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The Complementary Role of Transcription Factors in the Accurate Diagnosis of Clinically Nonfunctioning Pituitary Adenomas

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Abstract

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.

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Authors and Affiliations

  1. Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan

    Hiroshi Nishioka, Noriaki Fukuhara, Mitsuo Yamaguchi-Okada & Shozo Yamada

  2. Department of Pathology, Toranomon Hospital, Tokyo, Japan

    Naoko Inoshita

  3. Department of Pathology, University Health Network, Toronto, ON, Canada

    Ozgur Mete & Sylvia L. Asa

  4. Department of Endocrinology, Toranomon Hospital, Tokyo, Japan

    Kyohei Hayashi, Akira Takeshita & Yasuhiro Takeuchi

  5. Okinaka Memorial Institute for Medical Research, Tokyo, Japan

    Hiroshi Nishioka, Naoko Inoshita, Akira Takeshita, Yasuhiro Takeuchi & Shozo Yamada

Authors
  1. Hiroshi Nishioka
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  2. Naoko Inoshita
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  3. Ozgur Mete
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  4. Sylvia L. Asa
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  5. Kyohei Hayashi
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  6. Akira Takeshita
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  7. Noriaki Fukuhara
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  8. Mitsuo Yamaguchi-Okada
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  9. Yasuhiro Takeuchi
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  10. Shozo Yamada
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Correspondence to Hiroshi Nishioka.

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The authors declare that they have no competing interests.

Funding

This work was supported by the Okinaka Memorial Institute for Medical Research. This work was also supported in part by JSPS KAKENHI Grant Number 25460468.

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Nishioka, H., Inoshita, N., Mete, O. et al. The Complementary Role of Transcription Factors in the Accurate Diagnosis of Clinically Nonfunctioning Pituitary Adenomas. Endocr Pathol 26, 349–355 (2015). https://doi.org/10.1007/s12022-015-9398-z

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  • DOI: https://doi.org/10.1007/s12022-015-9398-z

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