1
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Detomas M, Altieri B, Flitsch J, Saeger W, Korbonits M, Deutschbein T. Novel AIP mutation in exon 6 causing acromegaly in a German family. J Endocrinol Invest 2023:10.1007/s40618-023-02031-5. [PMID: 36757586 DOI: 10.1007/s40618-023-02031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Abstract
The most frequent genetic alteration of familial isolated growth hormone producing pituitary neuroendocrine tumors is a germline mutation of the aryl hydrocarbon receptor-interacting protein (AIP) gene. Various AIP mutations are already known; however, an AIP mutation in exon 6 (c.811_812del; p.Arg271Glyfs*16) has not been reported yet. Here, we report a German family with two identical twins who were both affected by acromegaly and carried the above-mentioned novel AIP mutation. The father was found to be an unaffected carrier, while the paternal aunt most likely suffered from acromegaly as well and died from metastatic colorectal cancer. Apart from reporting a novel AIP mutation, this study does not only highlight the different clinical and histological features of the AIP mutated growth hormone producing pituitary neuroendocrine tumors but also confirms the poor responsiveness of dopamine agonists in AIP mutated acromegaly. Furthermore, it highlights the increased mortality risk of comorbidities typically associated with acromegaly.
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Affiliation(s)
- M Detomas
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Würzburg, Germany.
| | - B Altieri
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - J Flitsch
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Saeger
- Institute of Neuropathology, University of Hamburg, UKE, Hamburg, Germany
| | - M Korbonits
- Centre for Endocrinology, Barts and the London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - T Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
- Medicover Oldenburg MVZ, Oldenburg, Germany
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2
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Warmbier J, Lüdecke DK, Flitsch J, Buchfelder M, Fahlbusch R, Knappe UJ, Kreutzer J, Buslei R, Bergmann M, Heppner F, Glatzel M, Saeger W. Typing of inflammatory lesions of the pituitary. Pituitary 2022; 25:131-142. [PMID: 34463941 PMCID: PMC8821060 DOI: 10.1007/s11102-021-01180-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/17/2022]
Abstract
Inflammatory pituitary lesions account for 1.8% of all specimens from the German Pituitary Tumor Registry. They occure in 0.5% of the autoptical specimens and in 2.2% of the surgical cases. Women are significantly more often affected than men and are often younger when first diagnosed. In general, primary and secondary inflammation can be distinguished, with secondary types occurring more frequently (75.1%) than idiopathic inflammatory lesions (15.4%). In primary inflammation, the lymphocytic type is more common (88.5%) than the granulomatous type of hypophysitis (11.5%). The most common causes of secondary inflammation are Rathke's cleft cysts (48.6%), followed by tumors (17.4%) such as the craniopharyngioma (9.1%), adenoma (5.5%) or germinoma (2.0%). More causes are tumor-like lesions (7.1%) such as xanthogranuloma (3.5%) or Langerhans histiocytosis (3.5%), abscesses (5.5%), generalized infections (5.1%), spreaded inflammations (4.7%) and previous surgeries (4.0%). In 1.6% of all specimens the reason for the inflammation remains unclear. The described classification of hypophysitis is important for specific treatment planning after surgery.
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Affiliation(s)
- J. Warmbier
- grid.13648.380000 0001 2180 3484Institute of Neuropathology of the University of Hamburg, UKE, 20246 Hamburg, Germany
| | - D. K. Lüdecke
- grid.13648.380000 0001 2180 3484Clinic of Neurosurgery of the University of Hamburg, UKE, 20246 Hamburg, Germany
| | - J. Flitsch
- grid.13648.380000 0001 2180 3484Clinic of Neurosurgery of the University of Hamburg, UKE, 20246 Hamburg, Germany
| | - M. Buchfelder
- grid.5330.50000 0001 2107 3311Clinic of Neurosurgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - R. Fahlbusch
- grid.419379.10000 0000 9724 1951International Neuroscience Institute (INI), Rudolf-Pichelmayr-Str. 4, 30625 Hannover, Germany
| | - U. J. Knappe
- grid.5570.70000 0004 0490 981XDepartment of Neurosurgery, Johannes-Wesling-Klinikum Minden, Ruhr-University Bochum (RUB), 32429 Minden, Germany
| | - J. Kreutzer
- Praxis for Neurosurgery, 90941 Nuremberg, Germany
| | - R. Buslei
- grid.419802.60000 0001 0617 3250Institute of Pathology, SozialStiftung Bamberg, 96049 Bamberg, Germany
| | - M. Bergmann
- grid.419807.30000 0004 0636 7065Institute of Neuropathology, Klinikum Bremen-Mitte, 28205 Bremen, Germany
| | - F. Heppner
- grid.6363.00000 0001 2218 4662Institute of Neuropathology of the Humboldt University of Berlin, Charitè, 10117 Berlin, Germany
| | - M. Glatzel
- grid.13648.380000 0001 2180 3484Institute of Neuropathology of the University of Hamburg, UKE, 20246 Hamburg, Germany
| | - W. Saeger
- grid.13648.380000 0001 2180 3484Institute of Neuropathology of the University of Hamburg, UKE, 20246 Hamburg, Germany
- grid.13648.380000 0001 2180 3484Institutes of Pathology and Neuropathology of the University of Hamburg, UKE, Martinistraße 52, 20246 Hamburg, Germany
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3
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Abstract
PURPOSE The subclassification of adrenal cancers according to the WHO classification in ordinary, myxoid, oncocytic, and sarcomatoid as well as pediatric types is well established, but the criteria for each subtype are not sufficiently determined and the relative frequency of the different types of adrenal cancers has not been studied in large cohorts. Therefore, our large collection of surgically removed adrenal cancers should be reviewed o establish the criteria for the subtypes and to find out the frequency of the various types. METHODS In our series of 521 adrenal cancers the scoring systems of Weiss et al., Hough et al., van Slooten et al. and the new Helsinki score system were used for the ordinary type of cancer (97% of our series) and the myxoid type (0.8%). For oncocytic carcinomas (2%), the scoring system of Bisceglia et al. was applied. RESULTS Discrepancies between benign and malignant diagnoses from the first thee classical scoring systems are not rare (22% in our series) and could be resolved by the Helsinki score especially by Ki-67 index (more than 8% unequivocally malignant). Since all our cancer cases are positive in the Helsinki score, this system can replace the three elder systems. For identification of sarcomatoid cancer as rarest type in our series (0.2%), the scoring systems are not practical but additional immunostainings used for soft tissue tumors and in special cases molecular pathology are necessary to differentiate these cancers from adrenal sarcomas. According to the relative frequencies of the different subtypes of adrenal cancers the main type is the far most frequent (97%) followed by the oncocytic type (2%), the myxoid type (0.8%) and the very rare sarcomatoid type (0.2%). CONCLUSIONS The Helsinki score is the best for differentiating adrenal carcinomas of the main, the oncocytic, and the myxoid type in routine work. Additional scoring systems for these carcinomas are generally not any longer necessary. Signs of proliferation (mitoses and Ki-67 index) and necroses are the most important criteria for diagnosis of malignancy.
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Affiliation(s)
- S Minner
- Institute of Pathology of the University of Hamburg, UKE, Martinistraße 52, 20246, Hamburg, Germany
| | - J Schreiner
- Clinic of Internal Medicine, Endocrinological Department of the University of Würzburg, 97080, Würzburg, Germany
| | - W Saeger
- Institute of Pathology of the University of Hamburg, UKE, Martinistraße 52, 20246, Hamburg, Germany.
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4
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Villa C, Vasiljevic A, Jaffrain-Rea ML, Ansorge O, Asioli S, Barresi V, Chinezu L, Gardiman MP, Lania A, Lapshina AM, Poliani L, Reiniger L, Righi A, Saeger W, Soukup J, Theodoropoulou M, Uccella S, Trouillas J, Roncaroli F. A standardised diagnostic approach to pituitary neuroendocrine tumours (PitNETs): a European Pituitary Pathology Group (EPPG) proposal. Virchows Arch 2019; 475:687-692. [PMID: 31578606 DOI: 10.1007/s00428-019-02655-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 05/23/2019] [Accepted: 08/22/2019] [Indexed: 10/25/2022]
Abstract
The 2017 World Health Organization (WHO) classification proposes to type and subtype primary adenohypophyseal tumours according to their cell lineages with the aim to establish more uniform tumour groups. The definition of atypical adenoma was removed in favour of high-risk adenoma, and the assessment of proliferative activity and invasion was recommended to diagnose aggressive tumours. Recently, the International Pituitary Pathology Club proposed to replace adenoma with the term of pituitary neuroendocrine tumour (PitNET) to better reflect the similarities between adenohypophyseal and neuroendocrine tumours of other organs. The European Pituitary Pathology Group (EPPG) endorses this terminology and develops practical recommendations for standardised reports of PitNETs that are addressed to histo- and neuropathologists. This brief report presents the results of EPPG's consensus for the reporting of PitNETs and proposes a diagnostic algorithm.
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Affiliation(s)
- C Villa
- Department of Pathological Cytology and Anatomy, Foch Hospital, 40 rue Worth, 92151, Suresnes, France. .,INSERM U1016, CNRS UMR 8104, Cochin Institute, Paris Descartes University, 24 rue du faubourg Saint Jacques, 75014, Paris, France. .,Department of Endocrinology, CHU de Liège, University of Liège, Sart Tilman B35, 4000, Liège, Belgium.
| | - A Vasiljevic
- Université de Lyon 1, Université de Lyon, F-69000, Lyon, France.,Faculté de Médecine Lyon-Est, F-69372, Lyon, France.,Centre de Recherche en Cancérologie de Lyon (CRCL), INSERM U1052, CNRS UMR5286, Université de Lyon, Lyon, France.,Centre de Pathologie et de Neuropathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - M L Jaffrain-Rea
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Neuromed Institute, IRCCS, Pozzilli, Italy
| | - O Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - S Asioli
- Department of Biomedical and Neuromuscular Sciences, Section of Anatomic Pathology 'M. Malpighi' at Bellaria Hospital, University of Bologna, Bologna, Italy.,Pituitary Unit - Center for the Diagnosis and Treatment of Hypothalamic and Pituitary Diseases, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - V Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - L Chinezu
- Department of Histology, Pharmacy, Sciences and Technology of Tirgu Mures, University of Medicine, Târgu Mureș, Romania
| | - M P Gardiman
- Department of Medicine DIMED, Surgical Pathology & Cytopathology Unit, University Hospital of Padova, Padova, Italy
| | - A Lania
- Endocrinology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Research Hospital, Rozzano, Italy
| | - A M Lapshina
- Department of Fundamental Pathomorphology, Endocrine Research Center, Ministry of Health of Russia, Moscow, Russia
| | - L Poliani
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - L Reiniger
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - A Righi
- Department of Pathology, Rizzoli Institute, Bologna, Italy
| | - W Saeger
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Soukup
- The Fingerland Department of Pathology, University Hospital and Faculty of Medicine, Hradec Kralove, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic
| | - M Theodoropoulou
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - S Uccella
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - J Trouillas
- Université de Lyon 1, Université de Lyon, F-69000, Lyon, France.,Faculté de Médecine Lyon-Est, F-69372, Lyon, France
| | - F Roncaroli
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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5
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6
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Abstract
The adenohypophysis has a large intrasellar part and two small parts at the pituitary stalk and the pharynx. Near this extrasellar pituitary tissue, and also in sinus sphenoidalis and sinus cavernosus, ectopic pituitary adenomas can develop. They are indistinguishable in structure and function from usual intrasellar adenomas. The neurohypophysis can show dystopias within complex malformations. In so-called pituitary stalk interruption syndrome, a real ectopia of the neurohypophysis is found at the eminentia mediana of the hypothalamus. Ectopic tissue in the pituitary is extremely rare: foci of ganglionic cells were found in the neurohypophysis and adrenocortical tissue in the adenohypophysis. Focal squamous epithelia in the anterior pituitary are a common finding but they are rather metaplastic from parenchymal cells than ectopic tissue. Small foci of ectopic salivary gland tissue are not rare in the intermediate zone.
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Affiliation(s)
- W Saeger
- Institut für Neuropathologie, UKE, Universität Hamburg, Martinistraße 52, 20246, Hamburg, Deutschland.
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7
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Samsen A, Schneider S, Von Der Heyde S, Saeger W, Grebenstein B, Juhl H. Comprehensive molecular and phenotypic profiling of end-stage IV cancer identifies treatable targets and improves survival in individual patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx511.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Abstract
Inflammation of the adrenal glands is caused by autoimmunopathies or infections and can induce adrenal insufficiency. Autoimmune lymphocytic adrenalitis is often combined with other autoimmune diseases and the most frequent cause of Addison's disease; however, it only becomes clinically apparent when more than 90 % of the adrenal cortex has been destroyed. Histological features are characterized by lymphoplasmacytic inflammation leading to an increased destruction of adrenocortical tissue but less severe courses can also occur. The second most frequent form of adrenalitis is adrenal tuberculosis, showing typical granulomatous findings that are nearly always caused by spreading from a tuberculous pulmonary focus. Other bacterial as well as viral infections, such as Epstein-Barr virus (EBV), cytomegalovirus (CMV) and others, generally affect the adrenal glands only in patients with immunodeficiency disorders. In these infections, the adrenal cortex and medulla are frequently involved to roughly the same extent. Although surgical specimens from inflammatory adrenal lesions are extremely rare, the various forms of adrenalitis play an important role in the post-mortem examination of the adrenal glands for clarification of unclear causes of death (e.g. death during an Addisonian crisis).
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Affiliation(s)
- W Saeger
- Institute für Pathologie und Neuropathologie der Universität Hamburg, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Deutschland.
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9
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Bremer Pais I, Bernreuther C, Minnemann T, Saeger W, Hagel C, Iking-Konert C, Aberle J, Flitsch J. A 42-Year-Old Male with Diabetes Insipidus. Brain Pathol 2017; 27:695-696. [PMID: 28805007 DOI: 10.1111/bpa.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- I Bremer Pais
- Department of Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Bernreuther
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Minnemann
- amedes MVZ Hamburg GmbH, Mönckebergstraße 10, Hamburg, 20095, Germany
| | - W Saeger
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Iking-Konert
- Department of Nephrology and Rheumatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Aberle
- Department of Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Flitsch
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Asa SL, Casar-Borota O, Chanson P, Delgrange E, Earls P, Ezzat S, Grossman A, Ikeda H, Inoshita N, Karavitaki N, Korbonits M, Laws ER, Lopes MB, Maartens N, McCutcheon IE, Mete O, Nishioka H, Raverot G, Roncaroli F, Saeger W, Syro LV, Vasiljevic A, Villa C, Wierinckx A, Trouillas J. From pituitary adenoma to pituitary neuroendocrine tumor (PitNET): an International Pituitary Pathology Club proposal. Endocr Relat Cancer 2017; 24:C5-C8. [PMID: 28264912 DOI: 10.1530/erc-17-0004] [Citation(s) in RCA: 214] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 11/08/2022]
Abstract
The classification of neoplasms of adenohypophysial cells is misleading because of the simplistic distinction between adenoma and carcinoma, based solely on metastatic spread and the poor reproducibility and predictive value of the definition of atypical adenomas based on the detection of mitoses or expression of Ki-67 or p53. In addition, the current classification of neoplasms of the anterior pituitary does not accurately reflect the clinical spectrum of behavior. Invasion and regrowth of proliferative lesions and persistence of hormone hypersecretion cause significant morbidity and mortality. We propose a new terminology, pituitary neuroendocrine tumor (PitNET), which is consistent with that used for other neuroendocrine neoplasms and which recognizes the highly variable impact of these tumors on patients.
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Affiliation(s)
- S L Asa
- Department of Pathology and Endocrine Oncology Site GroupPrincess Margaret Cancer Centre, University Health Network, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - O Casar-Borota
- Department of PathologyUppsala University Hospital, Uppsala, Sweden
| | - P Chanson
- Service of Endocrinology and Reproductive DiseasesBicêtre Hospital, Paris, France
| | - E Delgrange
- Department of MedicineUniversity of Louvain, Mont-sur-Meuse, Belgium
| | - P Earls
- Department of Anatomical PathologySt Vincent's Hospital, Sydney, Australia
| | - S Ezzat
- Department of Medicine and Endocrine Oncology Site GroupPrincess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - A Grossman
- Department of EndocrinologyUniversity of Oxford, Oxford, UK
| | - H Ikeda
- Research Institute for Pituitary DiseaseSouthern Tohoku General Hospital, Fukushima, Japan
| | - N Inoshita
- Department of PathologyToranomon Hospital, Tokyo, Japan
| | - N Karavitaki
- Department of EndocrinologyQueen Elizabeth Hospital, University of Birmingham, Birmingham, UK
| | - M Korbonits
- Division of EndocrinologyQueen Mary Hospital, Barts and the London School of Medicine, London, UK
| | - E R Laws
- Department of NeurosurgeryHarvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - M B Lopes
- Departments of Pathology and Neurological SurgeryUniversity of Virginia, Charlottesville, Virginia, USA
| | - N Maartens
- Department of NeurosurgeryRoyal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - I E McCutcheon
- Department of NeurosurgeryUT MD Anderson Cancer Center, Houston, Texas, USA
| | - O Mete
- Department of Pathology and Endocrine Oncology Site GroupPrincess Margaret Cancer Centre, University Health Network, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - H Nishioka
- Department of NeurosurgeryToranomon Hospital, Tokyo, Japan
| | - G Raverot
- Department of EndocrinologyGroupement Hospitalier EST, Hospices Civils de Lyon, University of Lyon, Lyon, France
| | - F Roncaroli
- Department of NeuropathologyImperial College, London, UK
| | - W Saeger
- Institute of Neuropathology of the University of HamburgHamburg, Germany
| | - L V Syro
- Department of NeurosurgeryHospital Pablo Tobon Uribe, Medellin, Colombia
| | - A Vasiljevic
- Department of PathologyGroupement Hospitalier EST, Hospices Civils de Lyon, University of Lyon, Lyon, France
| | - C Villa
- Department of PathologyHôpital Foch, Suresnes, France
| | - A Wierinckx
- INSERM U1052Cancer Research Center of Lyon, University of Lyon, Lyon, France
| | - J Trouillas
- Faculty of Medicine Lyon-EstUniversity of Lyon, Lyon, France
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11
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Abstract
WHO classifications should be used for comparing the results from different groups of pathologist and clinicians by standardized histopathological methods. Our present report describes the important parameters of pituitary adenoma pathology as demand of the WHO classification for correlation to endocrine data and prognosis. The combination of HE stain based structures with immunostainings for pituitary hormones allows subclassification of adenomas as the best method not only for correlations to clinical hyperfunctions but also for statements to the sensitivity of drug therapies (somatostatin analogs, dopamine agonists). GH-, PRL- and ACTH-secreting pituitary adenomas are further classified based on the size and number of their secretory granules by electron microscopy, or as is mostly the case nowadays by cytokeratin staining pattern, into densely and sparsely granulated. Granulation pattern may be considered for the prediction of treatment response in patients with GH-secreting adenomas, since the sparsely granulated subtype was shown to be less responsive to somatostatin analog treatment. For prognosis, it is important to identify aggressive adenomas by measurements of the Ki-67 index, of the number of mitoses, and of nuclear expression of p53. Among the criteria for atypical adenomas, high Ki-67 labeling index and invasive character are the most important adverse prognostic factors. Promising molecular markers have been identified that might supplement the currently used proliferation parameters. For defining atypical adenomas in a future histopathological classification system, we propose to provide the proliferative potential and the invasive character separately.
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Affiliation(s)
- W Saeger
- Institutes of Pathology and Neuropathology, University of Hamburg, UKE, Martinistraße 52, 20246, Hamburg, Germany.
| | - J Honegger
- Clinic of Neurosurgery, University of Tübingen, 72076, Tübingen, Germany
| | - M Theodoropoulou
- Department of Endocrinology, Max Planck Institute of Psychiatry, 80804, Munich, Germany
| | - U J Knappe
- Department of Neurosurgery, Johannes-Wesling-Klinikum Minden, 32429, Minden, Germany
| | - C Schöfl
- Division of Endocrinology and Diabetes, Department of Medicine I, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - S Petersenn
- ENDOC Center for Endocrinology, 22587, Hamburg, Germany
| | - R Buslei
- Department of Neuropathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
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12
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Saeger W, Petersenn S, Schöfl C, Knappe UJ, Theodoropoulou M, Buslei R, Honegger J. Emerging Histopathological and Genetic Parameters of Pituitary Adenomas: Clinical Impact and Recommendation for Future WHO Classification. Endocr Pathol 2016; 27:115-22. [PMID: 26874696 DOI: 10.1007/s12022-016-9419-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The review assesses immunohistochemical findings of somatostatin receptors and of metalloproteinases in different pituitary adenoma types and the significance of molecular genetic data. Current evidence does not support routine immunohistochemical assessment of somatostatin or dopamine receptor subtype expression on hormone-secreting or nonfunctioning pituitary adenomas. Further prospective studies are needed to define its role for clinical decision making. Until then we suggest to restrict membrane receptor profiling to individual cases or for study purposes. The problems of adenoma expansion and invasion are discussed. Despite partially contradictory publications, proteases clearly play a major role in permission of infiltrative growth of pituitary adenomas. Therefore, detection of at least MMP-2, MMP-9, TIMP-2, and uPA seems to be justified. Molecular characterization is important for familial adenomas, adenomas in MEN, Carney complex, and McCune-Albright syndrome and can gain insight into pathogenesis of sporadic adenomas.
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Affiliation(s)
- W Saeger
- Institutes of Pathology and Neuropathology, University of Hamburg, UKE, Martinistraße 52, 20246, Hamburg, Germany.
| | - S Petersenn
- ENDOC Center for Endocrinology, 22587 Hamburg, Germany
| | - C Schöfl
- Division of Endocrinology and Diabetes, Department of Medicine I, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - U J Knappe
- Department of Neurosurgery, Johannes-Wesling-Klinikum Minden, 32429, Minden, Germany
| | - M Theodoropoulou
- Department of Endocrinology, Max Planck Institute of Psychiatry, 80804, Munich, Germany
| | - R Buslei
- Department of Neuropathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - J Honegger
- Clinic of Neurosurgery, University of Tübingen, 72076, Tübingen, Germany
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13
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Saeger W. [Inflammations of endocrinal organs]. Pathologe 2016; 37:213-214. [PMID: 27106913 DOI: 10.1007/s00292-016-0167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- W Saeger
- Institute für Pathologie und Neuropathologie der Universität Hamburg, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Deutschland.
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15
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Abstract
Pituitary adenomas have to be studied in detail for structural characteristics, especially regarding the degree of granulation and immunohistochemical hormone expression, such as growth hormone (GH), prolactin, adrenocorticotropic hormone (ACTH), thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), luteinizing hormone (LH) and proliferation markers (e.g. Ki-67 and p53) for correlation to clinical data and assessment of the prognosis. If histological and immunostaining data do not correlate to the patient data, explanations for the discrepancies must be found. All active adenoma types can also be present as inactive, so-called silent adenomas showing the same features. An increased Ki-67 index (> 3%), significant nuclear expression of protein p53 and mitoses are characteristic of atypical adenomas. Up to now the biological relevance of these atypical adenomas, especially their role as preneoplasms for pituitary carcinomas has not been fully elucidated. The only proof of a pituitary carcinoma is the existence of metastases. Extensive local invasion and a greatly increased Ki-67 index are not sufficient for this diagnosis. Craniopharyngiomas have to be classified into adamantinomatous types (intrasellar and suprasellar) and papillary types (only suprasellar). Regressive changes are found in adamantinomatous types only. Strong regression may lead to difficulties in the differential diagnosis of Rathke's cleft cysts with squamous metaplasia. Demonstration of nuclear expression of beta-catenin in these cases enables the diagnosis of craniopharyngioma. Papillary craniopharyngiomas are characterized by BRAF mutations that may be helpful in the differential diagnosis. All pituicytomas of the neurohypophysis, all spindle cell oncocytomas of the anterior pituitary and all granular cell tumors of the posterior pituitary express thyroid transcription factor 1 (TTF-1) and are thought to be variants of a common uniform spindle cell tumor of the pituitary.
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Affiliation(s)
- W Saeger
- Institut für Neuropathologie der Universität Hamburg, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Deutschland,
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Saeger W. [Neuroendocrine tumors]. Pathologe 2015; 36:217-9. [PMID: 25986887 DOI: 10.1007/s00292-015-0032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- W Saeger
- Institute für Pathologie und Neuropathologie der Universität Hamburg, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Deutschland,
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Abstract
In daily routine pathology of the adrenal glands three tumor entities are important: adrenocortical tumors, adrenomedullary tumors and metastases. The differentiation of these three main tumor types can often be difficult structurally but immunostaining enables a definite diagnosis in nearly all cases. Adrenocortical tumors are positive for steroidogenic factor 1 and melan-A and always negative for chromogranin A whereas adrenomedullary tumors express chromogranin A but never keratin. A broad spectrum of antibodies is available for the identification of metastases and even the rare epithelioid angiosarcomas. For adrenocortical tumors, adenomas and carcinomas can be differentiated using three scoring systems and the Ki-67 index in adenomas should not exceed 3%. Using scoring systems and the Ki-67 index approximately 90% of cortical tumors can be differentiated into benign or malignant tumors. For pheochromocytomas two scoring systems are used for differentiating benign and malignant tumors but the results are less dependable.
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Affiliation(s)
- W Saeger
- Institut für Pathologie der Universität Hamburg, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Deutschland,
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Plöckinger U, Tiling N, Blankenstein O, Weizsäcker KV, Allolio B, Kroiss M, Hauptmann K, Saeger W, Radke C, Steinmüller T, Rahman N, Chrusciel M, Doroszko M, Lacroix A, Huhtaniemi I, Quinkler M. Transient pregnancy-induced Cushing's Syndrome with Aberrant Adrenal hCG receptor. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Knappe UJ, Jaspers C, Salbeck R, Saeger W, Willenberg H, Santen R, Feldkamp J, Ehlenz K. Adrenalectomy for central ACTH-dependent hypercortisolism: tap and scan. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Knappe UJ, Jaspers C, Buschsieweke D, Salbeck R, Saeger W, Ehlenz K, Feldkamp J, Mann A. Ectopic ACTH-secreting pituitary adenomas. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Beuschlein F, Obracay J, Saeger W, Reincke M, Libe R, Lolli P, Terzolo M, Allolio B, Müller HH, Fassnacht M. Prognostic value of histological markers in localized adrenocortical carcinoma after complete resection. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rolfes J, Reinbold WD, Jaspers C, Santen R, Feldkamp J, Saeger W, Knappe UJ. Intraoperative ultrasound for resection control in transsphenoidal surgery. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Knappe UJ, Jaspers C, Salbeck R, Saeger W, Engelbach M, Jacobs B, Mann WA, Feldkamp J. Transsphenoidal microsurgery for ACTH-dependent hypercortisolism: a consecutive series. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schlaffer S, Buchfelder M, Droste M, Elbelt U, Bojunga J, Flitsch J, Honegger J, Kolenda H, Lammert A, Buslei R, Saeger W, Petersenn S. Treatment with temozolomide in aggressive pituitary tumors - data from a survey by the German Pituitary Study Group. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kreissl MC, Schirbel A, Fassnacht M, Hänscheid H, Verburg FA, Bock S, Saeger W, Knödler P, Reiners C, Buck AK, Allolio B, Hahner S. [123I]Iodometomidate imaging in adrenocortical carcinoma. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Unger N, Ueberberg B, Schulz S, Saeger W, Mann K, Petersenn S. Differential Expression of Somatostatin Receptor Subtype 1–5 Proteins in Numerous Human Normal Tissues. Exp Clin Endocrinol Diabetes 2012; 120:482-9. [DOI: 10.1055/s-0032-1314859] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- N. Unger
- Department of Endocrinology and Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - B. Ueberberg
- Department of Endocrinology and Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - S. Schulz
- Institute of Pharmacology and Toxicology, University of Jena, Jena, Germany
| | - W. Saeger
- Institute of Pathology, Marienhospital, Hamburg, Germany
| | - K. Mann
- Department of Endocrinology and Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - S. Petersenn
- Department of Endocrinology and Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
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Plöckinger U, Hoffmann U, Geese M, Lupp A, Buchfelder M, Flitsch J, Vajkoczy P, Jakob W, Saeger W, Schulz S, Dohrmann C. DG3173 (somatoprim), a unique somatostatin receptor subtypes 2-, 4- and 5-selective analogue, effectively reduces GH secretion in human GH-secreting pituitary adenomas even in Octreotide non-responsive tumours. Eur J Endocrinol 2012; 166:223-34. [PMID: 22065857 DOI: 10.1530/eje-11-0737] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Somatostatin analogues (SSA) reduce autonomous GH secretion by activating somatostatin receptors (sst) 2 and 5 in 50-60% of acromegalic patients. However, by inhibiting insulin secretion these SSA reduce glucose tolerance. DG3173 is a novel SSA with additional binding to sst4 and low insulin-suppressing activity. We investigated the effect of DG3173, including its relation to specific tumour characteristics, on GH secretion in human somatotroph adenoma cell cultures (hSA) in comparison with Octreotide. METHODS Twenty-seven hSA were characterised immunohistochemically for their hormone- and sst-expression, granularity and pre-surgical therapy with SSA. GH was determined in supernatants of hSA treated with DG3173 or Octreotide in time- (n=6) and dose-response (n=21) experiments. A positive response was defined as GH suppression to below 80% of baseline. RESULTS In the dose-response experiments DG3173 suppressed GH secretion in more adenomas than Octreotide (10/21 vs 5/21), including 38% (6/16) of Octreotide non-responders. In responders the extent of GH suppression and IC(50) were comparable for both SSA. The response-rate of both SSA was higher in monohormonal vs bihormonal adenomas, yet GH declined similarly in both groups. Neither pre-surgical SSA (n=6) nor tumour morphology was related to the GH response. However, semi-quantitative analysis indicated a small but significant negative correlation between the GH response to Octreotide and the immunoreactivity scores of sst2 expression. CONCLUSIONS DG3173 equalled Octreotide in suppressing GH secretion in hSA. Since DG3173 suppressed GH in some Octreotide-non-responsive adenomas, its clinical effectiveness will be worth testing. Moreover, its reduced insulin-suppressive potency would make it a valuable alternative to Octreotide.
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Affiliation(s)
- U Plöckinger
- Interdisziplinäres Stoffwechsel-Centrum, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Saeger W. Concerning the article "Cushing's disease associated with both pituitary microadenoma and corticotroph hyperplasia". Exp Clin Endocrinol Diabetes 2010; 118:68. [PMID: 20127571 DOI: 10.1055/s-0029-1243234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
OBJECTIVE Localization of microadenomas in Cushing's disease may be difficult as in up to 45% of patients sellar MRI fails to detect a pituitary tumor. Intraoperative transsphenoidal ultrasound may identify microadenomas as hyperechoic structures. We report on the first 18 consecutive cases with intraoperative use of a new device for direct contact high-frequency-ultrasound in patients with Cushing's disease. PATIENTS AND TECHNIQUE 18 patients (14 female, 4 male, age 24-71 years) with typical endocrinological findings for Cushing's disease were included in the study. One macroadenoma and 13 microadenomas were suspected or identified preoperatively by MRI. In 4 cases, two of them with recurrent disease, sellar MRIs were negative. During transsphenoidal microsurgery an end fire ultrasound-probe (B-mode frequency range 7.5-13 Mhz, field of view 5 mm, penetration 20 mm) was introduced after opening of sellar floor. The pituitary gland was scanned in direct contact to the capsule. RESULTS In 13 out of 17 cases (77%) with later on proven microadenomas high-frequency-ultrasound identified the tumors as hyperechoic masses, including 3 of the 4 cases with negative preoperative MRI. In 2 cases ultrasound correctly localized the tumor at a site different from MRI finding (MRI false positive). In the macroadenoma, identification of the border between tumor and anterior pituitary gland was not possible. In all 18 patients postoperative early decline of serum cortisol to subnormal levels confirmed remission of hypercortisolism (100%). Other pituitary functions were unaltered in 17 cases (94%). CONCLUSIONS Intraoperative scanning of the pituitary gland with high-frequency-ultrasound probes may identify intrapituitary anatomy and pathologies even in MRI-negative cases. This may prevent extensive exploration of the gland with the risk of subsequent hypopituitarism.
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Affiliation(s)
- U J Knappe
- Department of Neurosurgery, Johannes Wesling Klinikum, Minden, Germany.
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Abstract
Ghrelin is a peptide thought to be involved in the regulation of appetite. Furthermore, significant effects on the release of growth hormone (GH) and ACTH were demonstrated. Contributing to the physiological relevance of this hormone, we investigated the expression of ghrelin and its receptor (GHS-R) in several normal human tissues. RNA samples (BD Biosciences) underwent one-step TaqMan Real-Time RT-PCR. Immunohistochemistry was performed on paraffin-embedded tissues using specific primary antibodies against ghrelin and its receptor. Relevant ghrelin mRNA levels were detected in all human tissues with the highest levels in stomach, pituitary, and small intestine. By immunohistochemistry, ghrelin peptide expression was detectable in reproductive and endocrine organs (ovary, anterior pituitary, adrenal gland), and organs of the gastrointestinal tract (stomach, pancreas). GHS-R1a mRNA expression was demonstrated in 10 of 24 human organs analyzed with the highest levels in pituitary, adrenal gland, and spinal cord. Expression of the receptor peptide was detected by immunohistochemistry in endocrine and reproductive organs (anterior pituitary, thyroid, pancreas, testis), parts of the CNS (cerebrum, cerebellum), and in single cells of bone marrow. Expression of both ghrelin and its receptor in endocrine and reproductive organs may indicate new endocrine or paracrine mechanisms of regulation in these tissues.
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Affiliation(s)
- B Ueberberg
- Department of Endocrinology and Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
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Abstract
Acromegaly is a rare disease caused by a growth-hormone-secreting pituitary adenoma. Symptoms include enlargement of the hands, feet, and jaw with growing dental interspaces, as well as hypertrophy of the tongue and nasal and sinusoidal mucosa. The two latter symptoms are mostly responsible for the accompanying obstructive sleep apnea syndrome. Besides these "cosmetic" symptoms, the disease is associated with hypertension and diabetes mellitus, as well as with an increased risk for adenomas and carcinomas of the colon. The average time span from first symptom to diagnosis is well over 6 years; a single determination of insulin-like growth factor 1 in serum can confirm the disease. The treatment of choice remains surgical resection of the adenoma in suitable patients, whereas in extensive disease with invasion of surrounding tissue, drug therapy and/or radiotherapy may be necessary.
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Affiliation(s)
- J Flitsch
- Bereich Hypophysenchirurgie, Neurochirurgische Klinik, Universitätskrankenhaus Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg.
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Betzold JM, Saeger W, Lüdecke DK. Ultrastructural-morphometric effects of radiotherapy on pituitary adenomas in acromegaly. Exp Clin Endocrinol 2009; 100:106-11. [PMID: 1305059 DOI: 10.1055/s-0029-1211187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Within a series of 22 irradiated GH-producing adenomas we studied by light microscopical and morphometrical means the grading of nuclear pleomorphism, the proportion of densely granulated cells, the number of mitoses, multinuclear cells, necrotic or necrobiotic cells, and the degree of fibrosis in comparison to non-irradiated tumours. By electronmicroscopical morphometry we investigated the changes in area, circumference, area percentage, and number of intracellular structures. The rate of necrobiotic cells and the grade of nuclear pleomorphism were significantly higher in the irradiated tumours. The fibrotic areas were larger. No differences were observed in the degree of granulation and the rate of multinuclear cells. Mitoses were found in only one tumour. Within the group of the well-differentiated adenomas the areas and circumferences of the nuclei, nucleoli, mitochondria, immature secretory granules, and secretory granules increased significantly. The area percentages of the nuclei, mitochondria, immature secretory granules, and secretory granules increased as well. The mitochondria, Golgi-fields, and the rough endoplasmatic reticulum decreased in number. The undifferentiated adenomas changed almost in the same significant way. To us most of these changes are a sign of irradiation damage. The enlargement of intracellular structures could be a sign of an increased rate of secretory activity.
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Affiliation(s)
- J M Betzold
- Department of Pathology, Marienkrankenhaus Hamburg, F.R.G
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Abstract
Gangliocytomas are benign, slow growing neuronal tumors and are found for the most part in children and young adults. They are most often localized in either the spinal cord or the cerebral hemispheres. Gangliocytomas in the sellar region are extremely rare and only 43 such tumors (including 4 own cases) have ever been described in the literature. Although these tumors are genuine rarities without any epidemiological importance, they do provide some interesting information on tumorigenesis of pituitary adenomas: 65% of the sellar gangliocytomas are associated with a pituitary adenoma. 74% of patients with these tumors suffered hormonal oversecretion of at least one of the pituitary hormones (mostly growth hormone). With only one exception, the hypothalamic releasing hormone corresponding to the hormonal oversecretion syndrome could be demonstrated in the gangliocytoma immunohistochemically. Ultrastructural studies could demonstrate close cell to cell contacts between adenoma and gangliocytome cells. All these data support the hypothesis that chronic overstimulation by hypothalamic releasing hormones play a role in the development of hormone secreting pituitary adenomas. However, in contrast to sellar gangliocytemas, extrahypothalamic tumors secreting excessive hypothalamic hypophysiotropic hormones have never been associated with a pituitary adenoma. They have only been associated with pituitary cell hyperplasia. Therefore, the hypothesis can be made that hypothalamic releasing hormones only promote but do not initiate tumorigenesis of pituitary adenomas.
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Affiliation(s)
- M J Puchner
- Department of Neurosurgery, University Hospital Eppendorf, Hamburg, Germany
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Abstract
In the sellar region most tumors of our collection (n = 1937) are pituitary adenomas, followed by craniopharyngiomas, chordomas and meningiomas. Difficulties in morphological differential diagnosis by light microscopy may occur in meningiomas, plasmacytomas, chordomas and germinomas. In these cases, immunohistological investigations and sometimes even electron microscopy are helpful in solving the problems. Meningiomas can sometimes resemble pituitary adenomas. Of diagnostic value in these cases is the expression of vimentin and S-100-protein in the meningioma cells. Plasmacytomas may also mimic pituitary adenomas. In these cases, the positive reaction with antibodies against LCA and immunoglobulins or against kappa-light-chains and lambda-light-chains leads to the diagnosis. Chordomas, too, can sometimes be hardly distinguished from pituitary adenomas. In these cases, the expression of S-100-protein, vimentin and CEA by the chordoma cells and the typical electron microscopic features of chordomas are helpful for the differential diagnosis. Germinomas may sometimes be indistinguishable from lymphocytic hypophysitis. Of diagnostic importance are here the expression of HCG and placental alkaline phosphatase by germinoma cells. In the above mentioned cases, it is also important to perform immunohistochemical examinations for pituitary hormones including alpha-subunit. All these tumors do not express these hormones.
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Affiliation(s)
- D Sautner
- Department of Pathology of the Marienkrankenhaus, Hamburg, Germany
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Waldmann J, Feldmann G, Slater EP, Langer P, Buchholz M, Ramaswamy A, Saeger W, Rothmund M, Fendrich V. Expression of the zinc-finger transcription factor Snail in adrenocortical carcinoma is associated with decreased survival. Br J Cancer 2008; 99:1900-7. [PMID: 19018264 PMCID: PMC2600683 DOI: 10.1038/sj.bjc.6604755] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In this study, we evaluate whether Snail is expressed in adrenocortical cancer (ACC) and if its expression is related to patient outcome. One of the best known functions of the zinc-finger transcription factor Snail is to induce epithelial-to-mesenchymal transition (EMT). Increasing evidence suggests that EMT plays a pivotal role in tumour progression and metastatic spread. Snail and E-cadherin expression were assessed by immunohistochemistry in 26 resected ACCs and real-time quantitative RT–PCR expression analysis was performed. Data were correlated with clinical outcome and in particular with overall patient survival. Seventeen of 26 (65%) ACC tumour samples expressed Snail when assessed by immunohistochemistry. Snail expression was neither detected in normal adrenocortical tissue, nor in benign adrenocortical adenomas. Expression levels were confirmed on the mRNA level by Real-Time–PCR. Survival rates were significantly decreased in Snail-positive tumours compared to Snail-negative tumours: 10 out of 16 vs one out of eight patients succumbed to disease after a median follow up of 14.5 and 28.5 months, respectively (P=0.03). Patients with Snail-expressing ACCs presented in advanced disease (11 out of 12 vs 6 out of 14, P=0.01) and tend to develop distant metastases more frequently than patients with negative staining (7 out of 11 vs two out of eight, P=0.19). In conclusion, we describe for the first time that Snail is expressed in a large subset of ACCs. Furthermore, Snail expression is associated with decreased survival, advanced disease and higher risk of developing distant metastases.
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Affiliation(s)
- J Waldmann
- Department of Surgery, Philipps-Universität Marburg, Marburg, Germany
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Psaras T, Buslei R, Saeger W, Klein D, Capper D, Meyermann R, Mittelbronn M, Honegger J. Atypical type II silent corticotrophic adenoma developing into Cushing's disease upon second recurrence. Exp Clin Endocrinol Diabetes 2008. [DOI: 10.1055/s-0028-1096363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ueberberg B, Unger N, Sheu SY, Walz MK, Schmid KW, Saeger W, Mann K, Petersenn S. Differential expression of ghrelin and its receptor (GHS-R1a) in various adrenal tumors and normal adrenal gland. Horm Metab Res 2008; 40:181-8. [PMID: 18246525 DOI: 10.1055/s-2007-1004574] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ghrelin is a newly characterized, widely distributed peptide thought to be involved in the regulation of appetite. Significant effects on the release of growth hormone (GH) and ACTH have been demonstrated. This study compares the expression of ghrelin and its receptor (GHS-R) in various adrenal tumors and normal adrenal gland. Normal adrenal tissue was obtained after autopsy. Tissue was obtained from 13 pheochromocytomas (PHEOs), 15 cortisol-secreting adenomas (CPAs), 12 aldosterone-secreting adenomas (APAs), and 16 nonfunctional adenomas (NFAs) following laparoscopic surgery. Expression of ghrelin and GHS-R1a was investigated on RNA levels by using real-time reverse transcription polymerase chain reaction (RT-PCR) and on protein levels by using immunohistochemistry. In the seven normal adrenal glands analyzed, ghrelin mRNA levels were 12-fold lower than in stomach. Ghrelin protein expression was confirmed by immunohistochemistry. In all adrenal tumors, relevant levels of ghrelin mRNA were observed, with significantly lower expression in PHEOs and APAs than in normal adrenal gland. Ghrelin protein was detected in 0% of PHEOs, 55% of APAs, 87% of CPAs, and 54% of NFAs. GHS-R1a mRNA expression was detectable in normal adrenal gland, but the receptor protein was absent. In adrenal tumors, detectable levels of receptor mRNA were found in 38% of PHEOs, 13% of CPAs, and 25% of NFAs. GHS-R1a protein was absent in the majority of adrenal tumors. Expression of ghrelin in normal adrenal gland and adrenal tumors may indicate some unknown physiological function. The pathophysiological relevance of ghrelin expression in adrenal tumors remains to be investigated.
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Affiliation(s)
- B Ueberberg
- Division of Endocrinology, Medical Center, University of Duisburg-Essen, Essen, Germany
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Psaras T, Honegger J, Buslei R, Saeger W, Klein D, Capper D, Meyermann R, Mittelbronn M. Atypical type II silent corticotrophic adenoma developing into Cushing's disease upon second recurrence. Exp Clin Endocrinol Diabetes 2008; 115:610-5. [PMID: 17943697 DOI: 10.1055/s-2007-984437] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Herein, we report the case of a 73-year old male patient who presented with two recurrences of a pituitary adenoma within a period of 15 years. The first tumor resection 15 years ago revealed a non-functioning pituitary macroadenoma. 11 years later, the first recurrence of the tumor was reoperated. Throughout the early course of the disease, he suffered from secondary adrenal insufficiency and required replacement therapy with hydrocortisone. Currently, he presented with the second recurrence and clinical examination revealed signs of Cushing's disease. This was clearly confirmed by endocrinological evaluation. A retrospective analysis of all histological and immunohistochemical slides rendered an adenoma exhibiting chromophobia, ACTH-positivity and features of atypia such as elevated p53 and Ki67 expression as well as nuclear polymorphism. According to the revised WHO classification it was classified as atypical type II silent corticotroph adenoma at the time of the first and second surgery. The specimen removed during the recent surgery displayed the same histological features and was classified as corticotroph adenoma. The combination of an atypical type II adenoma and the switch in the hormone status to an endocrinologically active adenoma makes this case exceedingly rare.
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Affiliation(s)
- T Psaras
- Department of Neurosurgery, University of Tuebingen, Germany
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Saeger W, Lüdecke B, Lüdecke D. Clinical Tumor Growth and Comparison with Proliferation Markers in Non-functioning (Inactive) Pituitary Adenomas. Exp Clin Endocrinol Diabetes 2007; 116:80-5. [PMID: 18072009 DOI: 10.1055/s-2007-991131] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Steffin B, Saeger W, Quabbe HJ, Petersenn S, Ludecke DK, Honegger J, Buchfelder M, Reincke M. Predictive value of pituitary histology on clinical outcome in acromegaly: A retrospective cohort study. Exp Clin Endocrinol Diabetes 2007. [DOI: 10.1055/s-2007-972343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Saeger W, Lüdecke DK, Buchfelder M. The lymphocytic hypophysitis: Report of 19 cases from the German Registry of Pituitary Tumors. Exp Clin Endocrinol Diabetes 2007. [DOI: 10.1055/s-2007-972340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kreutzer J, Nimsky C, Bluemcke I, Buchfelder M, Saeger W, Buslei R. Pituicytoma: A low-grade glioma of the neurohypophysis – case report and review of literature. Exp Clin Endocrinol Diabetes 2007. [DOI: 10.1055/s-2007-972357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Saeger W, Buchfelder M, Lüdecke DK. Atypical pituitary adenomas: A new entity in the WHO classification of 2004. Exp Clin Endocrinol Diabetes 2007. [DOI: 10.1055/s-2007-972493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sotlar K, Saeger W, Stellmacher F, Stahmer J, Jäckle S, Valent P, Horny HP. "Occult" mastocytosis with activating c-kit point mutation evolving into systemic mastocytosis associated with plasma cell myeloma and secondary amyloidosis. J Clin Pathol 2006; 59:875-8. [PMID: 16873565 PMCID: PMC1860446 DOI: 10.1136/jcp.2005.028837] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A case of a 70-year-old man presenting with exsudative enteropathy due to light-chain-associated amyloidosis is reported. The diagnosis of systemic mastocytosis associated with IgG/lambda plasma cell myeloma and secondary generalised amyloidosis was carried out by morphological evaluation of bone marrow biopsy. The c-kit point mutation D816Y was detected by molecular analysis. Two years before, a cystadenolymphoma of the left parotid gland had been removed. A moderate increase of loosely scattered spindle-shaped mast cells, a subpopulation of them expressing CD25, an antigen that is not expressed by normal or reactive mast cells, was shown by retrospective analysis carried out on an intraparotideal lymph node. The c-kit mutation D816Y was shown by the molecular analysis of the lymph node. In summary, the notion that systemic mastocytosis may very rarely be associated with B cell neoplasms and that neoplastic mast cell infiltrates may be obscured because of only a minimal increase of atypical mast cells, which are outnumbered by other non-neoplastic cells in the same tissue, is supported by this case. This finding was preliminarily termed "occult" mastocytosis.
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Affiliation(s)
- K Sotlar
- Institute of Pathology, University of Tübingen, Tübingen, Germany
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Röcken C, Ernst J, Hund E, Michels H, Perz J, Saeger W, Sezer O, Spuler S, Willig F, Schmidt HHJ. [Interdisciplinary guidelines on diagnosis and treatment for extracerebral amyloidoses--published by the German Society of Amyloid Diseases (www.amyloid.de)]. Dtsch Med Wochenschr 2006; 131:S45-66. [PMID: 16835821 DOI: 10.1055/s-2006-947836] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Within the past 10 years, a new range of knowledge has been achieved in the field of amyloidosis, especially with regard to pathogenesis, diagnosis and therapy. Amyloidosis leads to variable and distinct symptoms and is caused by different underlying conditions. Some amyloidoses are acquired secondary to a chronic condition; others are caused by genetic mutations. Amyloid and amyloidosis occur more frequently than they are perceived. Among the frequent localized forms are the cerebral amyloidosis linked to Alzheimer disease (AD) and the pancreatic amyloidosis linked to diabetes mellitus. Among the most frequent systemic (extracerebral) forms is AL amyloidosis, which often has a poor prognosis and if untreated can rapidly lead to death. Systemic amyloidosis that happen at infancy are mainly AA amyloidosis that can progress to death already at early or at middle adulthood. Amyloidosis can be treated but therapeutic success significantly depends upon early diagnosis and proper classification of the amyloid type. It is mandatory that differential diagnosis demonstrate the presence of amyloid and clearly identify the type of the disease. Development of methods and techniques have contributed to improvements in the diagnosis and treatment. Early diagnosis and proper classification of amyloid is decisive for therapeutic options and upon them depend quality of life and mortality. The therapeutic spectrum is various and includes organ transplantation, chemotherapy, and anti-inflammatory strategies. Gene therapy and biological active substances have to be considered in the near future.
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Affiliation(s)
- C Röcken
- Institut für Pathologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin.
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Paust HJ, Loeper S, Else T, Bamberger AM, Papadopoulos G, Pankoke D, Saeger W, Bamberger CM. Expression of the glucocorticoid receptor in the human adrenal cortex. Exp Clin Endocrinol Diabetes 2006; 114:6-10. [PMID: 16450310 DOI: 10.1055/s-2005-873007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Glucocorticoids produced in the adrenal cortex act by binding to a specific intracellular protein, the glucocorticoid receptor (GR), which then modulates gene transcription in target tissues. Whether the adrenal cortex itself is a glucocorticoid target tissue has not been analyzed as yet. Since the presence of GR would be a prerequisite for such "intracortical" glucocorticoid action, this study was designed to analyze GR expression in the normal human adrenal gland using RT-PCR, Western blot, and immunohistochemistry. RT-PCR revealed the presence of GR mRNA in adrenal cortex as well as in NCIh295 cells. These results were confirmed at the protein level by Western blot employing a specific anti-human GR antibody. Immunohistochemically, weak GR staining was observed in the adrenal medulla. In contrast, GR was strongly expressed in the adrenal cortex with the zona reticularis showing the most intense staining. Transfection of a GR-responsive luciferase reporter gene into NCIh295 cells resulted in dexamethasone-dependent induction of luciferase activity, indicating that GR is functional in this tissue. In this study, we show for the first time that GR is expressed in the human adrenal cortex. Its preferential expression in the zona reticularis may indicate a functional role in the regulation of adrenal androgen biosynthesis.
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Affiliation(s)
- H-J Paust
- Center of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hofmann B, Kreutzer J, Saeger W, Blümcke I, Fahlbusch R, Buchfelder M, Buslei R. Clinico-pathological differentiation of cystic craniopharyngiomas from Rathke's cleft cysts. Exp Clin Endocrinol Diabetes 2006. [DOI: 10.1055/s-2006-933091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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