The Complementary Role of Transcription Factors in the Accurate Diagnosis of Clinically Nonfunctioning Pituitary Adenomas.
Clinically nonfunctioning pituitary adenomas (NFAs) may be hormonally inactive tumors of differentiated cells, mainly not only gonadotroph adenomas (GAs) but also silent corticotroph adenomas (SCAs) and other differentiated silent adenomas. Recently, the use of transcription factors has been recommended to confirm cytodiffererentiation of these neoplasms. Our objective was to assess the clinical significance of the new classification system using transcription factors. Five hundred sixteen consecutive NFAs were studied retrospectively. They were initially classified based on hormone immunohistochemistry as follows: 119 hormone-negative adenomas (23.1 %), 300 GAs (58.1 %), 51 SCAs (9.9 %), and 46 other silent adenomas. The 119 hormone-negative adenomas were further evaluated for expression of transcription factors including steroidogenic factor-1 (SF-1), estrogen receptor-α (ERα), pituitary-specific transcription factor 1 (Pit-1), and t-box transcription factor (Tpit). One hundred thirteen of 119 (95 %) hormone-negative adenomas showed mutually exclusive lineage-specific differentiation as gonadotrophs (SF-1 positive), corticotrophs (Tpit positive), or somatotrophs/mammosomatotrophs/lactotrophs/thyrotrophs (Pit-1 positive) in 79 cases (66.4 %), 32 cases (26.9 %), and 2 cases, respectively. The 32 ACTH-negative and Tpit-positive adenomas had higher pro-opiomelanocortin mRNA expression levels compared with GAs (P = 0.0001) on quantitative real-time PCR. They showed a female preponderance (P < 0.0001) and were more frequently giant adenomas (P = 0.0028) associated with marked cavernous sinus invasion (P < 0.0001) compared with GAs. These clinical features were identical to those of the 51 ACTH-positive SCAs. Our results justify the complementary role of transcription factors in the precise classification of NFAs that can more accurately characterize biological behavior. Our data suggest that more than one quarter of hormone-negative adenomas are SCAs that share distinct clinicopathological features with ACTH-expressing SCAs.
Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan. nishioka@tokyo-med.ac.jp.|Okinaka Memorial Institute for Medical Research, Tokyo, Japan. nishioka@tokyo-med.ac.jp.
Hiroshi
H
Nishioka
Department of Pathology, Toranomon Hospital, Tokyo, Japan.|Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
Naoko
N
Inoshita
Department of Pathology, University Health Network, Toronto, ON, Canada.
Ozgur
O
Mete
Department of Pathology, University Health Network, Toronto, ON, Canada.
Sylvia L
SL
Asa
Department of Endocrinology, Toranomon Hospital, Tokyo, Japan.
Kyohei
K
Hayashi
Department of Endocrinology, Toranomon Hospital, Tokyo, Japan.|Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
Akira
A
Takeshita
Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan.
Noriaki
N
Fukuhara
Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan.
Mitsuo
M
Yamaguchi-Okada
Department of Endocrinology, Toranomon Hospital, Tokyo, Japan.|Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
Yasuhiro
Y
Takeuchi
Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan.|Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
Shozo
S
Yamada
D000236:Adenoma / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D005260:Female; D018398:Homeodomain Proteins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000175:diagnosis*; D054339:Steroidogenic Factor 1 / Q000378:metabolism*; D020825:T-Box Domain Proteins / Q000378:metabolism*; D050817:Transcription Factor Pit-1 / Q000378:metabolism*; D055815:Young Adult
D014408:Biomarkers, Tumor; D018398:Homeodomain Proteins; D054339:Steroidogenic Factor 1; D020825:T-Box Domain Proteins; C486589:TBX19 protein, human; D050817:Transcription Factor Pit-1
Nonfunctioning pituitary adenomas; Pit-1; SF-1; Silent adenomas; Tpit; Transcription factors