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Review
, 56 (8), 561-8

Best Practice No 172: Pituitary Gland Pathology

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Review

Best Practice No 172: Pituitary Gland Pathology

J W Ironside. J Clin Pathol.

Abstract

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.

Figures

Figure 1
Figure 1
Examples of intraoperative diagnosis for pituitary region lesions. (A) Cytology of the normal anterior pituitary gland, with a mixed cell population exhibiting different tinctorial properties (smear preparation). (B) Gonadotroph adenoma, comprising a relatively uniform population of small cells with scanty pale staining cytoplasm (smear preparation). (C) Null cell adenoma, showing the close relation of the small tumour cells to capillary-like blood vessels. Some rosette-like structures are present (smear preparation). (D) Growth hormone adenoma, showing irregular tumour cells with greatly pleomorphic nuclei and a variable quantity of pale staining cytoplasm (smear preparation). (E) Lymphocytic hypophysitis. The anterior pituitary gland is invaded by large numbers of small lymphocytes (cryostat section). (F) Intrasellar meningothelial meningioma, with several whorl-like structures and scanty blood vessels (cryostat section). All stained with haematoxylin and eosin.

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