Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Silent Adenomas of Pituitary Gland : It's Immunohistochemical Features and Clinical Characteristics

  • Shim, Jae-Hyone (Departments of Neurosurgery, Brain Tumor Institute, Dong-A University College of Medicine) ;
  • Song, Young-Jin (Departments of Neurosurgery, Brain Tumor Institute, Dong-A University College of Medicine) ;
  • Kim, Dae-Chul (Departments of Pathology, Brain Tumor Institute, Dong-A University College of Medicine) ;
  • Park, Mi-Kyung (Departments of Endocrinology, Brain Tumor Institute, Dong-A University College of Medicine) ;
  • Choi, Sun-Seob (Departments of Radiology, Brain Tumor Institute, Dong-A University College of Medicine) ;
  • Kim, Ki-Uk (Departments of Neurosurgery, Brain Tumor Institute, Dong-A University College of Medicine)
  • Published : 2006.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The aim of the study was to review the clinical and radiological findings of those non-functioning adenomas[NFAs] with positive immnoreactivity for anterior pituitary hormones. Methods : Sixty patients with pituitary adenoma were treated at the author's institution between January 2000 and July 2005. All consecutive patients were underwent transsphenoidal surgery by same operator. In addition to the routine histopathological examination, surgical specimen was examined by immunohistochemical staining against adenohypophyseal cells. And clinical analysis was performed by retrospective review of medical records, neuroimaging examinations and immunohistochemical technique. We classified these pituitary adenomas into functioning adenomas [group F], immuno-positive NFAs [group S, so-called silent adenoma] and immuno-negative NFAs [group N], and compared clinical and radiological differences between group F, N, and S. Results : Of the 60 cases, group F was 25, group S was 25, and group N was 10. Among the group S, 5 cases showed reactivity against PRL, 1 against GH, 1 against both PRL and GH, 1 against TSH and GH, 2 against ACTH, 11 against FSH and 4 against both LH and FSH. Radiologically, invasiveness was noted in 8 in group S, compared to 3 in group N and 1 in group F [p = 0.02]. Intratumoral bleeding was noted in 7 of group S, 2 of group N and 2 of group F [p >0.05]. Conclusion : Silent adenomas were thought to behave more aggressive than other subgroups of pituitary adenomas. And so we suggest the immunohistochemical study against adenohypophyseal cells may be helpful for evaluating clinical course of pituitary adenoma, expecially for, NFAs.

Keywords

References

  1. Asa SL, Ezzat S : The cytogenesis and pathogenesis of pituitary adenomas. Endocr Rev 19 : 798-827, 1998 https://doi.org/10.1210/er.19.6.798
  2. Bradley KJ, Wass JA, Turner HE : Non-functioning pituitary adenomas with positive immunoreactivity for ACTH behave more aggressively than ACTH immuno-negative tumors but do not recur more frequently. Clin Endocrinol 58 : 59-64, 2003 https://doi.org/10.1046/j.1365-2265.2003.01674.x
  3. Black PM, Hsu DW, Klibanski A, Kliman B, Jameson JL, Ridgway EC, et al : Hormone Production in clinically nonfunctioning pituitary adenomas. J Neurosurg 66 : 244-250, 1987 https://doi.org/10.3171/jns.1987.66.2.0244
  4. Horvath E, Kovacs K : Pathology of the hypothalamus and pituitary gland in Mendelsohn G(ed) : Diagnosis and Pathology of Endocrine Diseases. Philadelphia : JB Lippincott, 1988, pp379-412
  5. Horvath E, Kovacs K : The adenohypophysis. In Kovacs K, Asa SL(eds) : Functional endocrine pathology. Boston : Blackwell, 1990, Vol 1, pp245-281
  6. Horvath E, Kovacs K, Killinger DW, Smyth HS, Platts ME, Singer W :Silent corticotropic adenomas of the human pituitary gland. a histologic, immunocytologic, and ultrastructural study. Am J Pathol 98 : 617-638, 1980
  7. Horvath E, Kovacs K, Smyth HS, Killinger DW, Scheithauer BW, Randall R, et al : A novel type of pituitary adenoma : morphological features and clinical correlations. J Clin Endocrinol Metab 66 : 1111-1118, 1988 https://doi.org/10.1210/jcem-66-6-1111
  8. Jameson JL, Klibanski A, Black PM, Zervas NT, Lindell CM, Hsu DW, et al : Glycoprotein hormone genes are expressed in clinically nonfunctioning pituitary adenomas. J Clin Invest 80 : 1472-1478, 1987 https://doi.org/10.1172/JCI113228
  9. Jeon WY, Kim OL, Kim SH, Bae JH, Choi BY, Cho SH : The sugcical result of pituitary adenoma by transsphenoidal approach. J Korean Neurosurg Soc 30 : 1278-1283, 2001
  10. Klibanski A : Nonsecreting pituitary tumors. Endocrinol Metab Clinic North Am 16 : 793-804, 1987
  11. Kovacs K, Horvath E, Bayley TA, Hassaram ST, Ezrin C : Silent corticotroph cell adenoma with lysosomal accumulation and crinophagy;A distinct clinicopathologic entity. Am J Med 64 : 492-499, 1978 https://doi.org/10.1016/0002-9343(78)90236-X
  12. Kovacs K, Horvath E, Ryan N, Ezrin C : Null cell adenoma of the pituitary. Virchows Arch A Pathol Anat Histol 387 : 165-174, 1980 https://doi.org/10.1007/BF00430697
  13. Kovacs K, Lloyd R, Horvath E, Asa SL, Stefaneanu L, Killinger DW,et al : Silent somatotroph adenomasof the human pituitary. A morphological study of three cases including immunocytochemistry, electron microscopy, in vitro examination and in situ hybridization. Am J Med 134 : 345-353, 1989
  14. McComb DJ, Ryan N, Horvath E, Kovacs K : Subclinical adenomas of the human pituitary. Arch Pathol Lab Med 107 : 488-491, 1983
  15. Nagaya T, Seo H, Kuwayama A, Sakurai T, Tsukamoto N, Nakane T, et al : Pro-opiomelanocortin gene expression in silent corticotroph cell adenoma and Cushing's disease. J Neurosurg 72 : 262-267, 1990 https://doi.org/10.3171/jns.1990.72.2.0262
  16. Randall RV, Scheithauer BW, Laws ER Jr : Hormone containing nonsecreting pituitary tumors : clinically silent monohormonal pituitary adenomas. Trans Am Clin Climatol Assoc 96 : 98-103, 1984
  17. Sakurai T, Seo H, Yamamoto N, Nagaya T, Nakane T, Kuwayama A, et al : Detection of mRNA of prolactin and ACTH in clinically nonfunctioning pituitary adenomas. J Neurosurg 69 : 653-659, 1988 https://doi.org/10.3171/jns.1988.69.5.0653
  18. Scheithauer BW, Jaap AJ, Horvath E, Kovacs K, Lloyd RV, Meyer FB, et al : Clinically silent corticotroph tumors of the pituitary gland. Neurosurgery 47 : 723-729, 2000 https://doi.org/10.1097/00006123-200009000-00039
  19. Scheithauer BW, Kovacs KT, Laws ER Jr, Randall RV : Pathology of invasive pituitary tumors with special reference to functional classification. J Neurosurg 65 : 733-744, 1986 https://doi.org/10.3171/jns.1986.65.6.0733
  20. Yamada S, Kovacs K, Horvath E, Aiba T : Morphological study of clinically nonsecreting pituitary adenomas in patients under 40 years of age. J Neurosurg 75 : 902-905, 1991 https://doi.org/10.3171/jns.1991.75.6.0902
  21. Yamada S, Sano T, Stefaneanu L, Kovacs K, Aiba T, Sawano S, et al : Endocrine and morphological study of a clinically silent somatotroph adenoma of the human pituitary. J Clin Endocrinol Metab 76 : 352-356, 1993 https://doi.org/10.1210/jc.76.2.352