Clinical Implications of Pituitary Adenomas Exhibiting Dual Transcription Factor Staining: A Case Series of 27 Patients.
Clinical Implications of Pituitary Adenomas Exhibiting Dual Transcription Factor Staining: A Case Series of 27 Patients.
复制标题
表现出双转录因子染色的垂体腺瘤的临床意义：27 名患者的病例系列。
DOI：
10.1016/j.wneu.2023.11.036
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发表时间：
2024
影响因子：
2
通讯作者：
Zada,Gabriel
中科院分区：
文献类型：
--
作者：
Bove,Ilaria;Cheok,StephanieK;Feng,JeffreyJ;Briggs,RobertG;Ruzevick,Jacob;Cote,DavidJ;Shah,Ishan;Little,Andrew;Laws,Edward;Castro,AnaValeria;Carmichael,John;Shiroishi,Mark;Hurth,Kyle;Zada,Gabriel
根据2017年世界卫生组织神经内分泌肿瘤分类，垂体腺瘤（PA）根据垂体特异性转录因子（TF）的免疫表达进行分类。PA的一个小的子集表现出多种TF染色的免疫组化，我们提出了一系列的27个病理证实的双重TF染色PA（dsTF-PA）的情况下，并报告临床相关的implications.MethodsA回顾性图表审查的多机构数据库的患者PA手术切除2008-2021之间进行。PA表达免疫阳性2+ TF。患者的人口统计学，神经影像学特征，组织病理学结果，和临床data. ResultsTwenty 7例患者病理证实的dsTF-PA，其中17名女性（63%），年龄范围从20-84岁。23例（85.2%）患者患有功能性PA，肢端肥大症是最常见的功能亚型（86.4%）。单个肿瘤中最常见的TF组合是PIT-1/SF-1（85.2%）。6例PA显示Knosp海绵窦浸润等级为3或4级，6例患者（24.0%）的Ki-67标记指数≥3%，均为PIT-1/SF-1染色。在78%的功能性dsTF-PA中实现了激素缓解。在平均随访期28.5 months. ConclusionsPA显示dsTF-PAs的复发或进展的证据没有PA代表一个小的，但临床相关的诊断子集的PA根据2021年世界卫生组织的标准，大多数是GH生产。使用TF染色的精确分类在理解这些肿瘤的生物学方面起着关键作用。随着TF分类的发展，在PA的这个子集中可以实现有利的结局。
ObjectiveAccording to the 2017 World Health Organization classification of neuro-endocrine tumors, pituitary adenomas (PAs) are classified according to immunoexpression of the pituitary-specific transcription factors (TFs). A small subset of PAs exhibit multiple TF staining on immunohistochemistry and we present a series of 27 pathologically-confirmed cases of dual TF staining PAs (dsTF-PAs), and report clinically relevant implications.MethodsA retrospective chart review of a multi-institutional database of patients with PAs surgically resected between 2008–2021 was performed. PAs expressing immunopositivity 2+ TFs. Patient demographics, neuro-imaging characteristics, histopathologic findings, and clinical data were collected.ResultsTwenty-seven patients had pathologically verified dsTF-PAs, of whom 17 were female (63%), with ages ranging from 20–84 years. Twenty-three (85.2%) patients harbored functional PAs, with acromegaly being the most common functional subtype (86.4%). The most common combination of TFs within a single tumor was PIT-1/SF-1 (85.2%). Six PAs exhibited Knosp cavernous sinus invasion grades of 3 or 4 and the Ki-67 labeling index was ≥3% in 6 patients (24.0%) and all stained for PIT-1/SF-1. Hormonal remission was achieved in 78% of functional dsTF-PAs. No PAs showed evidence of recurrence or progression over the mean follow-up period of 28.5 months.ConclusionsPAs exhibiting dsTF-PAs represent a small but clinically relevant diagnostic subset of PAs according to the 2021 World Health Organization criteria, as a majority are GH-producing. Precise classification using TF staining plays a key role in understanding the biology of these tumors. Favorable outcomes can be achieved in this subset of PAs with evolving TF classification.