Asa Sylvia L, Ezzat Shereen
Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Endocr Oncol. 2022 Mar 30;2(1):R14-R23. doi: 10.1530/EO-22-0041. eCollection 2022 Jan.
The entity known as pituitary carcinoma has been traditionally defined as a tumor of adenohypophysial cells that metastasizes systemically or craniospinally independent of the histological appearance of the lesion. Reported cases of pituitary carcinoma have clinically and histologically resembled their non-metastatic counterparts that were classified as adenomas; the majority of cases were initially diagnosed as adenomas, and with tumor progression and spread, the diagnosis was changed to carcinoma. This classification has been challenged since the definition of malignancy in most organs is not based only on metastatic spread. The extent of local invasion resulting in an inability to completely resect an adenohypophysial tumor can have serious consequences that can cause harm and are therefore not benign. To address this dilemma, it was proposed that pituitary tumors be classified as neuroendocrine tumors. This change in nomenclature is totally appropriate since these tumors are composed of classical neuroendocrine cells; as with other neuroendocrine tumors, they have variable behavior that can be indolent but can involve metastasis. With the new nomenclature, there is no requirement for a distinction between adenomas and carcinomas. Moreover, the WHO/IARC has provided an overarching classification for neuroendocrine neoplasms at all body sites; in this new classification, the term 'neuroendocrine carcinoma' is reserved for poorly differentiated high-grade malignancies that are clinically, morphologically and genetically distinct from well-differentiated neuroendocrine tumors. It remains to be determined if there are true pituitary neuroendocrine carcinomas.
传统上，垂体癌被定义为一种腺垂体细胞肿瘤，它可发生全身或颅脊柱转移，而与病变的组织学表现无关。已报道的垂体癌病例在临床和组织学上与其被归类为腺瘤的非转移性对应物相似；大多数病例最初被诊断为腺瘤，随着肿瘤进展和扩散，诊断变为癌。由于大多数器官中恶性肿瘤的定义并非仅基于转移扩散，这种分类受到了挑战。导致无法完全切除腺垂体肿瘤的局部侵袭程度可能会产生严重后果，可能造成损害，因此并非良性。为解决这一困境，有人提议将垂体肿瘤归类为神经内分泌肿瘤。这种命名上的改变是完全合适的，因为这些肿瘤由典型的神经内分泌细胞组成；与其他神经内分泌肿瘤一样，它们具有可变的行为，可能进展缓慢，但也可能发生转移。采用新的命名法后，无需区分腺瘤和癌。此外，世界卫生组织/国际癌症研究机构已经对所有身体部位的神经内分泌肿瘤提供了一个总体分类；在这个新分类中，“神经内分泌癌”一词仅用于分化差的高级别恶性肿瘤，这些肿瘤在临床、形态和基因上与分化良好的神经内分泌肿瘤不同。是否存在真正的垂体神经内分泌癌仍有待确定。
