The latest edition of the WHO classification of the central nervous system was published in 2021.This review summarizes the major revisions to the classification of anterior pituitary tumors.The most important revisio...The latest edition of the WHO classification of the central nervous system was published in 2021.This review summarizes the major revisions to the classification of anterior pituitary tumors.The most important revision involves preferring the terminology of pituitary neuroendocrine tumor(PitNET),even though the terminology of pituitary adenoma(PA)still can be used according to this WHO classification compared to the previous one.Moreover,immunohistochemistry(IHC)examination of pituitary-specific transcription factors(TFs),including PIT1,TPIT,SF-1,GATA2/3,and ERα,is endorsed to determine the tumor cell lineage and to facilitate the classification of PitNET/PA subgroups.However,TF-negative IHC staining indicates PitNET/PA with no distinct cell lineages,which includes unclassified plurihormonal(PH)tumors and null cell(NC)tumors in this edition.The new WHO classification of PitNET/PA has incorporated tremendous advances in the understanding of the cytogenesis and pathogenesis of pituitary tumors.However,due to the shortcomings of the technology used in the diagnosis of PitNET/PA and the limited understanding of the tumorigenesis of PitNET/PA,the application of this new classification system in practice should be further evaluated and validated.Besides providing information for deciding the follow-up plans and adjunctive treatment after surgery,this classification system offers no additional help for neurosurgeons in clinical practice,especially in determining the treatment strategies.Therefore,it is necessary for neurosurgeons to establish a comprehensive pituitary classification system for PitNET/PA that incorporates neuroimaging grading data or direct observation of invasiveness during operation or the predictor of prognosis,as well as pathological diagnosis,thereby distinguishing the invasiveness of the tumor and facilitating neurosurgeons to decide on the treatment strategies and follow-up plans as well as adjunctive treatment after surgery.展开更多
Pituitary neuroendocrine tumors(PitNETs)are pathologically characterized by dysregulation of neuroendocrine function and systemic disruption of hormonal homeostasis,yet their regulatory effects on peripheral immune ne...Pituitary neuroendocrine tumors(PitNETs)are pathologically characterized by dysregulation of neuroendocrine function and systemic disruption of hormonal homeostasis,yet their regulatory effects on peripheral immune networks remain poorly characterized.Here,we systematically analyzed bulk RNA sequencing(RNA‑seq)from 883 PitNET tumors,108 PitNET‑associated peripheral blood mononuclear cells(PBMC)samples,and 175 healthy PBMC controls,combined with 69 single‑cell RNA sequencing(scRNA-seq)samples covering tumors,normal pituitaries,as well as tumor‑derived and normal PBMCs.We identified a systemic immune disequilibrium in PitNET patients,characterized by increased circulating lymphocyte proportions,accompanied by upregulated cytokine-receptor interaction signatures.Notably,tumor resection reversed this imbalance,as supported by the normalization of monocyte and neutrophil counts,validated by flow cytometry and routine blood data from 600 samples(200 healthy controls and 200 PitNET patients with paired pre-and post-surgery follow‑up).Trajectory analysis identified terminally differentiated,secretory-specialized cell populations with lineage-specific hormone and cytokine hypersecretion.Ligand-receptor inference suggested these tumor-derived factors potentially engage circulating immune cell receptors.A random‑forest classifier based on PBMC transcriptomes distinguished PitNET subtypes,underscoring the diagnostic potential of peripheral immune signatures.Furthermore,in an estrogen-induced rat model,elevated PRL level coincided with the same peripheral immune skewing.Overall,our work provides a valuable resource and demonstrates PitNETs can be systemic immune modulators,where intrinsic hormone secretory activity and monocyte-lymphocyte imbalance collectively drive peripheral immune dysfunction.展开更多
文摘The latest edition of the WHO classification of the central nervous system was published in 2021.This review summarizes the major revisions to the classification of anterior pituitary tumors.The most important revision involves preferring the terminology of pituitary neuroendocrine tumor(PitNET),even though the terminology of pituitary adenoma(PA)still can be used according to this WHO classification compared to the previous one.Moreover,immunohistochemistry(IHC)examination of pituitary-specific transcription factors(TFs),including PIT1,TPIT,SF-1,GATA2/3,and ERα,is endorsed to determine the tumor cell lineage and to facilitate the classification of PitNET/PA subgroups.However,TF-negative IHC staining indicates PitNET/PA with no distinct cell lineages,which includes unclassified plurihormonal(PH)tumors and null cell(NC)tumors in this edition.The new WHO classification of PitNET/PA has incorporated tremendous advances in the understanding of the cytogenesis and pathogenesis of pituitary tumors.However,due to the shortcomings of the technology used in the diagnosis of PitNET/PA and the limited understanding of the tumorigenesis of PitNET/PA,the application of this new classification system in practice should be further evaluated and validated.Besides providing information for deciding the follow-up plans and adjunctive treatment after surgery,this classification system offers no additional help for neurosurgeons in clinical practice,especially in determining the treatment strategies.Therefore,it is necessary for neurosurgeons to establish a comprehensive pituitary classification system for PitNET/PA that incorporates neuroimaging grading data or direct observation of invasiveness during operation or the predictor of prognosis,as well as pathological diagnosis,thereby distinguishing the invasiveness of the tumor and facilitating neurosurgeons to decide on the treatment strategies and follow-up plans as well as adjunctive treatment after surgery.
基金supported by the National Research Center for Translational Medicine under grant number NRCTM(SH)2023-15(to Z-B.W.)Fundamental Research Funds for the Central Universities(No.YG2023ZD06 to Z-B.W.)+3 种基金National Natural Science Foundation of China(82472640 to Z-B.W.,82373131 and 82573142 to S-J.L.,82200153 to Y-T.D.,82500265 to S-S.Y.)Health care leader of Shanghai Municipal Health Commission(No.2022LJ006 to Z-B.W.)the Natural Science Foundation of Shanghai,China(25ZR1402349 to S-S.Y.)the Innovative Research Team of HighLevel Local Universities in Shanghai.
文摘Pituitary neuroendocrine tumors(PitNETs)are pathologically characterized by dysregulation of neuroendocrine function and systemic disruption of hormonal homeostasis,yet their regulatory effects on peripheral immune networks remain poorly characterized.Here,we systematically analyzed bulk RNA sequencing(RNA‑seq)from 883 PitNET tumors,108 PitNET‑associated peripheral blood mononuclear cells(PBMC)samples,and 175 healthy PBMC controls,combined with 69 single‑cell RNA sequencing(scRNA-seq)samples covering tumors,normal pituitaries,as well as tumor‑derived and normal PBMCs.We identified a systemic immune disequilibrium in PitNET patients,characterized by increased circulating lymphocyte proportions,accompanied by upregulated cytokine-receptor interaction signatures.Notably,tumor resection reversed this imbalance,as supported by the normalization of monocyte and neutrophil counts,validated by flow cytometry and routine blood data from 600 samples(200 healthy controls and 200 PitNET patients with paired pre-and post-surgery follow‑up).Trajectory analysis identified terminally differentiated,secretory-specialized cell populations with lineage-specific hormone and cytokine hypersecretion.Ligand-receptor inference suggested these tumor-derived factors potentially engage circulating immune cell receptors.A random‑forest classifier based on PBMC transcriptomes distinguished PitNET subtypes,underscoring the diagnostic potential of peripheral immune signatures.Furthermore,in an estrogen-induced rat model,elevated PRL level coincided with the same peripheral immune skewing.Overall,our work provides a valuable resource and demonstrates PitNETs can be systemic immune modulators,where intrinsic hormone secretory activity and monocyte-lymphocyte imbalance collectively drive peripheral immune dysfunction.
