Pituitary adenoma pathophysiology: Difference between revisions

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{{CMG}} {{AE}} {{AAM}}
{{CMG}} {{AE}} {{AAM}}
==Overview==
==Overview==
On gross pathology, a well circumscribed [[suprasellar]] mass is a characteristic finding of pituitary adenoma.
On gross pathology, a well circumscribed [[suprasellar]] mass is a characteristic finding of pituitary adenoma. On microscopic histopathological analysis, a monomorphic expansion of usually one cell type with lack of [[reticulin ]]network among neoplastic cells is a characteristic finding of pituitary adenoma.
On microscopic histopathological analysis, a monomorphic expansion of usually one cell type with lack of [[reticulin ]]network among neoplastic cells is a characteristic finding of pituitary adenoma.
==Pathology==
==Pathophysiology==
===Pathological feature===
*'''''Pathological feature<small><ref name=National Cancer institute> Pituitary adenoma (2015). http://www.cancer.gov/types/pituitary/hp/pituitary-treatment-pdq#section/_96. Accessed on 9 28 2015.</ref></small>'''''
Pituitary adenoma may be classified into 4 grades based on radioanatomical findings:<ref name=National Cancer institute> Pituitary adenoma (2015). http://www.cancer.gov/types/pituitary/hp/pituitary-treatment-pdq#section/_96. Accessed on 9/28/2015.</ref>
:*The radioanatomical classification places adenomas into 1 of 4 grades:
*'''Stage I''' involves microadenomas (<1 cm) without [[sella]] expansion
::*'''Stage I''' involve microadenomas (<1 cm) without [[sella]]r expansion.
*'''Stage II''' involves macroadenomas (≥1 cm) and may extend above the sella
::*'''Stage II''' involve macroadenomas (≥1 cm) and may extend above the sella.
*'''Stage III''' involves macroadenomas with enlargement and invasion of the floor or suprasellar extension
::*'''Stage III''' involve macroadenomas with enlargement and invasion of the floor or suprasellar extension.
*'''Stage IV''' involves macroadenomas that cause destruction of the sella
::*'''Stage IV''' involve macroadenomas that cause destruction of the sella.
 
*'''''Microadenoma<small><ref name=Radiopaedia> pituitary micro adenoma Dr Amir Rezaee and Dr Frank Gaillard. 2015 http://radiopaedia.org/articles/pituitary-microadenoma</ref></small>'''''
===Microadenoma===
:*Pituitary microadenomas are defined as adenomas less than 10 mm in size.
:*Pituitary microadenomas are defined as adenomas less than 10 mm in size.<small><ref name=Radiopaedia> pituitary micro adenoma Dr Amir Rezaee and Dr Frank Gaillard. 2015 http://radiopaedia.org/articles/pituitary-microadenoma</ref></small>
:*Most frequently diagnosed as a result of investigating hormonal imbalance.
:*Most frequently diagnosed as a result of investigating hormonal imbalance.
:*They are confined to the [[sella]] and has no scope to produce mass effect related symptoms.
:*They are confined to the [[sella]] and have no scope to produce mass effect related symptoms.
====Microscopic Pathology====
<Gallery>
<Gallery>
Pituitary adenoma (1) GH production.jpg|Histopathological image of pituitary adenoma with GH production. Acidophilic cell type. Hematoxylin & esoin stain.<ref name=Wikipedia1> https://en.wikipedia.org/wiki/Pituitary_adenoma#/media/File:Pituitary_adenoma_%281%29_GH_production.jpg</ref>
Pituitary adenoma (1) GH production.jpg|Histopathological image of pituitary adenoma with GH production. Acidophilic cell type. Hematoxylin & esoin stain.<ref name=Wikipedia1> https://en.wikipedia.org/wiki/Pituitary_adenoma#/media/File:Pituitary_adenoma_%281%29_GH_production.jpg</ref>
Line 21: Line 22:
Pituitary adenoma (2) GH production.jpg|Histopathological image of pituitary adenoma with GH production. Acidophilic cell type. Hematoxylin & esoin stain.<ref name=Wikipedia1> https://en.wikipedia.org/wiki/Pituitary_adenoma#/media/File:Pituitary_adenoma_%281%29_GH_production.jpg</ref>
Pituitary adenoma (2) GH production.jpg|Histopathological image of pituitary adenoma with GH production. Acidophilic cell type. Hematoxylin & esoin stain.<ref name=Wikipedia1> https://en.wikipedia.org/wiki/Pituitary_adenoma#/media/File:Pituitary_adenoma_%281%29_GH_production.jpg</ref>
</Gallery>
</Gallery>
*'''''Macroadenoma<small><ref name=radio>Pituitary adenoma. Dr Amir Rezaee and Dr Yuranga Weerakkody. Radiopaedia.org 2015.http://radiopaedia.org/articles/pituitary-adenoma</ref></small>'''''
===Macroadenoma===
:*Pituitary macroadenomas are the most common [[suprasellar]] mass in adults.
*Pituitary macroadenomas are the most common [[suprasellar]] mass in adults.<small><ref name=radio>Pituitary adenoma. Dr Amir Rezaee and Dr Yuranga Weerakkody. Radiopaedia.org 2015.http://radiopaedia.org/articles/pituitary-adenoma</ref></small>
:*They are defined as adenomas greater than 10 mm in size and are most frequently diagnosed due to compression of the surrounding structures, such as [[optic chiasm]].
*They are defined as adenomas greater than 10 mm in size and are most frequently diagnosed due to compression of the surrounding structures, such as the [[optic chiasm]].
:*Larger adenomas can lead to hormonal imbalance due to mass effect rather than secretion.
*Larger adenomas can lead to hormonal imbalance due to mass effect rather than secretion.
:*[[Hypopituitarism]] or moderately elevated [[prolactin]] are both seen, the later due to stalk effect; prolactin release (unlike other pituitary hormones) is tonically inhibited by prolactin inhibitory hormone (a.k.a. dopamine) and as such compression of the pituitary infundibulum can result in elevation of systemic prolactin levels due to interruption of normal inhibition.
*[[Hypopituitarism]] or moderately elevated [[prolactin]] are both seen, the latter due to stalk effect. Prolactin release (unlike other pituitary hormones) is tonically inhibited by prolactin inhibitory hormone ([[dopamine]]) and as such compression of the pituitary infundibulum can result in elevation of systemic prolactin levels due to interruption of normal inhibition.
:*Macroadenomas are approximately twice as common as micoadenoma.
*Macroadenomas are approximately twice as common as micoadenoma.
====Microscopic Pathology====
<Gallery>
<Gallery>
Image:
Image:
Nonfunctioning pituitary adenoma (1).jpg|Histopathological image of nonfunctioning pituitary adenoma. Hematoxylin & eosin stain.<ref name=Wikipedia>https://en.wikipedia.org/wiki/Pituitary_adenoma#/media/File:Nonfunctioning_pituitary_adenoma_%281%29.jpg</ref>
Nonfunctioning pituitary adenoma (1).jpg|Histopathological image of nonfunctioning pituitary adenoma. Hematoxylin & eosin stain.<ref name=Wikipedia>https://en.wikipedia.org/wiki/Pituitary_adenoma#/media/File:Nonfunctioning_pituitary_adenoma_%281%29.jpg</ref>
</Gallery>
</Gallery>
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Neurology]]
[[Category:Neurosurgery]]
[[Category:Endocrinology]]

Latest revision as of 14:11, 26 May 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]

Overview

On gross pathology, a well circumscribed suprasellar mass is a characteristic finding of pituitary adenoma. On microscopic histopathological analysis, a monomorphic expansion of usually one cell type with lack of reticulin network among neoplastic cells is a characteristic finding of pituitary adenoma.

Pathology

Pathological feature

Pituitary adenoma may be classified into 4 grades based on radioanatomical findings:

  • Stage I involves microadenomas (<1 cm) without sella expansion
  • Stage II involves macroadenomas (≥1 cm) and may extend above the sella
  • Stage III involves macroadenomas with enlargement and invasion of the floor or suprasellar extension
  • Stage IV involves macroadenomas that cause destruction of the sella

Microadenoma

  • Pituitary microadenomas are defined as adenomas less than 10 mm in size.[1]
  • Most frequently diagnosed as a result of investigating hormonal imbalance.
  • They are confined to the sella and have no scope to produce mass effect related symptoms.

Microscopic Pathology

  • Histopathological image of pituitary adenoma with GH production. Acidophilic cell type. Hematoxylin & esoin stain.[2]

    Histopathological image of pituitary adenoma with GH production. Acidophilic cell type. Hematoxylin & esoin stain.[2]

  • Histopathological image of pituitary adenoma with GH production. Acidophilic cell type. Hematoxylin & esoin stain.[2]

    Histopathological image of pituitary adenoma with GH production. Acidophilic cell type. Hematoxylin & esoin stain.[2]

Macroadenoma

  • Pituitary macroadenomas are the most common suprasellar mass in adults.[3]
  • They are defined as adenomas greater than 10 mm in size and are most frequently diagnosed due to compression of the surrounding structures, such as the optic chiasm.
  • Larger adenomas can lead to hormonal imbalance due to mass effect rather than secretion.
  • Hypopituitarism or moderately elevated prolactin are both seen, the latter due to stalk effect. Prolactin release (unlike other pituitary hormones) is tonically inhibited by prolactin inhibitory hormone (dopamine) and as such compression of the pituitary infundibulum can result in elevation of systemic prolactin levels due to interruption of normal inhibition.
  • Macroadenomas are approximately twice as common as micoadenoma.

Microscopic Pathology

  • Histopathological image of nonfunctioning pituitary adenoma. Hematoxylin & eosin stain.[4]

    Histopathological image of nonfunctioning pituitary adenoma. Hematoxylin & eosin stain.[4]

References

  1. ↑ pituitary micro adenoma Dr Amir Rezaee and Dr Frank Gaillard. 2015 http://radiopaedia.org/articles/pituitary-microadenoma
  2. ↑ 2.0 2.1 https://en.wikipedia.org/wiki/Pituitary_adenoma#/media/File:Pituitary_adenoma_%281%29_GH_production.jpg
  3. ↑ Pituitary adenoma. Dr Amir Rezaee and Dr Yuranga Weerakkody. Radiopaedia.org 2015.http://radiopaedia.org/articles/pituitary-adenoma
  4. ↑ https://en.wikipedia.org/wiki/Pituitary_adenoma#/media/File:Nonfunctioning_pituitary_adenoma_%281%29.jpg

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