Clinical significance of granulation pattern in corticotroph pituitary adenomas

Abstract

Objective: The granulation pattern of pituitary tumors may be important to predict tumor behavior, treatment outcomes, and recurrences. Therefore, we compared densely granulated corticotroph tumor (DGCT) and sparsely granulated corticotroph tumor (SGCT) in terms of clinicopathologic findings. Material and Method:A total of 41 patients (31 females/10 males) were assessed in the study. The granulation patterns were detected by Periodic Acid-Schiff (PAS) and adrenocorticotropic hormone (ACTH) immunoreactivity. Diffuse and strong staining by PAS and ACTH were identified as DGCT, whereas faint staining by PAS and focal, weak staining by ACTH were identified as SGCT. Perinuclear ring-like patterns with low molecular weight keratin were identified as Crooke's cell tumors. DGCTs and SGCTs were compared in terms of clinical findings and treatment outcomes. Results:The majority of the patients (71%) had DGCTs (n=29); whereas 24% of the patients had SGCTs (n=10) and 5% of the patients had Crooke's cell tumors (n=2). DGCTs and SGCTs were similar in terms of age, sex, estimated duration of disease, baseline cortisol and ACTH levels. SGCTs were larger than DGCTs (p=0.034). The remissions with surgery rates were similar between the groups; however, hypothalamic-pituitaryadrenal axis recovery time was longer in SGCTs (p=0.033). Persistent disease after surgery was slightly higher in DGCTs and recurrences were frequent in SGCTs; however, the differences were not statistically significant. Conclusion:DGCTs are often small microadenomas, while SGCTs are larger. Recurrences were slightly more common in SGCTs; however, further studies including larger series are needed to be able to obtain more significant results.

Clinical, Biological, Radiological Pathological and Immediate Post-Operative Remission of Sparsely and Densely Granulated Corticotroph Pituitary Tumors: A Retrospective Study of a Cohort of 277 Patients With Cushing’s Disease

“…In this large cohort, DG corticotroph PitNETs were more frequent than SG, as in two other studies ( 36 , 38 ). According to Dogansen et al.…”

“…According to Dogansen et al. ( 36 ), we found no statistically significant difference in sex and age between both phenotypes. In contrast, Mete et al.…”

“…Although limited cases have been published on granularity patterns and invasiveness among corticotroph tumors, our current study on the large patients’ series with Cushing’s disease also suggests more invasive behavior of sparsely granulated corticotroph tumors ( 35 , 36 ). Witek et al.…”

“…reported that greater tumor volumes were associated with higher Ki-67 among SG corticotroph PitNETs on a group of 59 patients ( 35 ). Another study performed among 41 corticotroph tumors, showed that both phenotypes occurred equally among men and women, and at similar age groups with alike biochemical presentation, but SG granulated corticotroph tumors reached larger sizes ( 36 ). But yet, the retrospective analysis of 15 years’ experience revealed that two out of four reported cases of pituitary carcinomas were initially diagnosed as sparsely granulated corticotroph tumors ( 36 ).…”

“…Another study performed among 41 corticotroph tumors, showed that both phenotypes occurred equally among men and women, and at similar age groups with alike biochemical presentation, but SG granulated corticotroph tumors reached larger sizes ( 36 ). But yet, the retrospective analysis of 15 years’ experience revealed that two out of four reported cases of pituitary carcinomas were initially diagnosed as sparsely granulated corticotroph tumors ( 36 ). There exist reports of transformation from DG to SG corticotroph tumors with subsequent metastases to the liver rising a diagnosis of pituitary carcinoma ( 37 ).…”