Immunohistochemical and Clinicopathologic Profiling of Pituitary Adenomas at a Nigerian Tertiary Hospital
DOI:
https://doi.org/10.30442/ahr.1001-06-225Abstract
Background: Pituitary adenoma is the most common pituitary tumour and the third most common intracranial tumour worldwide. Only a few studies have been done in Africa on the immunohistochemical expression pattern and clinicopathologic presentations of the different hormonal subtypes of pituitary adenomas.
Objective: To evaluate the immunohistochemical hormonal profiles and clinicopathologic behaviour of pituitary adenomas diagnosed within ten years at the Lagos University Teaching Hospital, Lagos, Nigeria.
Methods: In this 10-year retrospective, cross-sectional study, all cases of pituitary adenomas diagnosed at the hospital mentioned above between 1 January 2009 and 31 December 2018 were analysed. Their paraffin-embedded tissue blocks were stained with haematoxylin and eosin and then with immunostains for growth hormome (GH), adrenocorticotrophic hormone (ACTH), thyroid stimulating hormone (TSH), follicular stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL), using their standard immunohistochemistry protocols.
Results: Seventy pituitary adenoma cases were studied. The male-to-female ratio of the patients was 1.6:1. The median age was 45 years, and the peak age of occurrence was the fifth decade for both sexes. Most were null cell adenomas (44.7%) and FSH-beta gonadotrophs (22.9%). The least diagnosed were thyrotroph (1.4%) and corticotroph adenomas (1.4%). Most of the adenomas were macroadenomas, and the most common presenting symptom was visual impairment.
Conclusion: Pituitary adenoma is commoner in males in their 5th decade of life at the Lagos University Teaching Hospital, Lagos, Nigeria. The null cell adenoma is the commonest type of pituitary adenoma diagnosed in the center, and the majority of the patient diagnosed with pituitary adenoma present late with complications of visual impairment.
References
deRobles P, Fiest KM, Frolkis AD, Pringsheim T, Atta C, St Germaine-Smith C, et al. The worldwide incidence and prevalence of primary brain tumors: a systematic review and meta-analysis. Neuro Oncol.2015;17:776–783. https://doi.org/10.1093/neuonc/nou283.
Soyemi SS, Faduyile FA, Sanni DA, Mgbehoma AI, Idowu OE, Obafunwa JO. Clinicoepidemiological profile and morphological spectrum of intracranial tumours seen in a tertiary healthcare facility: A 6-year retrospective study. Ann Trop Pathol 2020;11:166-170.
Ndubuisi CA, Ohaegbulam SC, Iroegbu LU, Ekuma ME, Mezue WC, Erechukwu UA. Histologically Confirmed Intracranial Tumors Managed at Enugu, Nigeria. J Neurosci Rural Pract 2017;8:585-590. https://doi.org/10.4103/jnrp.jnrp_155_17.
Malami SS, Wemimo RM, Kabiru A, Taiwo AA, Umar M, Abiodun AE, et al. Histopathological pattern of intracranial tumours at a Tertiary Health Facility in Sokoto, North-West, Nigeria. Am J Lab Med. 2019;4:119-123. https://doi.org/10.11648/j.ajlm.20190406.17.
Idowu O, Akang E, Malomo A. Symptomatic primary intracranial neoplasms in Nigeria, West Africa J Neurol Sci Turk 2007;24:212–218.
Olasode BJ, Shokunbi MT, Aghadiuno PU. Intracranial Neoplasms in Ibadan, Nigeria. East Afr Med J 2000; 77:2000. https://doi.org/10.4314/eamj.v77i1.46360.
Ohaegbulam SC, Saddeqi N, Ikerionwu S. Intracranial tumours in Enugu, Nigeria. Cancer 1980;46:2322-2324. https://doi.org/10.1002/1097-0142(19801115)46:10<2322::aid-cncr2820461034>3.0.co;2-f
Odeku EL, Adeloye A, Osuntokun BO, Williams AO. Intracranial tumour patterns in Ibadan, Nigeria. Afr J Med Sci 1973;4:137-141.
Jibrin P, Ibebuike K, Ado-wanka AN. Histopathological pattern of intracranial tumours in National Hospital, Abuja. Afr Health Sci 2018;18:281-286. https://doi.org/10.4314/ahs.v18i2.12.
Igun GO. Diagnosis and management of brain tumours at Jos University Teaching Hospital, Nigeria. East Afr Med J 2001;78:148-151. https://doi.org/10.4314/eamj.v78i3.9082.
Omon HE, Komolafe EO, Olasode BJ, Ogunbameru R, Adefidipe AA, Anele CO, et al. Clinicopathological Profile of Central Nervous System Tumors in a Tertiary Hospital in Southwest Nigeria. J West Afri Coll Surg 2021;11:1-5. https://doi.org/10.4103/jwas.jwas5621.
Uchime KE, Adebayo LA, Odukoya LA, Ajayi OO, Anunobi CC. The Histopathological patterns of intracranial neoplasm at Lagos University Teaching Hospital, Nigeria. A ten-year hospital-based retrospective study. Afr Health Sci 2023:23:492-503. https://doi.org/10.4314/ahs.v23i1.51.
Danjuma S, Dauda HA, Kene AI, Akau KS, Jinjiri IN. Profile and Outcome of Management of Brain Tumours in Kaduna Northwestern Nigeria. J Korean Neurosurg Soc 2022:65:751-757. https://doi.org/10.3340/jkns.2021.0071.
Osamura RY, Lopes MBS, Grossman A, Kontogeorgos G, Trouilla J. WHO classification of tumours of the pituitary. In: Lloyd RV, Osamura RY, and Klöppel RJ, (Editors). WHO classification of tumours of endocrine glands. 4th ed. Lyon, France: IARC; 2017. p. 11–63.
Daly AF, Tichomirowa MA, Beckers A. The epidemiology and genetics of pituitary adenomas. Best Pract Res Clin Endocrinol Metab 2009;23:543-554. https://doi.org/10.1016/j.beem.2009.05.008.
Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, et al. The prevalence of pituitary adenomas: a systematic review. Cancer 2004;101:613-619. https://doi.org/10.1002/cncr.20412.
Sinnatamby CS. Central nervous system. In: Horne T, Bowes J, editors. Last Anatomy, Regional and Applied. 12th ed. Edinburg: Churchill Livingstone Elsevier; 2011. p682-684.
Young B, Lowe J, Stevens A, Heath J. Endocrine system. In: Ozols I, (Editor). Wheater’s Functional Histology: A text and colour Atlas. 5th ed. Philadelphia: Churchill Livingstone Elsevier; 2006. p328-332.
Barrett K, Brooks H, Boitano S, Barman S, (Editors). Ganong’s Review of Medical Physiology. 23rd ed. New York: The McGraw-Hill; 2010. p377-389.
Ellis H. The Central Nervous System. In: Sugden M (Editor). Clinical Anatomy: A revision and applied anatomy for clinical students. 11th ed. Oxford: Blackwell Publishing Ltd; 2006. p347-348.
Lloyd RV, Kovacs K, Young JR. WF, Farrell WE, Asa SL, Trouilias J, et al. Pituitary tumours. In: Pathology and genetics of tumors of endocrine glands. Lloyd RV, Dellelis RA, Heitz PU, Eng C. (Editors). New York, IARC press. 2004. pp. 9-45.
Wan XY, Chen J, Wanj JW, Lui YC, Shu K, Lei T. Overview of the 2022 WHO Classification of pituitary adenomas/pituitary neuroendocrine tumors: clinical practices, controversies, and perspectives. Curr Med Sci 2022;42:1111-1118. https://doi.org/10.1007/s11596-022-2673-6.
Villa C, Baussart B, Guillaume A, Raverot G, Roncaroli F. The World Health Organization Classification of pituitary neuroendocrine tumors: a clinic-pathologic appraisal. Endocrine-Related Cancer 2023;30:e230021. https://doi.org/10.1530/ERC-23-0021.
Salami A, Malomo AO, Shokunbi T, Akang E. Immunohistochemical Analysis of Pituitary Adenomas in a West African Hospital. Afr J Neurol Sci 2013;32:72-75.
Nwokoro OC, Ukekwe FI, Nzegwu MA, Okafor OC, Uche EO. Immunohistochemical Patterns of Pituitary Adenomas in Southeastern Nigeria, a 10-year Histopathologic Review. Libyan J Med 2022;18:2245587. https://doi.org/10.1080/19932820.2023.2245587.
Mathew LR, Annapurneswar S, Mallikarjuna VS. Immunohistochemistry of 169 cases of Pituitary Adenoma. J Med Sci Clin Res 2017;05:15884-15901. https://dx.doi.org/10.18535/jmscr/v5i1.106.
Heshmat MY, Kovi J, Simpson C, Kennedy J, Fan KJ. Neoplasms of the central nervous system: incidence and population selectivity in the Washington DC, metropolitan area. Cancer 1976;38:2135–2142. https://doi.org/10.1002/1097-142(197611)38:5%3C2135::AID-CNCR2820380543%3E3.0.CO;2-T.
McDowell BD, Wallace RB, Carnahan RM, Chrischilles EA, Lynch CF, Schlechte JA. Demographic differences in incidence for pituitary adenoma. Pituitary 2011;14:23–30. https://doi.org/10.1007/s11102-010-0253-4.
Hemminki K, Försti A, Ji J. Incidence and familial risks in pituitary adenoma and associated tumors. Endocr Relat Cancer 2007;14:103–109. https://doi.org/10.1677/ERC-06-0008.
Gruppetta M, Mercieca C, Vassallo J. Prevalence and incidence of pituitary adenomas: a population-based study in Malta. Pituitary 2013;16:545-553. https://doi.org/10.1007/s11102-012-0454-0.
Aflorei ED, Korbonits M. Epidemiology and etiopathogenesis of pituitary adenomas. J Neuro-Oncol 2014;117:379-394. https://doi.org/10.1007/s11060-013-1354-5.
Teramoto A, Hirakawa K, Sanno N, Osamura Y. Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology 1994;193:161–164. https://doi.org/10.1148/radiology.193.1.8090885.
Raappana A, Koivukangas J, Ebeling T, Pirila T. Incidence of pituitary adenomas in Northern Finland in 1992–2007. J Clin Endocrinol Metab. 2010; 95(9):4268–75. doi: 10.1210/jc.2010-0537.
Webb C, Prayson RA. Pediatric pituitary adenomas. Arch Pathol Lab Med 2008;132:77–80. https://doi.org/10.5858/2008-132-77-PPA.
Osamura RY, Kajiya H, Takei M, Egashira N, Tobita M, Takekoshi S. Pathology of the Human Pituitary Adenomas. Histochem Cell Biol 2008;130:495-507. https://doi.org/10.1007/s00418-008-0472-1.
Cury ML, Fernandes JC, Machado HR, Elias LL, Moreira AC, de Castro Mb. Non-functioning pituitary adenomas: Clinical features, laboratory and imaging assessment, therapeutic management and outcome. Arq Bras Endocrinol Metab 2009;53:31-39. https://doi.org/10.1590/s0004-27302009000100006.
Drummond JB, Ribeiro-Oliveira A Jr., Soares BS. Non-Functioning Pituitary Adenomas. [Updated 2022 Oct 12]. In: Feingold KR, Anawalt B, Blackman MR, et al. (Editors). Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534880/
Nishioka H, Inoshita N, Mete O, Asa SL, Hayashi K, Takeshita A, et al. The Complementary Role of Transcription Factors in the Accurate Diagnosis of Clinically Nonfunctioning Pituitary Adenomas. Endocr Pathol 2015;26:349–355. https://doi.org/10.1007/s12022-015-9398-z.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Annals of Health Research (The Journal of the Medical and Dental Consultants' Association of Nigeria, OOUTH, Sagamu, Nigeria)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The articles and other materials published in the Annals of Health Research are protected by the Nigerian Copyright laws. The journal owns the copyright over every article, scientific and intellectual materials published in it. However, the journal grants all authors, users and researchers access to the materials published in the journal with the permission to copy, use and distribute the materials contained therein only for academic, scientific and non-commercial purposes.
