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  • Author: Dieter K Lüdecke x
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Dieter K Lüdecke

The commonest cause of incomplete resection of pituitary adenomas appears to be invasion of the cavernous sinus, and there are increasing numbers of publications describing different surgical approaches to this problem. Parkinson (1) pioneered the transcranial operative approach, and Hakuba (2) has reported four modifications, including his experience with 13 different neoplasms. The main disadvantage, even in the hands of experienced neurosurgeons, is the high complication rate (2-6).

In this issue of the European Journal of Endocrinology, Matsumo et al. (6) report a slightly modified transcavernous approach that they have used in four patients with different types of pituitary adenomas, and they have compared the results obtained in four patients with adenomas that were operated by the transsphenoidal technique. This is the first investigation to compare the endocrine outcome in large invasive adenomas using these different techniques but, because of the small number of cases, and their heterogeneity, it must

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Tina Weber, Wolfgang Saeger and Dieter K. Lüdecke

Abstract. In a series of 124 pituitary adenomas displaying oncocytic alterations, we studied the degree of oncocytic transformation by light microcopical and morphometrical means for semiquantitative analysis. We established three groups with different percentages of oncocytically transformed cells for comparison of clinical and immunocytochemical data. Of the patients, 32.3% exposed adenomas with less than 50% oncocytic alterations (group I), whereas 22.6% showed tumours with oncocytic transformations between 51% and 75% (group II). Oncocytic parts consisting of more than 75% of the tumour cells were found in 41.1% of the patients (group III). All three groups differed in the rate of immunocytochemically positive cases, but not in sex distribution, tumour size, and rate of recurrency. Immunocytochemical analyses for PRL and GH (81 vs 78 adenomas) showed a decline of immunohistochemically positive adenomas with increasing proportions of oncocytic transformation for both hormones. Whereas in group I 38% of the adenomas were PRL-positive and 15% GH-positive, group III displayed only 9% PRL-positive and 3% GH-positive adenomas. The results display the correlation between the increasing volume of oncocytic transformation and its effect on decreasing hormone content in pituitary adenomas.

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Matthias Riedel, Joachim Noldus, Wolfgang Saeger and Dieter K. Lüdecke

Abstract. In 204 patients with sellar lesions and isolated hyperprolactinaemia we analysed and compared many different morphological, immunocytochemical, hormonal, and clinical data for a differentiation of primary (Prl produced by a tumour) and secondary (Prl elevation by PIF inhibition) hyperprolactinaemia. We found Prl-positive pituitary adenomas with primary hyperprolactinaemia in 62.7% and a secondary Prl elevation with different alterations in 37.3% (Prl-negative adenomas 28.9%, craniopharyngeomas 5%, and non-tumourous conditions 3.4%). In secondary hyperprolactinaemia the Prl values did not exceed 130 μg/l, higher levels indicated Prl-producing adenomas with a high probability. In patients with Prl elevation below 130 μg/l the clinical and sometimes the morphological analysis were not sufficient for a differentiation. Here immunocytochemical studies are necessary for a clear classification of hyperprolactinaemia.

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Gesche Tallen, Susanne Fehr, Wolfgang Saeger, Holger Uhlig and Dieter K Lüdecke

A non-isotopic in situ hybridization method with digoxigenin-labelled probes was used to examine growth hormone (GH), prolactin (PRL) and human β-chorionic gonadotropin (β-hCG(LH)) gene expression in 63 pituitary tumours in acromegaly and 20 adenomas in hyperprolactinaemia. hCG and LH were detected simultaneously because of the extensive homology (more than 90%) of their mRNA sequences (1). A comparison with former results obtained with 35S-labelled probes shows the value of the easier and faster non-isotopic method. Additionally, immunohistochemical data are included to give even more evidence for the synthesis of the respective hormones by the tumour cells. In all 63 adenomas in acromegaly, GH mRNA was revealed in 59 PRL mRNA and in 36 β-hCG(LH) mRNA. A positive immunostaining for GH was found in all, for PRL in 40, and for β-hCG(LH) in 34 adenomas. The comparison of the two in situ hybridization methods revealed no differences concerning GH mRNA detection, but not all tumours positive after non-isotopic PRL and β-hCG(LH) mRNA detection showed signals with the radioactive method. Referring to the 20 PRL-secreting adenomas, PRL gene expression was demonstrable in all, GH mRNA in 12, and β-hCG(LH) mRNA in 2 cases. Comparing the positive results of immunohistochemistry with those of in situ hybridization, correspondence was found in 19 cases for PRL, in 5 cases for GH and in no case for β-hCG(LH).

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Wolfgang Saeger, Dieter K Lüdecke, Michael Buchfelder, Rudolf Fahlbusch, Hans-Jürgen Quabbe and Stephan Petersenn

In 1996, the German Registry of Pituitary Tumors was founded by the Pituitary Section of the German Society of Endocrinology as a reference center for collection and consultant pathohistological studies of pituitary tumors. The experiences of the first 10 years of this registry based on 4122 cases will herein be reported. The data supplement former collections of the years 1970–1995 with 3480 surgically removed tumors or lesions of the pituitary region. The cases were studied using histology, immunostainings and in some cases also molecular pathology or electron microscopy. The adenomas were classified according to the current World Health Organization classification in the version of 2004. From 1996 on 3489 adenomas (84.6%), 5 pituitary carcinomas (0.12%), 133 craniophar-yngiomas (3.2%), 39 meningiomas (0.94%), 25 metastases (0.6%), 22 chordomas (0.5%), 115 cystic non-neoplastic lesions (2.8%), and 46 inflammatory lesions (1.1%, 248 other lesions or normal tissue (6.0%)) were collected by us. The adenomas (100%) were classified into densely granulated GH cell adenomas (9.2%), sparsely granulated GH cell adenomas (6.3%), sparsely granulated prolactin (PRL) cell adenomas (8.9%), densely granulated PRL cell adenomas (0.3%), mixed GH/PRL cell adenomas (5.2%), mammosomatotropic adenomas (1.1%), acidophilic stem cell adenomas (0.2%), densely granulated ACTH cell adenomas (7.2%), sparsely granulated ACTH cell adenomas (7.9%), Crooke cell adenomas (0.03%), TSH cell adenomas (1.5%), FSH/LH cell adenomas (24.8%), null cell adenomas (19.3%), null cell adenoma, oncocytic variant (5.8%), and plurihormonal adenomas (1.3%). Following the WHO classification of 2004, the new entity ‘atypical adenoma’ was found in 12 cases in 2005. Various prognostic parameters and clinical implications are discussed.