Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Feb 22;12(2):514.
doi: 10.3390/cancers12020514.

How to Classify the Pituitary Neuroendocrine Tumors (PitNET)s in 2020

Jacqueline Trouillas  1   2 , Marie-Lise Jaffrain-Rea  3   4 , Alexandre Vasiljevic  1   2   5   6 , Gérald Raverot  1   2   5   7 , Federico Roncaroli  8 , Chiara Villa  9   10   11
Affiliations
Review

How to Classify the Pituitary Neuroendocrine Tumors (PitNET)s in 2020

Jacqueline Trouillas et al. Cancers (Basel). .

Abstract

Adenohypophyseal tumors, which were recently renamed pituitary neuroendocrine tumors (PitNET), are mostly benign, but may present various behaviors: invasive, "aggressive" and malignant with metastases. They are classified into seven morphofunctional types and three lineages: lactotroph, somatotroph and thyrotroph (PIT1 lineage), corticotroph (TPIT lineage) or gonadotroph (SF1 lineage), null cell or immunonegative tumor and plurihormonal tumors. The WHO 2017 classification suggested that subtypes, such as male lactotroph, silent corticotroph and Crooke cell, sparsely granulated somatotroph, and silent plurihormonal PIT1 positive tumors, should be considered as "high risk" tumors. However, the prognostic impact of these subtypes and of each morphologic type remains controversial. In contrast, the French five-tiered classification, taking into account the invasion, the immuno-histochemical (IHC) type, and the proliferative markers (Ki-67 index, mitotic count, p53 positivity), has a prognostic value validated by statistical analysis in 4 independent cohorts. A standardized report for the diagnosis of pituitary tumors, integrating all these parameters, has been proposed by the European Pituitary Pathology Group (EPPG). In 2020, the pituitary pathologist must be considered as a member of the multidisciplinary pituitary team. The pathological diagnosis may help the clinician to adapt the post-operative management, including appropriate follow-up and early recognition and treatment of potentially aggressive forms.

Keywords: classification of pituitary neuroendocrine tumors; classification of pituitary tumors; pituitary adenoma; pituitary tumor.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Five-Tiered prognostic classification of PitNETs [19].
Figure 2
Figure 2
Standardized pathological report for PitNETs, adapted from EPPG [41].
See this image and copyright information in PMC

References

    1. Osamura R.Y., Grossman A., Korbonits M., Kovacs K., Lopes M.B.S., Matsuno A., Trouillas J. WHO Classification of Tumours of Endocrine Organs. WHO; Lyon, France: 2017. Pituitary adenoma; pp. 14–18. Chapter 1: Tumors of the Pituitary Gland.
    1. McCormack A., Dekkers O.M., Petersenn S., Popovic V., Trouillas J., Raverot G., Burman P. ESE survey collaborators Treatment of aggressive pituitary tumours and carcinomas: Results of a European Society of Endocrinology (ESE) survey 2016. Eur. J. Endocrinol. 2018;178:265–276. doi: 10.1530/EJE-17-0933. - DOI - PubMed
    1. Trouillas J., Burman P., McCormack A., Petersenn S., Popovic V., Dekkers O., Raverot G. Aggressive pituitary tumours and carcinomas: Two sides of the same coin? Eur. J. Endocrinol. 2018;178:C7–C9. doi: 10.1530/EJE-18-0250. - DOI - PubMed
    1. Asa S.L., Casar-Borota O., Chanson P., Delgrange E., Earls P., Ezzat S., Grossman A., Ikeda H., Inoshita N., Karavitaki N., et al. From pituitary adenoma to pituitary neuroendocrine tumor (PitNET): An International Pituitary Pathology Club proposal. Endocr. Relat. Cancer. 2017;24:C5–C8. doi: 10.1530/ERC-17-0004. - DOI - PubMed
    1. Ho K.K.Y., Fleseriu M., Wass J., van der Lely A., Barkan A., Giustina A., Casanueva F.F., Heaney A.P., Biermasz N., Strasburger C., et al. A tale of pituitary adenomas: To NET or not to NET: Pituitary Society position statement. Pituitary. 2019;22:569–573. doi: 10.1007/s11102-019-00988-2. - DOI - PubMed