Clinical and Pathological Features of Pit1/SF1 Multilineage Pituitary Neuroendocrine Tumor

Xingchao Wang; Hanlu Tang; Zhixu Bie; Ying Wang; Ruofei Yuan; Zhe Zhang; Zhixia Xiong; Zhijun Yang; Zhiyong Bi; Bo Wang; Pinan Liu

doi:10.1227/neu.0000000000002846

Clinical and Pathological Features of Pit1/SF1 Multilineage Pituitary Neuroendocrine Tumor

Neurosurgery. 2024 Jan 30. doi: 10.1227/neu.0000000000002846. Online ahead of print.

Authors

Xingchao Wang¹, Hanlu Tang¹, Zhixu Bie¹, Ying Wang², Ruofei Yuan¹, Zhe Zhang¹, Zhixia Xiong³, Zhijun Yang¹, Zhiyong Bi¹, Bo Wang¹, Pinan Liu^{1

2}

Affiliations

¹ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing , China.
² Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing , China.
³ Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing , China.

PMID: 38289085
DOI: 10.1227/neu.0000000000002846

Abstract

Background and objectives: Lineage-based classification has critical clinical implications in pituitary neuroendocrine tumor (PitNET). As the most prevalent subtype of multilineage PitNET, PitNET originating from both pituitary-specific positive transcription factor 1 (Pit1) and steroidogenic factor-1 (SF1) lineages (Pit1/SF1-adenoma) is expected to exhibit rich and varied clinical behaviors. A comprehensive understanding of the clinical and pathological characteristics of Pit1/SF1-adenoma will provide mechanistic insight and influence the prognosis and treatment of PitNET.

Methods: A retrospective study was conducted by reviewing 57 cases of Pit1/SF1-adenoma between 2018 and 2022. We also included 88 cases of PitNET arising from Pit1 cell lineage (Pit1-adenoma) and 70 cases of PitNET arising from SF1 cell lineage (SF1-adenoma) as controls. Comprehensive data, including demographic, symptom, endocrinal, radiological, surgical, pathological, and prognostic information, were systematically collected. All specimens were immunostained for pituitary transcription factors (PTFs) and pituitary hormones.

Results: The detection rate was 8.0% for Pit1/SF1-adenoma within PitNET surgical specimens. Pit1/SF1-adenoma displayed a male predominance, with the mean diagnosis age falling between Pit1-adenoma and SF1-adenoma. The endocrine activity of Pit1/SF1-adenoma was lower than Pit1-adenoma but higher than SF1-adenoma. Pit1/SF1-adenoma had a higher incidence of cavernous sinus invasion (56.1%) than both Pit1-adenoma (38.6%, P = .039) and SF1-adenoma (27.1%, P = .001). Furthermore, Pit1/SF1-adenoma showed more postoperative complications than Pit1-adenoma (29.8% vs 8.0%, P = .001). Nonfunctional Pit1/SF1-adenoma had a higher radiological tumor recurrence rate than nonfunctional SF1-adenoma (34.8% vs 10.9%, P = .021). Notably, the immunostaining pattern was diverse in Pit1/SF1-adenoma, with various combinations of staining intensity for PTFs and 15 combinations for 6 pituitary hormones. Intriguingly, various PTFs combinations had no different impact on the outcome of Pit1/SF1-adenoma.

Conclusion: Pit1/SF1-adenoma represents a unique pathological subtype of PitNET, characterized by distinctive clinical behaviors. Identifying Pit1/SF1-adenoma can facilitate more precise management of PitNET by the practical use of Pit1/SF1 immunostaining.