHO classification of pituitary adenomas from 2017.
- Keywords
- WHO klasifikácia 2017,
- MeSH
- Humans MeSH
- Pituitary Neoplasms * diagnosis classification MeSH
- Neoplasm Grading classification MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Hypofyzární adenomy jsou nejčastější tumory selární oblasti. V jejich terapii se kombinují postupy neurochirurgické, radiační a medikamentózní. Ve vybraných případech je možným přístupem i observace pacienta. U akromegalie, Cushingovy choroby a TSH produkujících adenomů je metodou volby neurochirurgický výkon. V léčbě rezidua adenomu se uplatňuje ozáření Leksellovým gama nožem, do nástupu účinku gama nože je podávána medikamentózní léčba. Velké a progredující afunkční adenomy necháváme operovat; pokud jsou dostatečně vzdálené od optických struktur, je možné jejich ozáření. U prolaktinomů je primární léčbou medikamentózní léčba dopaminergními agonisty. Při léčbě hypofyzárních adenomů je nezbytná mezioborová spolupráce endokrinologa, neurochirurga a radiochirurga.
Pituitary adenomas are the most common tumours of the sellar region. A combination of neurosurgery, radiation and pharmacological approaches are applied for the treatment of pituitary adenomas. In certain cases, patient observation is another option. Neurosurgery is the first-choice treatment for acromegaly, Cushing´s disease and TSH secreting adenomas. Leksell gamma knife irradiation is used in the treatment of tumour residues. Until the effect of the irradiation is evident, pharmacological treatment must be administered. Large and/or growing non-functioning pituitary adenomas are operated. Irradiation is possible if there is sufficient distance between the margin of the adenoma and the optic pathway. The primary therapy for prolactinomas is pharmacological treatment with dopamine agonists. Multidisciplinary collaboration among endocrinologists, neurosurgeons and radiosurgeons is necessary in the treatment of pituitary adenomas.
- MeSH
- Adrenocorticotropic Hormone MeSH
- Acromegaly diagnosis surgery therapy MeSH
- Pituitary ACTH Hypersecretion diagnosis therapy MeSH
- Hypopituitarism MeSH
- Ketoconazole therapeutic use MeSH
- Humans MeSH
- Metyrapone therapeutic use MeSH
- Pituitary Neoplasms * diagnosis classification therapy MeSH
- Prolactinoma diagnosis drug therapy MeSH
- Radiosurgery instrumentation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
V oblasti tureckého sedla se na malém prostoru nachází mnoho tkání různého embryonálního původu, proto zde může vzniknout mnoho různých patologií, které se však díky rychlému rozvoji a pokroku technologií daří odstraňovat stále méně a méně invazivními metodami.
- MeSH
- Arteriosclerosis etiology complications MeSH
- Central Nervous System metabolism drug effects MeSH
- Diagnostic Techniques, Endocrine trends utilization MeSH
- Adult MeSH
- Mental Disorders etiology drug therapy MeSH
- Hormone Replacement Therapy * methods utilization MeSH
- Cardiovascular System physiopathology drug effects MeSH
- Comorbidity MeSH
- Bone Density drug effects MeSH
- Humans MeSH
- Metabolic Diseases diagnosis etiology MeSH
- Pituitary Neoplasms * diagnosis classification metabolism MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- Growth Hormone * deficiency therapeutic use MeSH
- Body Composition drug effects MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Keywords
- lanreotid, Somavret, Sandostatin LAR, Dostinex,
- MeSH
- Acromegaly diagnosis etiology therapy MeSH
- Cushing Syndrome diagnosis etiology therapy MeSH
- Dopamine pharmacology MeSH
- Ergolines pharmacology MeSH
- Gigantism diagnosis etiology therapy MeSH
- Hyperprolactinemia diagnosis etiology therapy MeSH
- Hypopituitarism diagnosis etiology therapy MeSH
- Humans MeSH
- Pituitary Neoplasms diagnosis classification therapy MeSH
- Octreotide pharmacology MeSH
- Receptors, Somatostatin classification drug effects MeSH
- Growth Hormone analogs & derivatives antagonists & inhibitors MeSH
- Somatostatin analogs & derivatives pharmacology MeSH
- Pituitary Function Tests classification MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
