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Best Practice No 172: pituitary gland pathology
1Division of Pathology, School of Clinical and Molecular Medicine, University of Edinburgh, Western General Hospital, Edingurgh EH4 2XU, UK. j.w.ironside@ed.ac.uk
Journal of Clinical Pathology
|August 2, 2003
Summary
Diagnosing pituitary tumors requires clear classification. This review highlights the need for standardized criteria for pituitary adenoma prognosis, especially regarding invasion, and suggests a revised diagnostic approach.
Area of Science:
- Endocrinology
- Neurosurgery
- Pathology
Background:
- Pituitary gland tumors, particularly adenomas, are common endocrine neoplasms.
- Current classification relies heavily on histological and immunocytochemical features.
- Prognostic indicators, especially for tumor invasion, remain poorly defined.
Purpose of the Study:
- To review evidence on the diagnosis and classification of pituitary tumors.
- To assess the relevance of histological and genetic features to prognosis.
- To identify uncertainties and propose an improved diagnostic and classification approach.
Main Methods:
- Comprehensive literature review of published evidence.
- Analysis of histological, ultrastructural, and immunocytochemical classification studies.
- Evaluation of cytogenetic, genetic, and molecular biological findings.
Main Results:
- Extensive multicenter studies exist for pituitary adenoma classification.
- Limited consensus on prognostic features, particularly invasion, in adenomas.
- Inconsistent genetic abnormalities found in relation to pituitary tumor progression.
Conclusions:
- A need exists to reassess nomenclature and diagnostic criteria for invasive pituitary adenomas and carcinomas.
- Current clinical and pathological criteria for invasion lack correspondence.
- A proposed diagnostic and classification approach integrates robust historical criteria with provisional data for future prospective studies.