NEUROENDOKRINI TUMORI HIPOFIZE – SAVREMENI DIJAGNOSTIČKI PRISTUP

  • Milena Mihajlović Doktor medicine
  • Emilija Manojlović Gačić Institut za patologiju "Prof. dr Đorđe Joannović", Medicinski fakutet, Univerzitet u Beogradu
DOI: https://doi.org/10.5937/mp73-37336
Ključne reči: PitNET, transkripcioni faktori, TPIT, PIT1, SF-1.

Sažetak


            Neuroendokrini tumori hipofize (PitNET) su neuroendokrini tumori koji vode poreklo od ćelija adenohipofize. Iako benigni, PitNET ponekad pokazuju agresivno biološko ponašanje koje je bilo inspiracija za promenu tradicionalnog imena “adenomi hipofize”.

            Trenutni standard u dijagnostici PitNET-ova prema kriterijuma SZO je imunohistohemija, uz primenu antitela prema hormonima adenohipofize i transkripcionih faktora TPIT (T-box family member TBX19), PIT1 (pituitary transcription factor 1) and SF-1 (steroidogenic factor-1) prema kojima se određuje linija diferencijacije.

            U PIT1 liniji diferencije nalaze se somatotrofni, laktotrofni i tireotrofni tumori. Somatotrofni tumori su PIT1 linije diferencije i proizvode hormone rasta (GH). SZO definiše sledeće podkategorije somatotrofnih tumora: gusto granulirani somatotrofni tumor i oskudno granulirani somatotrofni tumor.

            Laktotrofni tumori su najčešći neuroendokrini tumori hipofize. Transkripcioni faktori PIT1 i estrogen receptor α (ERα) imaju ključnu ulogu u njihovoj genezi. Postoje dva podtipa laktotrofnih tumora koji se razlikuju po obrascu bojenja prolaktina (PRL), i to su gusto i oskudno granulirani laktotrofni tumori.

            Tirotrofni tumori eksprimiraju PIT1 i GATA vezujući protein 3 (GATA3) a mogu da pokažu valijabilnu pozitivnost na tireostimulišući hormon (TSH).

            Pored ova tri glavna tipa tumora PIT1 linije diferencijacije, u ovoj grupi se nalaze i mešoviti laktotrofni i somatotrofni tumor, mamosomatotrofni tumor, acidofilni tumor “matičnih ćelija”, zreli i nezreli plurihormonski tumor PIT1 linije diferencije.

            Kortikotrofni tumori eksprimiraju trenskripcioni factor TPIT, i produkuju adrenokortikotrofni hormon (ACTH). Oni mogu biti gusto i oskudno granulirani. Retki podtip kortikotrofnih tumora, koji može da pokazuje agresivno ponašanje, je Crooke cell tumor.

            Gonadotrofni tumori su SF1 linije diferencije i oni produkuju folikulo stimulišući hormon (FSH) i luteinizirajući hormon (LH).

            Null-cell tumori ne pokazuju određenu liniju diferencijacije i ne eksprimiraju ni jedan od transkripcionih faktora. Primenom transkripcionih faktora se ovi tumori dijagnostikuju metodom eliminacije, te se njihov broj smanjuje.

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Objavljeno
2023/02/06
Broj časopisa
Vol. 73 Br. 4 (2022): Medicinski podmladak
Rubrika
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