Cell Lineage-Specific Differences in Clinical Behavior of Non-Functioning Pituitary Adenomas

Area of Science:

• Endocrinology
• Oncology
• Pathology

Background:

• Immunohistochemistry (IHC) for cell lineage-specific transcription factors (TFs) has updated pituitary adenoma classification since 2017.
• This has led to new subtypes of hormone-negative non-functioning pituitary adenomas (NFPAs) and fewer null cell adenomas (NCAs).

Purpose of the Study:

• To investigate the relationship between cell lineage-specific TF expression and radiological invasion in NFPAs.
• To explore associations with prognosis, including recurrence and radiotherapy needs.

Main Methods:

• A comprehensive literature search was conducted across Medline, Embase, and CENTRAL up to July 2023.
• 27 cohort studies were included, analyzing radiological invasion, recurrence, or radiotherapy in NFPAs based on TF expression.
• Data extraction and risk of bias assessment were performed independently by two authors.

Main Results:

• Cavernous sinus invasion was more common in NCAs and TPIT+ NFPAs compared to SF1+ NFPAs.
• NCAs also showed higher rates of cavernous sinus invasion compared to PIT1+ NFPAs.
• Limited studies prevented detailed analysis of recurrence and radiotherapy data.

Conclusions:

• Cell lineage-specific TFs identified via IHC are crucial for distinguishing NFPA subtypes.
• These subtypes exhibit different clinical behaviors, particularly regarding invasion patterns.
• Further research is needed to fully elucidate prognostic implications.