Proposal of a new clinical cyto-functional classification of pituitary adenomas

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Pituitary adenomas have been classified historically on the basis of tinctorial affinities, followed by the basis of ultrastructure and immunohistochemistry. The current development of technologies necessitate the new classification of pituitary adenomas which integrates these numerous informations as well as the clinical informations. For this purpose, we suggest a new clinical cytofunctional classification of pituitary adenomas, which is based on clinical manifestations and integrates the information on biology, images, function and ultrastructure. We have examined about 600 surgically obtained adenoma tissues by immunohistochemistry (IHC), in situ hybridization (ISH) and electronmicroscopy. By IHC and ultrastructural techniques, most GH-producing adenomas present multihormonal expressions and it has been suggested that pituitary specific transcriptional factor Pit-1 may have a role in the functional differentiation and the multihormonality of GH, TSH and PRL secreting adenomas. Clinically non-functioning adenomas have demonstrated gonadotropin secretion and the descrepancy between hormonal expression by IHC and gene expression by ISH.Furthermore, we have investigated the expression of various transcripts including hypothalamic hormones, hypothalamic hormone receptors, estrogen receptor, retinoid X receptor, which regarded to have important eoles on tumorigenesis and cell differentiation, using in situ polymerase chain reaction. Introduction of the molecular biotechniques in clinical cyto-functional classification is expected to provide a better understanding of the pathogenesis, pathophysiologies and functions of pituitary adenomas.