{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T02:14:46Z","timestamp":1793499286451,"version":"4.5.0"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Pituitary adenomas (PAs) are common lesions that often present with endocrinopathy and\/or visual symptoms. Classification of PAs has historically been based on functional status and histopathological staining of anterior pituitary hormones. In 2017, the WHO revised the classification of PAs, establishing cell lineages identified by the transcription factors (TFs) PIT1, TPIT, and SF1. The clinical behavior of PA subtypes based on TF typing, including growth patterns, response to treatment, and recurrence rates, is unknown. The authors aimed to assess clinical presentation and outcomes according to TF lineage in a contemporary series of PAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective multicenter clinical study of patients undergoing resection of PAs between June 2017 and August 2021 was performed. Included tumors underwent immunohistochemical staining for WHO-defined TFs (TPIT, PIT1, and SF1). Clinical data including demographics, tumor characteristics, extent of resection, and clinical outcomes pertaining to tumor control and hormonal remission were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 238 patients were included in the analysis, with the following clinical breakdown of PA subtypes: nonfunctional PAs (n = 150, 63.0%); growth hormone\u2013secreting PAs causing acromegaly (n = 53, 22.3%); adrenocorticotropic hormone\u2013secreting PAs causing Cushing\u2019s disease (n = 30, 12.6%); and prolactinomas (n = 2, 0.8%). The most common TFs identifying cell lineages were SF1 (n = 104 samples, 43.7%), TPIT (n = 53, 22.3%), and PIT1 (n = 46, 19.3%). Thirty-five samples (14.7%) were positive for two TFs. Prevalence of suprasellar extension was highest in SF1 tumors (91.3%) and lowest in PIT1 tumors (54.3%), and varied significantly across groups (p &lt; 0.001). Cavernous sinus and clival\/sphenoid invasion also varied among TF subtypes, with the highest rates seen in PIT1 PAs (p = 0.002). Although no significant differences in progression-free survival (PFS) were noted across TF subtypes, among nonfunctional PAs the median PFS for SF1, PIT1, and TPIT TFs were 83 months, 26 months, and 45 months, respectively (p = 0.002). Nonfunctional PIT1 PAs had a significantly shorter PFS\/recurrence-free survival compared to functional PIT1 tumors (HR 59.45, 95% CI 2.54\u20131394, p = 0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The modern WHO diagnosis of PAs incorporates pituitary TF staining to standardize classification according to PA cell lineage. TF designation is associated with major clinical and endocrine variables including PA extension, extrasellar growth patterns, Ki-67 labeling index, and PFS among patients with PA subtypes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.10.jns24853","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T21:47:57Z","timestamp":1741988877000},"page":"146-154","source":"Crossref","is-referenced-by-count":5,"title":["A contemporary, multiinstitutional analysis of transcription factor lineage in pituitary adenomas: comparative study of neuroimaging, histopathology, and clinical outcomes"],"prefix":"10.3171","volume":"143","author":[{"given":"Stephanie K.","family":"Cheok","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California;"},{"name":"Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Ruzevick","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California;"},{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Briggs","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Cote","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishan","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Gomez","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Bove","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhiraj J.","family":"Pangal","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben A.","family":"Strickland","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Shiroishi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yana","family":"Zavros","sequence":"additional","affiliation":[{"name":"Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle M.","family":"Hurth","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Neuropathology, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Mathew","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Neuropathology, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norman E.","family":"Garrett","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew S.","family":"Little","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward R.","family":"Laws","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana V.","family":"Castro","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Henry Ford Health, Detroit, Michigan;"},{"name":"Department of Physiology, Michigan State University, East Lansing, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig M.","family":"Horbinski","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Neuropathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Carmichael","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, University of Southern California, Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12 Suppl 2","key":"b1","series-title":"Neuro Oncol","first-page":"iii1","article-title":"CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2014-2018","volume":"23","author":"Ostrom 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Brain Tumor Pathol. 2018;35(2):57\u201361."},{"issue":"1","key":"b16","series-title":"Hormones (Athens)","first-page":"1","article-title":"High-risk pituitary adenomas and strategies for predicting response to treatment","volume":"21","author":"Kontogeorgos G","year":"2022","unstructured":"Kontogeorgos G, Thodou E, Osamura RY, Lloyd RV. High-risk pituitary adenomas and strategies for predicting response to treatment. Hormones (Athens). 2022;21(1):1\u201314."},{"issue":"2","key":"b17","series-title":"Endocrine","first-page":"452","article-title":"Double pituitary adenomas","volume":"43","author":"Iacovazzo D","year":"2013","unstructured":"Iacovazzo D, Bianchi A, Lugli F,  Double pituitary adenomas. Endocrine. 2013;43(2):452\u2013457."},{"issue":"6","key":"b18","series-title":"Pituitary","first-page":"620","article-title":"Double pituitary adenomas in a large surgical series","volume":"22","author":"Zieli\u0144ski G","year":"2019","unstructured":"Zieli\u0144ski G, Sajjad EA, Maksymowicz M, P\u0119kul M, Koziarski A. Double pituitary adenomas in a large surgical series. Pituitary. 2019;22(6):620\u2013632."},{"issue":"3","key":"b19","series-title":"J Neurosurg","first-page":"1139","article-title":"Expression of additional transcription factors is of prognostic value for aggressive behavior of pituitary adenomas","volume":"134","author":"Micko A","year":"2020","unstructured":"Micko A, R\u00f6tzer T, Hoftberger R,  Expression of additional transcription factors is of prognostic value for aggressive behavior of pituitary adenomas. J Neurosurg. 2020;134(3):1139\u20131146."},{"issue":"5","key":"b20","series-title":"Pituitary","first-page":"514","article-title":"Clinical, pathologic, and imaging characteristics of pituitary null cell adenomas as defined according to the 2017 World Health Organization criteria: a case series from two pituitary centers","volume":"22","author":"Almeida JP","year":"2019","unstructured":"Almeida JP, Stephens CC, Eschbacher JM,  Clinical, pathologic, and imaging characteristics of pituitary null cell adenomas as defined according to the 2017 World Health Organization criteria: a case series from two pituitary centers. Pituitary. 2019;22(5):514\u2013519."},{"issue":"1","key":"b21","series-title":"Endocr Pathol","first-page":"63","article-title":"Null cell adenomas of the pituitary gland: an institutional review of their clinical imaging and behavioral characteristics","volume":"26","author":"Balogun JA","year":"2015","unstructured":"Balogun JA, Monsalves E, Juraschka K,  Null cell adenomas of the pituitary gland: an institutional review of their clinical imaging and behavioral characteristics. Endocr Pathol. 2015;26(1):63\u201370."},{"issue":"12 Suppl 2","key":"b1","series-title":"Neuro Oncol","first-page":"iii1","article-title":"CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2014-2018","volume":"23","author":"Ostrom QT","year":"2021","unstructured":"Ostrom QT, Cioffi G, Waite K, Kruchko C, Barnholtz-Sloan JS. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2014-2018. Neuro Oncol. 2021;23(12 Suppl 2):iii1\u2013iii105."},{"issue":"6","key":"b2","series-title":"Mod Pathol","first-page":"900","article-title":"Epidemiology and biomarker profile of pituitary adenohypophysial tumors","volume":"31","author":"Mete O","year":"2018","unstructured":"Mete O, Cintosun A, Pressman I, Asa SL. Epidemiology and biomarker profile of pituitary adenohypophysial tumors. Mod Pathol. 2018;31(6):900\u2013909."},{"issue":"3","key":"b3","series-title":"Endocr Pathol","first-page":"228","article-title":"Overview of the 2017 WHO Classification of Pituitary Tumors","volume":"28","author":"Mete O","year":"2017","unstructured":"Mete O, Lopes MB. Overview of the 2017 WHO Classification of Pituitary Tumors. Endocr Pathol. 2017;28(3):228\u2013243."},{"issue":"1","key":"b4","series-title":"Endocr Pathol","first-page":"6","article-title":"Overview of the 2022 WHO Classification of Pituitary Tumors","volume":"33","author":"Asa SL","year":"2022","unstructured":"Asa SL, Mete O, Perry A, Osamura RY. Overview of the 2022 WHO Classification of Pituitary Tumors. Endocr Pathol. 2022;33(1):6\u201326."},{"key":"b5","series-title":"Front Oncol","first-page":"739290","article-title":"Clinical relevance of new World Health Organization classification system for pituitary adenomas: a validation study with 2-year experience","volume":"11","author":"Hong SW","year":"2021","unstructured":"Hong SW, Kim SH, Lim SH,  Clinical relevance of new World Health Organization classification system for pituitary adenomas: a validation study with 2-year experience. Front Oncol. 2021;11:739290."},{"issue":"1","key":"b6","series-title":"Endokrynol Pol","first-page":"53","article-title":"Pituitary transcription factors in the immunohistochemical and molecular diagnosis of pituitary tumours\u2014a systematic review","volume":"72","author":"Burcea IF","year":"2021","unstructured":"Burcea IF, N\u0103stase VN, Poian\u0103 C. Pituitary transcription factors in the immunohistochemical and molecular diagnosis of pituitary tumours\u2014a systematic review. Endokrynol Pol. 2021;72(1):53\u201363."},{"issue":"5","key":"b7","series-title":"Neurosurgery","first-page":"916","article-title":"Pituitary centers of excellence","volume":"71","author":"McLaughlin N","year":"2012","unstructured":"McLaughlin N, Laws ER, Oyesiku NM, Katznelson L, Kelly DF. Pituitary centers of excellence. Neurosurgery. 2012;71(5):916\u2013926."},{"issue":"4","key":"b8","series-title":"Neurosurgery","first-page":"610","article-title":"Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings","volume":"33","author":"Knosp E","year":"1993","unstructured":"Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993;33(4):610\u2013618."},{"issue":"6","key":"b9","series-title":"Neurosurgery","first-page":"823","article-title":"Functional gonadotroph adenomas: case series and report of literature","volume":"79","author":"Cote DJ","year":"2016","unstructured":"Cote DJ, Smith TR, Sandler CN,  Functional gonadotroph adenomas: case series and report of literature. 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J Clin Med. 2019;8(11):1962."},{"issue":"4","key":"b12","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Patterns of extrasellar extension in growth hormone-secreting and nonfunctional pituitary macroadenomas","volume":"29","author":"Zada G","year":"2010","unstructured":"Zada G, Lin N, Laws ER Jr. Patterns of extrasellar extension in growth hormone-secreting and nonfunctional pituitary macroadenomas. Neurosurg Focus. 2010;29(4):E4."},{"issue":"3","key":"b13","series-title":"Pituitary","first-page":"480","article-title":"Growth hormone secreting pituitary adenomas show distinct extrasellar extension patterns compared to nonfunctional pituitary adenomas","volume":"25","author":"Pangal DJ","year":"2022","unstructured":"Pangal DJ, Wishart D, Shiroishi MS, Ruzevick J, Carmichael JD, Zada G. Growth hormone secreting pituitary adenomas show distinct extrasellar extension patterns compared to nonfunctional pituitary adenomas. Pituitary. 2022;25(3):480\u2013485."},{"issue":"6","key":"b14","series-title":"Cell","first-page":"849","article-title":"A pituitary cell-restricted T box factor, Tpit, activates POMC transcription in cooperation with Pitx homeoproteins","volume":"104","author":"Lamolet B","year":"2001","unstructured":"Lamolet B, Pulichino AM, Lamonerie T,  A pituitary cell-restricted T box factor, Tpit, activates POMC transcription in cooperation with Pitx homeoproteins. Cell. 2001;104(6):849\u2013859."},{"issue":"2","key":"b15","series-title":"Brain Tumor Pathol","first-page":"57","article-title":"New WHO classification of pituitary adenomas (4th edition): assessment of pituitary transcription factors and the prognostic histological factors","volume":"35","author":"Nishioka H","year":"2018","unstructured":"Nishioka H, Inoshita N. New WHO classification of pituitary adenomas (4th edition): assessment of pituitary transcription factors and the prognostic histological factors. Brain Tumor Pathol. 2018;35(2):57\u201361."},{"issue":"1","key":"b16","series-title":"Hormones (Athens)","first-page":"1","article-title":"High-risk pituitary adenomas and strategies for predicting response to treatment","volume":"21","author":"Kontogeorgos G","year":"2022","unstructured":"Kontogeorgos G, Thodou E, Osamura RY, Lloyd RV. High-risk pituitary adenomas and strategies for predicting response to treatment. Hormones (Athens). 2022;21(1):1\u201314."},{"issue":"2","key":"b17","series-title":"Endocrine","first-page":"452","article-title":"Double pituitary adenomas","volume":"43","author":"Iacovazzo D","year":"2013","unstructured":"Iacovazzo D, Bianchi A, Lugli F,  Double pituitary adenomas. Endocrine. 2013;43(2):452\u2013457."},{"issue":"6","key":"b18","series-title":"Pituitary","first-page":"620","article-title":"Double pituitary adenomas in a large surgical series","volume":"22","author":"Zieli\u0144ski G","year":"2019","unstructured":"Zieli\u0144ski G, Sajjad EA, Maksymowicz M, P\u0119kul M, Koziarski A. Double pituitary adenomas in a large surgical series. Pituitary. 2019;22(6):620\u2013632."},{"issue":"3","key":"b19","series-title":"J Neurosurg","first-page":"1139","article-title":"Expression of additional transcription factors is of prognostic value for aggressive behavior of pituitary adenomas","volume":"134","author":"Micko A","year":"2020","unstructured":"Micko A, R\u00f6tzer T, Hoftberger R,  Expression of additional transcription factors is of prognostic value for aggressive behavior of pituitary adenomas. J Neurosurg. 2020;134(3):1139\u20131146."},{"issue":"5","key":"b20","series-title":"Pituitary","first-page":"514","article-title":"Clinical, pathologic, and imaging characteristics of pituitary null cell adenomas as defined according to the 2017 World Health Organization criteria: a case series from two pituitary centers","volume":"22","author":"Almeida JP","year":"2019","unstructured":"Almeida JP, Stephens CC, Eschbacher JM,  Clinical, pathologic, and imaging characteristics of pituitary null cell adenomas as defined according to the 2017 World Health Organization criteria: a case series from two pituitary centers. 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