WHO Classification of Tumours of Endocrine Organs

283 Pages·2019·103.409 MB·English

by  Ricardo V. Lloyd, Robert Y. Osamura, Gunter Kloppel, Juan Rosai

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Contents
1 Tumouorfts hp ei tugiltaanrdy 123
Spinedpliet hteulmiowauilrtt hhy musd-llrirkeer entlation
11
WHOc lassioffti ucmaotouiftro hsnpe i tuitary 125
12 lntratthhyyrmcoiaicrd c inoma
Introduction 127
13 Paraganagnlmdie osmean chymatlu/msoturrosm al
Pituaidteanroym a 127
14 Paraganglioma
Somatoatdreonpohm a 128
19 Peripnheerrsvahele attuhm ours
Lactoatdreonpohm a 129
24 Benivgans ctuulmaoru rs
T hyrotroph adenoma 129
28 Angiosarcoma
Corticaodternoopmha 132
30 Smoomtuhs ctluem ours
Gonadoatdreonpohm a 133
Soliftiabrryo us tumour
34
Nuclelal dle noma 135
37 Haematolytmupmhoouirds
Plurihoarnmdo ndaoalud belneo mas 39 Langercheahlnilss tlocytosls 135
Pituciatracriyn oma 136
41 Rosai-Ddoirsremaasne
Pitubiltaasrtyo ma Follidceunldacrerisl tallr cc oma 136
45
Craniopharyngioma 46 Primtahryyrl oyimdp homa 137
Neuroannapdla ranetuurmoonuarls 48 Germ tcuemlolu rs 139
Ganglioacnymdti oxmgeaad n gliocytoma-a4d8e nomSae contduamroyu rs 142
Neurocytoma
49
Paraganglioma 50 3 Tumouorft shp ea rathgylraonidds 145
Neuroblastoma 51 WHOc lassiofrti ucmaotouiftro hsnpe a rathgylraonidds1 46
Tumoouftr shp eo stepriitouri tary 52 TNM stoaftg uimnogou ftr hse parathyroid 1g4l6a nds
Mesenchaynmsdat lr otmuamlo urs 55 Parathcyarrociidn oma 147
Meningioma 55 Parathaydreoniodm a 153
Schwannoma 56 Secondmaersye,n chaynmodat lht eurm ours 159
Chordoma 57
Haemangiopericfyitbortmouaum/soS uorl ita5r8y 4 Tumouorfts ha ed recnoarlt ex
161
Haematolytmupmhoouirds 60 WHOc lalscsaltofift o unm oouftr hse adcroerntaelx 162
Gercme tlulm ours 61 TNMc lassioffti ucmaotouiftro hsne adcroerntaelx 162
Secontduamroyu rs 63 Adrecnoarltc iacracli noma
163
Adrecnoarlta idceanlo ma
169
65 Secxo rsdt-rotmuamlo urs
2 Tumouorfts ht eh yrgoliadn d 173
WHOc lassioffti ucmaotouiftro hsnte h yrgoliadn d 66 Adenomtautmooidu r
174
TNMc lassioffti ucmaotouiftro hsnte h yrgoliadn d 67 Mesenchaynmsdat lr otmuamlo urs
175
68 Myelolipoma
Introduction
175
69 Schwannoma
Folliacduelnaorm a
176
Hyalitnriazbiencgu lar tumour 73 Haematoltymupmhoouirds
177
Otheenrc apsufloaltleidc ulatrh-yprtaoutimtdoe urrnse7 d5 Secontduamroyu rs
178
76
Tumooufur nsc ermtaaliingp noatnetn tial
Non-infvoalslitivhceyu rnloeaiordp lwaistmh 5 Tumouorfts ha ed remneadlu alnlda
78
papillnaurcyl-feleaiarkt eu res extra-apdarreangaaln glla
179
81
Papitlhlyarrcoayir dc inoma WHOc lassioffti ucmaotouiftro hsnae d remneadlu alnlda
92 extra-paadrraegnaanlg lia
Follitchuylrcaoarir dc inoma
180
96
H0rt(holnec occeytltulim co)u rs TNMs tagoiftn ugm oouftr hsae d remneadlu alnlda
100
Poodrilfyf ertehnytricoaaitrdec di noma extra-paadrraegnaanlg lia
180
Anapltahsytrcioacir dc inoma 104 Introduction
181
107 Phaeochromocytoma
Squamcoeuclsal r cinoma
183
108
Extra-paadrraengaaln gliomas
Medultlhayrrcyoa irdc inoma
190
114
Mixmeedd ulalnafdro yl ltihcyurcloaairrdc inoma Heaadn nde cpka ragangliomas
190
117
Sympatphaertaigca nglioma
Mucoepidcearrmcoiindo ma
192
119
Sclermouscionegp ldcearrmcoiiwndio etmohas inophilia Neurobtluamsotouiftrc hs ae d renal gland
196
121
Composite phaeochromocytoma
Mucinous carcinoma
204
122
Compopsairtaeg anglioma
Ectopic thymoma
206
6 Neoplaosftm hsne e uroendpoacnrcirneea s
209
WHOc lassioffin ceaotpiloaonsft m hse
neuroendpoacnrcirneea s
210
TNMc lassioffit cuamtooiufonr nes u roendpoacnrcirneea s
210
Introduction
211
Non-func(tnioonn-isnygnn deruormoiecn)dt oucmroiunres
215
lnsulinoma
222
Glucagonoma
225
Somatostatinoma
227
Gastrinoma
229
VIPoma
231
Serotonin-tpurmoodwuuircatsinh nwd gi thcoaurtc inoid
syndrome
233
ACTH-protduumcoiwunirgtC uhs hsiynngd rome 234
Pancrneeautrioce ndcoacrrciin(nepo omoadr ilfyf erentiated
neuroendnoecorpilnaes m) 235
Mixneedu roendocreiunreo-ennodnnoe-conrpilnaes m2s3 8
Mixdeudc tal-neurcoaerncdioncormianse 238
Mixaecdi nar-neurcoaerncdioncormianse 239
241
7 nhIeirtetdu mosuyrn dromes
242
Introduction
243
Multeinpdloec nreionpel taysp1ie a
248
Multeinpdloec nreionpel taysp2ie a
253
Multeinpdloec nreionpel as4i a type
255
Hyperparathytruomiosduyirns dmr-ojmaew
257
VoHni ppel-sLyinnddraoum e
Famiplairaalg anglioma-phaseyoncdhrroommeosc ytoma
262
causbeySd O HBS,O HCa,n SdO HOm utations
266
Neurofibrtoymp1ae t osis
269
Carnceoym plex
272
McCune-Aslybnrdirgohmte
275
Faminloina-lm edtuhlylrcaoarinydc er
275
Cowdseynn draonmPdeT EN-relleastieodn s
276
Famialdieanlo maptooluyspa onsAdiP sC -relleastieodn s
277
Non-syndromtihcy rcfoaainmdci elri al
278
Wernseyrn draonmCdea rnceoym plex
280
OICEsRy1n drome
282
Glucacgeohlnyl p erpalnandse ioap lasia
285
Contributors
295
Declaroafit nitoenr ests
296
IARC/WCHoOm mitftoterhe Ie C D-O
297
Sourocfef si gures
300
Sourocfet sa bles
301
References
347
Subjiencdte x
355
Liosfat b breviations
CHAPTER 1
Tumourosft hep ituitgalrayn d
Pituaidteanroym a
Pituciatracriyn oma
Pitubiltaasrtyo ma
Craniopharyngioma
Neuroannapdla raneutruomnoaulr s
Tumouorfts hp eo stepriitouri tary
Mesenchaynmsdat lr otmuamlo urs
Haematolytmupmhoouirds
Gercme tlulm ours
Secondtaurmyo urs
WHOc lassifoiftc uamtoiuoornfts h pei tuitary
Pituiatdaernyo mas
Mesenchaynmdas lt rotmuamlo urs
9530/0
Pituaidteanroym a
Meningioma
8272/0
9560/0
Somatotardoepnho ma
Schwannoma
8272/0
9370/3
Lactotardoepnho ma
ChordoNmOaS,
8271/0
9371/3
Thyrotardoepnho ma
Chondcrhooirdd oma
8272/0
9372/3
Corticoatdreonpohm a Dediffercehnotridaotmead
8272/0
Gonadotardoepnho ma Haemangiopericyftiobmrtaou/umSsoo ulri tary
8272/0
Nuclelal dle noma Gra1dH eP C/SFT 8815/0
8272/0
8815/1
Plurihoarnmddoo nuaballd ee nomas Gra2dH eP C/SFT
8272/0
8815/3
Gra3dH eP C/SFT
Pituictaarrcyi noma
8272/3
Haematolymtpuhmooiudr s
Pituibtlaarys toma 8273/3"
Gercme tlulm ours
Germinoma 9064/3
Craniopharyngioma 9350/1
Adamantincormaantiooupsh aryngioma Yolskat cu mour 9071/3
9351/1
Papilclraarnyi opharyngioma Embrycoanracli noma 9070/3
9352/1
Choriocarcinoma 9100/3
Te ratoNmOaS, 9080/1
Neuroannadpl a raneutruomnoaulr s
Ganglioacnydmt ioxmead Matutreer atoma
9080/0
gangliocytoma-adenoma Immattuerrea toma
9080/3
9492/0
Neurocytoma Treatowmiatm ha ligtnraannts formation
9506/1 9084/3
Paraganglioma gercme tlulm our
8693/3 Mixed 9085/3
Neuroblastoma
9500/3
Secondtaurmyo urs
Tumouorfts h peo sterior pituitary
Pituicytoma
9432/1
Them orphocloodgeaysr f er otmh Ien ternaCltsaislofntiaicnlooa fD iseases
Granucletalurlm oouftr h see lrleagri on
9582/0
foOrn col(oIgCyO l-8O9)8 BAelh.a viiscoo udre /d0f obre nitgunm ours:
Spincdelolenl c ocytoma
8290/0
/1f ourn specbiofiredde,ro lrui nncee,r bteahianv i/o2fu ocrra; r cinIonm a
Selelpaern dymoma
9391•/ 1 siatnudg rad1e1l 1n traepnletohpellaalsnaid/la 3f ; om ra ligtnuamnotu rs.
hec lassifiismc oadtiiffoirneo tdmh per eviWoHuOsc lassiftiackaitnigo n,
:
inatcoc oucnhta ngienos u urn derstaonftd hienlsgee s ions.
"Thenseewc odewse raep probvyet dhI eA RC/WHCOo mmitftoIerCe D -O.
12 Tumouorfts hp ei tugiltaanrdy
Introduction
OsamuRr.Ya .
LopMe.sB .S .
GrossAm.a n
KontogeGo.r gos
TrouJi.l las
Thicsh apdteesrc rpiibteusai dteanroy­
(I.mei.t octoiucan ntd K i-p6r7o lifera­
onp ituitlairyn-ecfaeotglrhel de e signa­
masp,i tuictaarrcyi noma, and various
tioofan d enomFaoesrx. a mptlhneee, w tioinn deixna) d,d ittoio otnhc elri nical
othteurm ooucrcsu rirtni hnsege lalnadr
paramestuecarhss i nvaassisoens sed
design°astoimoant aodternoopdmhea ­"
parasreelglioaofrtn h pei tugiltaanrdy.
by MsRtIu daineds/i onrt raopeexr­ative
finaeg sr oouftp u motuhraasrt de e rived
Pituitary tahmdeoe snfotrm eaqsu,e nt
aminaftoitroh ne ,e vaolIfun adtiivoind ual
froamP ITl1i neaangdse e crgertoew th
tumoiunrvso ltvhriiensgg i aormneo, s tly
hormotnheri;es p latchfeeos r mteerr mt umotuhrmasat y beihnaam voerc el ini­
benitgunm ouPrist.u ictaarcriyn iosm a
•grohwotrhm one-praoddeuncoimnacg"a .la lgyg remsasninvAeedr e.n oimnav a­
verrya raen,db ecaussiego nfsh isto­
Then ewc lassifriecmaatibinaossn e ds ioansa, s sesseMdR Is tbuyd aineds/
patholmoagliicganlaa rnleca yc kiitnsg ,
oni mmunohistofcothrhe mema iisnto rriy n traopeexraamtiinsvaheto iubolend ,
diagniosos nilcsyo nsidwehremened ­
secrehtoirnmgo nOetsh.ie mrm unohciosn­sidaenir mepdo rptraongtn foesat­ic
tastaarspeer se sAen netwe. n tpiittyu,i ­
tochemicals ucmahask r ekrearatsli,­tn ,u rient hemsoer cel iniacgaglrleys sive
tabrlya stiodsme as,c riitnbh ecidhs a pter
lofwo dri fferebnettiwaectelinio nni caadlelnyo( msaepse.1 7{ 2814}}.
asp arotfa k nowgne nebtaicck ground
relehviasntto lsougbitcysapulec sah,s Specaidaeln osmuab tytpheacsto m­
(OICmEuRt1a tAilosdnoe) s.c riidnbe e­d
densaenldsy p arsely sgormaan­muolnaslthyeo daw g gresbseihvaevm iuosutr
taairlte u moaurrissi itnnh pgeo stpeir­itoort roph awdheinwcoehmr paers e,v ioaulssb­oet akiennta oc couTnhte.si en ­
tuitianpr ayr,t itchuolbsaeerl iteovb eed l iyd entointf hibeea dso ifus l trastrculcutsdupera arlsg erlayn ulsaotmeadt otroph
derifvreopdmi tui(ctymhtoeed si gfliieadfl e atuErleesc.tm riocnr osicson poyw adeno(msae Seo matotraodpehn oma,
celolfts h e posterior pituitary}, Including
raruesleytd oc laspsiitfuyti utmaoruyr ps1..9 l)a,c toatdreonpohim nma esn ( see
pituicytomcae,tl ulgm rooauftnr hu el ar Lactoatdreonpohpm 2.a4 ,C) r,o ockeel l
postepriitouria tnadsr pyi,nc delolenl ­ Prognaonspdir se diction adenoamnasd i lceonrtt icaodternoop­h
cocytoAmlat.h otuhgehts uem oaurresA lthomuogsphti tuitarbye htauvmmeoa (u sresCe o rticaodteronpohpm 3.a0 ,) ,
verrya rteh,er ierc ogniisit mipoonr tbaennti g(nil.dyeo n. o mte tastaansdi zaen)dp lurihoPrImTo1n-aplao dseintoi­ve
becatuhseeay ra ec rucdiiaflf edrie­natrtieha elr ecfaolralede edn omtahsef,yr em­a( previcoaulslsleiydl s eunbtt 3y pe
agnofsoitrsh m eo scto mmoand enomqau;e nitnlvyai dnett hoae d jacsetnrtu acd­enosmeaPle;u rihormaonnddao lu ble
theretfhoeraiecr,c urdaitaeg nhoassi tsu rleesa,d tiorn egc urrTehnecree.f aodreen,o pm3.a9 s},.
important itmhpelriacpaetuitocinlcsi .na incdpa alt holpoagriacmaelt ers for
Othteurm oaurrissi intnh sgee lrleagri opnr ediscutccihln ign aigcgarlelbsyes ­ivGee neptirocf ainlsdeu sceptibility
thaartre e vieiwnde edti anicll curdaen hia­viaoreuesr s ential. Althomuogsahtd enoamrasesp oradic,
opharyn(gani oonm-atr uamroewu irta h Int h2e0 0c4l assitfhiceca atteiogofon rc,ye rtfaaimnis lyinadlr oamreaess soci­
bimoadgaedl i strimbeusteinocnh}y,pm iatlu tiutmaorwuyar sds i viidnettdho r eaet ewdi tphi tuiatdaernyo miansc.l ud­
tumouarngsde, r cme tlulm ours. subcatetgyopriiacedasel:n oamtay,p iin­mgu lteinpdloec nreionpel taysp1ie,a
caald enoamnadc, a rcinAotmyap.i mcuallt iepnldeo crine neo4p,l asia type
adenowmearsde e fibnyae h di gmhi totCiacr ney cofmampililesixoa,ll a ted pi­
Newc lassifoifpc iattuiiotna ry
indaeK xi,- p6r7o lifienrda>et3 xi% o,n t uitary adenoma, McCune-Albright syn­
adenomas
ands tronnugc lpe5a3sr t ainWiintghd. r omSeD,H -relfaatmeidpl iitauli tary
Terminology
Ouirm prouvnedde rstoaftn hdreio nlget hecsrei ttehriein ac,i doefan tcyep iacdaeln onmeau,r ofibtryopm1ea,v t oons is
adenowmaars e lavtairvie(al5by-l 1e0 %),
oft ranscriptiinto hnde i ffafcetroerns­ Hippel-slyinnddraoaumn edD, I CER1
tiaotfia onnt epriitourci etlaalrnsydt hea npdr ognsoisgtniicf ciocuanlnodbct ee syndrome b(lpaisttuoMimotasao)trf. y
establdiesshpmeiodtr ete h a1n0y ears
reguloafst pieocnpi iftiuchi otramroyn es thteu moausrsso cwiiafttahem di slyina­l
(e.PgI.TS 1F,1a ,n dTP IhTa)cs h angeodfr eseaorntc hhue t iolfit thyic sl asd­romseesc rgertoewh tohr moanned /or
sificTahteiroentf.ho tere er,"m a typical
ouurn derstoaftn hdpeir negs unmae­d prolaacntdsi ung gaecstti voaftt hieo n
adenoimsan "ol ongreerc ommended.
tuorfet hpei tucietlaflrrsyow mh iacdh­ PITt1r anscription factor.
Howevweerr ,e commtehnaeds sess­
enomdaesr iIvnle i.go hfthti n se kwn owl­
menotfm arkoefrt su mopurro liferation
edgteh,ce u rrcelnats siffoiccuasteiso n
Introduc1t3i on
LopMe sB .S.
Pituiatdaernyo ma
OsamuRrY.a.
MatsAu.n o
GrossAm.a n
TrouJi llas
KorboMn.i ts
Io vaIc.<s
Definition
Pituaidteanroyim saan eoplparsotliicf ­
eratoifao nnt epriitourhi otramroyn e-pro­
ducicnegl Tlhset. u moaurrtesy pically
benibgunct,a bne a ggreasnsidin vvea ­
siivneat doj ascternutc tures.
ICD-c0o de
8272/0
Epidemiology
Pituaidteanroym caosn staiptpurtoex i­ 1.02
Fig.P ituaidteanroMyma ac.r oscopy.
mate1l5y%o ta liln tranceroapnli.aa slm s
Mospti tutiutmaorauyrra esd enoamnads
adenom(a<1s c m)m,a croadenomas
arbee niagnndn on-in(via.cseoi.nv ­e
(1-c4m )o,rg iaandte no(m>a4 sc m).
finteotd h see ltluar cBiucitan )v.a sive
Manayd enom(a3s5 -4in5av%d)ei nto
adenoamraaesl fsroe qPuietnutci.at ra­ry
Fig1.. 01
Invapsiivteu itary Kandoesnpo ma,
cinoamraresa raec,c oufnotorin n0lgy. 1- adjacsetnrtu c(t1u7r9e9s, m3a0c8­8);
gra4d.Ae d enoImnav oblivlianctgae vrearslni onuuss
0.2o%fa lpli tueintdaorcytr uimnoeu rs. roadenaonmdag si aandte nomaarse
surroucnadrioantrgit de ries.
particluilkteaoilr nylv yai dnett hoce a v­
Adenomaartsee rmseidl wehnettn h ee rnous Suspirnaussae.nl pdla arra sellar
Etiology
Somcea saersi dsuete o n owsno matpiact isehnotnw osc linsiicgaannlstd h ereex tensciaonbn esd istinguished from
mutatbiuottno sar,s ubstparnotpioairlns­ o h ormoenlaelv iatnth iseoe nr buumt t ruien vatsoit ohcnea veronros upsh e­
tioonfp ituaidteanroytm haeest ioltohgteyu moduerm onsthroartmeopsnr eo ­noisdianlou nst hbea soifas n atomical
isp oorly unTdheefr isntdooiofnd gd.su ctoinio mnm unohist[o2c9h1e4smJti.us dtlir8ey7as 7n Jid magiOnntg h.be a sis
experismteundtsiauelgs gt ehstatht te u ­Recentthtleey r",ma ggrehsasbsie veeno" f e ndoscveoirfpiicticao ,on nlgyr a3d e
morigmeencihca niinsvmostl hvleeo ssu sebdy c linitcodi easnisg rnaadtieao n­d4 t umoaucrcso rtdoti hnleg< nosp
ofa ntioncfoagcetonoritr chso e v erelxo­giicnavlalasydi evneo mwahsig,cr ho w
classiafrineco awct oinosni dteobr ee d
pressofio onnc ogfeancitcpo rrosb,a brlayp itdelntydro, e courpr r ograensadsr ,e
invaisnittvhoece a versnionu{us4s )6 .1
ono rn eatrhc ee slulr face. resitsotc aonmtb itnreeda timnecnltu d­
insgu rgaenrrdya di[a4t16i,o1n7 42,1824,
Microscopy
Localization 2255}.
Imprciyntto logy
Mospti tuaidteanroyam raleso caltioz ed
Forra piindt raopdeiraagtniiovmse­i s,
thsee ltluar cbiucstao ,m oec ciuntr h eI maging
prisnpte cimmeanybs eh elpffoduril s ­
sphenosiidnauls ;a rtceha elslee dO net chb­ea soifts h eliarr gdeismte nsion,
tingubiesthiwnepgei nt uaidteanroym as
toppiict uaidteanroyfm 2a7s6 4J. adenomaarsed esignaastm eidc ro-
ando thteurm ouirnsc,l umdailnigg nant
Clinical
features
Thsei gannssd y mptoofpm ist uitary ad­
enomiansc lsuydmep tomsb yct ahues ed
excehsosr mopnreosd ubcyse od- called
functiaodneinnogm Maass.se ffects,
sucahsb itemhpeomriaaln doippilao,p ia,
anhde adaacrhmeeo ,sc to mmosneleyn
inc linincoanl-lfyu ncatdieonnoimnags .
Symptoofhm ysp opitcuaiantl aosrcoi­ sm
cuerx:c ess porgfor douwchttoihrom no ne
(GHp)r,o laTcStHai,nn Ad,C THr,e spec­
tivcealcnya ,u ascer omeagnagdli yg an­
tisgma,l actoarnrdhh yopeoag onadism,
hyperthyarnoCdiu dsihdsiismne,ga .sI en
sucshy mptocmaastetishcc,e o rrespond­
insge rhuomr mloenveae rleesl evated.
14 Tumoouftr hspe i tugiltaanrdy
lymphoamsat,r ocayntdso emcao,n dary
inhgo rmosnheosu bledr outipneerl­mya joorfit thayed enoma whceelrlesa,s
tumo(u1r1s, 2192}.
formGeHd,p: r olaTcStHi-nbA,eC tTaH,, s pargsrealnyu sloamtaetdo atdreonpoh­
FSH-bLeHt-ab,e atnada, l pshuab unmiats.( SGSsAh)o wwe akaenrdm orfeo ­
Microsaclogpoyr aintdph rmo tocol lmmunohistofcohtrer mainsstcrrcyia pGltH ii omnm unoreactivity.
TypicaolnHl &yEs, t aisnoimnagt,o trophs
factionrcsl,u PdIiTnS1gF, 1 a,n dT PITl,m munoreafcotril voiwt-ym olecular­
areeo sinoapnhdic loirct icoatrreo phs
mayb eu seffuoflru rtchlears sifiwceaitgihcotyn t,o keruastiinnCg,K ?/8
basophGiolniacd.o traonpdth hsy ro­
butth vea liodfti hteyms aer kiesrs st i(lClA MSo.rC2 K)1 a8n tibomdaiyae lss,o
tropahruses uaclhlryo mop(h1o4b0i0c,
undienrv estigation. facilaidtdaitteid oinsaclr imionf ation
1820,2029).
lmmunohistsotcahieanmliilncfogaow lrss pecaidfeinco mCayst.o keirsda itfi­n
thcel assiofifpc iattuiaiodtnea nroym afsu sealndys tropnogsliyit nic voer tico­
accortdoti hneghi orr mocnoen taenndt t roapdhe nomIactsa .an l sdoi stinguish
lmmunophenotype
lmmunohistiostc hhgeeo mlsidts atnrdy­
distingsupieschiefsi c tahdaetSn oGmSaAfssr otmh ediern seglrya nulated
arfdo trh dei agnoofps iitsu tiutmaoruycr osu plrde viboedu esslcyr oinbolenyad n counterdpoatr-tolsrig: kl eo buclya­r
andf otrh ecilra ssifiinctsaoet vieonun l trastbrausciTtshu.edr eanlso ifst ey­ tokerraetaicnti iscv ointsyiw sitttehhn et
maisnu btyspoemsa:t otlraoctpoht,r corpeht,o ry graang uilvceeesnal nlwd i ptrheisne onfct eh e fibbordoisueesse n
thyrotcroorpthi,c ogtornoapdho,t rtoupmhoc,ua rbn e d etermbianseoedndt heu ltrastrinuS cGtSuARrsia.nl gl-ycl yi­ke
nuclel(l ilm munonaengdta rtainvsec irnitpe­annsddii tsyt riobfhu otrimoornne a­lt okeriamtmiunn ostianni onrimanangld
tifoanc tor-naengpdal tuirvieh)o,r amcotniabvlyii. mt myu nohistoFcoehrxe ­mniesotprlya.s tic icdsoi ratgincooofst triocp hs
Thger emaatj oorfti utmyo (uerxsc epta mlpaldcee­,n sgerlayn ulsaotmeadt otCrroopohck hea nges.
totraodpehn omaarsse)t rongly apdoesniotmaiarvcseeh aractbeysr tirzoendAg n timitocahnotnidbrocidaainlbe es
fosry naptoapnhcdyh srionm ogAr.a niimnm unorefaocGrtH it vhirtoyu gthhoeuu ste tdo i denotnicfoyc cyhtaincg es.
lmmunohistofcohtreh mefi osltlroycw y-topalnabdsy md iffuse oflt ahbeTe hlelrienmfga onroyef t, h epsaer tiicmu-lar
Fi1g..0S 4p argsrealnyu sloamtaetdoa tdreonpoAhmS ap.a rse gpraatnwtuielatrafi hntb iroonu sB F biobdrbyoo.ud sy p owsiitht ive keCEr laetcimtnir cosrnto asicnoipnyg..
..
.
- \
Fi1g..0 L5a ctoatdreonpoAhmS ap.a rgsrealnyu tlyapBteP e.rd o lsatcatiirnnei vneagGa ollspg alt .tC eE rlnecmtircorno scopy.
-
. ,,
-
'-
Fi1g..0 T6h yroatdreonpoFhmo acafi.lb ris.o s Fig1.. 0C7r oeo c ealdle noHm&aEs. t aiannidn gF ig1.. 08G onadolardoepnhoP msae.u dorosette
keratin (sitnasienti)n.g
pattern.
Pituitary a1d5e noma
munohistopcahtetmaeirrcsenau sli table
Tab1l.e0M o1r phofculnacsttsiioioopffnnii atcluaa idteanroym as
alterntaout litvreass tsrtuucdtiuersa.l
Transcnrf aicpttoiros
Prolifieesr vaatliuuoasnti etndhgm e i totic anodt hceorf actors
lmmunophenotype
Adenotmyap e
couanntd t hKei -p6r7o lifienrdaet ion
Somatoatdreonpohm a
asd etermuisnietndhgM e I Ba1n tibody
±
PIT1
8
GH± P RLa lpshuab unit
{3908,14K)i.- c6o7m mosntlaydi infs­
Densely granualdaetneodm as omatotroph
2 2
LMWCpKe:r inourdc ilfefaurs e
fusetlhyr ougthhoeau dte nomwai,t h
PIT1
identihfoitasbpilonoet n sla fy e cwa ses.
GH± P RL
Spargsrealnyus loamtaetdao dternoopmha
LMWCdKo:t (-fliibkbreoo duise s)
Whepnr esseuncthh,o tspsohtosub led
usefdo trh mei totic counts. The validity PITE1R,- alpha
GH+ P R(Li sna mcee ll)
Mammosomaadteontormoap h
±
ofp 5i3 mmunostfaopirrn eidnigbc et­ing alpshuab unit
haviiossu trci olnlt ro!v3e9r18s,1i4al) .
2 2 PITE1R,- alpha
GH+ P R(Li dni ffceerlelnst)
Mixseodm ataontldra ocpthao dternoopmha
±
Tof aciltihteartaepp eruetdiicct thieo n,
subunit
alpha
expresosfti hoseno matosrteacteipn­
Lactoatdreonpohm a
toSrSsT -R5{ 49c6a)bn e t esitnes do ­
2
PI,TE 1R-alpha
PRL
Spargsrealnyul laactteaoddt ernoaop mha
matotrcooprht,i coantdrt ohpyhr,o troph
PITE1R,- alpha
PRL
adenomas. Densgerlayn ullaactteaoddt ernoopmha
I
PRLG,H( foacniadnl c onstant)
Acidosptheclmeal ldllec n oma
LMWC:fK ibbroodu(isie nsc onstant)
Ultrastructure
I
Electmriocnr osicson ponyte cessary
Thyroatdreonpohm a TSH-,ba eltpsahuab unit PI,TG 1ATA2
fotrh reo utiinnvee stoifgp aittiuoint ary
I
Corticaodternoopmha
tumouHrosw.e vuelrt,r astructural evalu­
3
TPIT
Densgerlayn ucloartteladcd oetnroompAahC T,LH MWC:dK ifpfautstee rn
atimoanyb eu seifnut lhde i fferential di­
agnoosfiu sn ditterentianadt ed tumours
TPIT
Spargsrealnyuc loartteiadcd oetnroomApaCh T LHM,W C:dK ifpfautstee rn
I
ina verlyi mintuemdb oefra denoma
ACTLHM,W C:rK ingp-altitkeernT PIT
Crocoekaledl e noma
subtyspuecsah,s p lurihoPrImTo1n-al
Gonadotroph adenoma
posiatdievneo ma.
Spargsrealnyug loantaeddao dternoaop FmhSa H -,bL eHt-abaeltpsahu,ab unSiFt,G1 ATAE2R,- alpha
(varcioomubsi nations()v ariable)
Reporting
Null cell adenoma
Classifoifpc iattuiaiodtnea nroymr aes­ Nom arkers None
quirmeosr pholaongdhi ocramlo inma­l I
Pluorrlmhoandaeln omas
munohistocahsesmeiscsamle nt (see
±
PlurihPoIrTm1oiv-nepaa odlse inbto ma GHP,R ,LT SH-baeltpsahu ab uPnIiTt1
Tab1l.e0 T1he)K .i -p6r7o lifienrdaetxi on
Adenowmiuatnshu sual Varicooumsb inationsO thterra nscription
canb eu seads a paramfeotprer ro g­
immunohisctoomcbhienmaltciaoln s
fac(tvoarrsi able)
nosetviacl uoafit nidoinv aiddeunaolm as
Doubaldee nomas
{3908,14A)d.d itpiaornaamle tthearts
2 2
mayb eo fp rognostic isnpi ig­nificance
Distiandcetn omas
UsuPaRlaLln yAd C T,H IP IaTn1Td P ,I T
tuiatdaernyo amralesi sitTnea db 1l.e.0
respectively
2 respectively
ACT,aH droecorticontrophiocrm o;nF eSH-,bf eotlallcleh-osrtmiomnuelb aesUtuGnabHg;gu, rn oihwtot rmho ne;
Prognosis
LH-bleuttae,ih nolrmzosinuenb gub neitLMatW; C K,l ow-emcoullarc-ywteoikgPehRratLtp ,ir no;l;T a ScHt-i,bn eta
Certsauibnt yopfpe ist uaidteanroym as
lhoylrd-sthiomrmuolsnauetib nubgne .it ta
1
tentdos homwo re-aggbreehsasviivoeu r
Moscotm mosnu bt.y pe
{4612,41)S8:G SAl.a ctomtarcorpoha db­ Previosuislsleuynb ttyca3 pal edle end.o ma
enomianm enC,r oockeela ld enoma,
silceonrtt icaodternoopamhna d,p luri­
hormoPnIaTl1 -paodseintoi(mvpaer evi­
Tab1l.e0 2
Othpearr amtehtmaeatryb s eo fp rognsoisgtniicIf npi ictaunaicdteea nroiymna a dsd ittoti hoen
ousclayl lseildse unbtt 3ya pdee noma).
morphofculnacstsi(iosfnTeiabaecall 1t e.i 0o1n)
More-dedtiasicluesodsft i hoenes net i­
Tumosuir(z lea rdgiemsetn sion):
microa(d1<ec nm,om) maac road(e1nc-om4)om ,gra i aandte n(o>mc4am )
tiiesis n cluidnte hiden divsiedcutailo ns
one ach type. Tumo'suc rlinpirceasalet niton:
clinfiucnacltclilyoi nnininocgna,-l fluyno csrti iloennitn g,
Itn he0 04c lassiftihcceaa tteigooofnr ,y
2
InvasiovneM nR(eIKs nso gsrpa :d e) (grade
non-inva1so i2rv)o ei r n va(sgir3vao ed4r e)
pitutiutmaorwuyar ssd iviidnettdrho e e
_
Metaisotsras spinal spread:
carcinoma
subcatetgyopriaicdeaesln: o amtay,p ical
adenoamnadc, a rcinHoomwae.vt ehri,sA dditlimomnuanlo hlst:o chemistry
divicsoiuonlnod bt e c linivcaallildya ted
-ChromoAg ranin
{2370,3N0e8v8e}r.ts h,se olmeoef t he
�
-Low-moleccuyltaork:C-e Kwr7ea(/itC8giA h.2nMt,)CS K18
_
patholpoagriacmaeiltn ecrlsu1 dnte hda t
- Prolimfaerrk:Kae itir,-pos 65n7(3 il ni mciatseeds )
classifdiosc eaettmiob o eon f v alause
-Transcfriapcattniocdoro nsf a:Pc It,ToS 1rF,Es1 R-a,Tl Pp,IhG TaAT,AN 2euroD1
prognomsatrikces rusca,hs a ighi ­
� �
-Predmiacrtki:Sev SreTs ,RS 2ST,RM SGMMTS.H 6
totiincda enxda h igKhi -p6r7o llferat1on
16 Tumouorfts hp ei tuitary gland