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How to Classify and Define Pituitary Tumors: Recent Advances and Current Controversies

Pituitary tumors are very complex and heterogeneous and have a very wide range of proliferative and aggressive behaviors, and how to define and classify these tumors remains controversial. This review summarizes the epidemiology and progress in the classification and definition of pituitary tumors,...

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Autores principales: Dai, Congxin, Kang, Jun, Liu, Xiaohai, Yao, Yong, Wang, Haijun, Wang, Renzhi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010908/
https://www.ncbi.nlm.nih.gov/pubmed/33815274
http://dx.doi.org/10.3389/fendo.2021.604644
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author Dai, Congxin
Kang, Jun
Liu, Xiaohai
Yao, Yong
Wang, Haijun
Wang, Renzhi
author_facet Dai, Congxin
Kang, Jun
Liu, Xiaohai
Yao, Yong
Wang, Haijun
Wang, Renzhi
author_sort Dai, Congxin
collection PubMed
description Pituitary tumors are very complex and heterogeneous and have a very wide range of proliferative and aggressive behaviors, and how to define and classify these tumors remains controversial. This review summarizes the epidemiology and progress in the classification and definition of pituitary tumors, as well as controversial issues. Based on the results of radiologic and autopsy studies, the prevalence of pituitary tumors has recently increased significantly. However, the majority of pituitary tumors are incidentally discovered and asymptomatic, and such tumors are called pituitary incidentalomas. Most of these incidentalomas do not induce symptoms, remain stable in size, and do not need treatment. The recent revised classification strategies mainly depend on immunohistochemistry (IHC) to detect pituitary hormones and pituitary transcription factors; therefore, the accuracy of diagnosing pituitary tumors has improved. Although new classification strategies and definitions for pituitary tumors have been presented, there are still some controversies. The term pituitary neuroendocrine tumor (PitNET) was proposed by the International Pituitary Pathology Club, and this terminology can encompass the unpredictable malignant behavior seen in the subset of aggressive pituitary adenomas (PAs). However, some endocrinologists who oppose this change in terminology have argued that the use of tumor in the terminology is misleading, as it gives PAs a harmful connotation when the majority are not aggressive. Such terminology may add new ambiguity to the origin of PAs and unnecessary anxiety and frustration for the majority of patients with benign PAs. The classification of aggressive PAs mainly relies on subjective judgment of clinical behavior and lacks objective biomarkers and unified diagnostic criteria. However, the term “refractory” could more accurately represent the characteristics of these tumors, including their clinical behaviors, radiological features, and pathologic characteristics. Moreover, the diagnostic criteria for refractory PAs are stricter, more objective, and more accurate than those for aggressive PAs. Early identification of patients with these tumors through recognition and increased awareness of the definition of refractory PAs will encourage the early use of aggressive therapeutic strategies.
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spelling pubmed-80109082021-04-01 How to Classify and Define Pituitary Tumors: Recent Advances and Current Controversies Dai, Congxin Kang, Jun Liu, Xiaohai Yao, Yong Wang, Haijun Wang, Renzhi Front Endocrinol (Lausanne) Endocrinology Pituitary tumors are very complex and heterogeneous and have a very wide range of proliferative and aggressive behaviors, and how to define and classify these tumors remains controversial. This review summarizes the epidemiology and progress in the classification and definition of pituitary tumors, as well as controversial issues. Based on the results of radiologic and autopsy studies, the prevalence of pituitary tumors has recently increased significantly. However, the majority of pituitary tumors are incidentally discovered and asymptomatic, and such tumors are called pituitary incidentalomas. Most of these incidentalomas do not induce symptoms, remain stable in size, and do not need treatment. The recent revised classification strategies mainly depend on immunohistochemistry (IHC) to detect pituitary hormones and pituitary transcription factors; therefore, the accuracy of diagnosing pituitary tumors has improved. Although new classification strategies and definitions for pituitary tumors have been presented, there are still some controversies. The term pituitary neuroendocrine tumor (PitNET) was proposed by the International Pituitary Pathology Club, and this terminology can encompass the unpredictable malignant behavior seen in the subset of aggressive pituitary adenomas (PAs). However, some endocrinologists who oppose this change in terminology have argued that the use of tumor in the terminology is misleading, as it gives PAs a harmful connotation when the majority are not aggressive. Such terminology may add new ambiguity to the origin of PAs and unnecessary anxiety and frustration for the majority of patients with benign PAs. The classification of aggressive PAs mainly relies on subjective judgment of clinical behavior and lacks objective biomarkers and unified diagnostic criteria. However, the term “refractory” could more accurately represent the characteristics of these tumors, including their clinical behaviors, radiological features, and pathologic characteristics. Moreover, the diagnostic criteria for refractory PAs are stricter, more objective, and more accurate than those for aggressive PAs. Early identification of patients with these tumors through recognition and increased awareness of the definition of refractory PAs will encourage the early use of aggressive therapeutic strategies. Frontiers Media S.A. 2021-03-17 /pmc/articles/PMC8010908/ /pubmed/33815274 http://dx.doi.org/10.3389/fendo.2021.604644 Text en Copyright © 2021 Dai, Kang, Liu, Yao, Wang and Wang http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Dai, Congxin
Kang, Jun
Liu, Xiaohai
Yao, Yong
Wang, Haijun
Wang, Renzhi
How to Classify and Define Pituitary Tumors: Recent Advances and Current Controversies
title How to Classify and Define Pituitary Tumors: Recent Advances and Current Controversies
title_full How to Classify and Define Pituitary Tumors: Recent Advances and Current Controversies
title_fullStr How to Classify and Define Pituitary Tumors: Recent Advances and Current Controversies
title_full_unstemmed How to Classify and Define Pituitary Tumors: Recent Advances and Current Controversies
title_short How to Classify and Define Pituitary Tumors: Recent Advances and Current Controversies
title_sort how to classify and define pituitary tumors: recent advances and current controversies
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010908/
https://www.ncbi.nlm.nih.gov/pubmed/33815274
http://dx.doi.org/10.3389/fendo.2021.604644
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