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Pituitary incidentalomas (PIs) are defined as previously unexpected pituitary lesions which are accidentally discovered during imaging examinations performed for unrelated reasons, including pituitary adenoma, craniopharyngioma, Rathke's cyst, pituitary hyperplasia and other sellar lesions. With the wide application of imaging techniques, especially MRI, more and more pituitary incidentalomas have been detected. However, there are still many problems regarding the definition of pituitary incidentaloma, natural course of disease, intervention indication at the first diagnosis, follow⁃up plan, and so on, resulting in misdiagnosis and overtreatment. This review attempts to discuss the definition, relevant factors for predicting the natural course of tumor, diagnosis, surgical indications, and individualized follow ⁃up plan, and so on, in order to attract clinical attention and conduct related research to further clarify the clinical unsolved problems.

Objective To report 4 patients with pituitary abscess (PA), and summarize etiology, clinical manifestation, imaging, endocrinological characteristics, treatment and prognosis of PA in combination with literatures review. Methods and Results Four patients (3 cases were primary PA, one case was secondary PA) from January 2015 to August 2019 were included in the study during 534 cases whose sellar region lesion were diagnosed. The main clinical manifestations were headache (4 cases), blurred vision and temporal blindness (4 cases), fatigue and anorexia (4 cases), polyuria (2 cases) and transient hyperthermia (2 cases). MRI showed cystic occupying lesions in the sellar region, with typical enhancement in the cystic wall (4 cases). Endocrinology showed hypothyroidism (4 cases), hypoadrenocorticism (3 cases) and hypogonadism (3 cases). After hormone replacement therapy (HRT) and antibiotic anti-infection treatment, endoscopic transsphenoidal removal of PA was adopted. The clinical symptoms gradually improved. Pituitary function in 3 cases returned to normal, one case still needed HRT. MRI showed no sign of recurrence of PA. Conclusions Early symptoms in PA is prone to hypopituitarism. PA is characterized by edge-enhanced cystic space-occupying lesion in MRI. Endoscopic transsphenoidal removal of PA is the fine-line treatment and the prognosis is good while the patients' recurrence rate is low. [ABSTRACT FROM AUTHOR]

Craniopharyngioma is a benign tumor of WHO grade I. As the location of craniopharyngioma is deep, around which the peripheral structure is complex, the tumor adheres closely to the pituitary stalk and hypothalamus, and a small number of craniopharyngioma have the growth characteristics of malignant tumor, the total resection of craniopharyngioma is hard to achieve. Radiotherapy is only effective in some patients and is often associated with complications such as radiation damage to the pituitary and optic nerve. So, the treatment of craniopharyngioma is still challenging for neurosurgeons and endocrinologists. With the development of molecular biology technology, some new findings are made ragarding the pathological classification of craniopharyngioma and its mechanism. The revised 4th edition of 2016 WHO classification of central nervous system tumors classifies craniopharyngioma into adamantinomatous and papillary craniopharyngioma. There are significant differences in clinical susceptibility, histopathological characteristics and genetic changes between two types. These differences not only help to clarify molecular pathological classification of craniopharyngioma, but also provide a theoretical basis for its molecular targeted therapy. However, more transformational studies and multicenter clinical trials are needed to develop more effective molecular targeted therapy drugs. [ABSTRACT FROM AUTHOR]

Sellar malignant tumors are uncommon and usually reported as metastatic diseases from breast or lung cancers. Spindle cell carcinoma (SCC) is a rare malignancy and has been found in breast,oral cavity,lungs,kidneys,and hepatobiliary pancreatic system but not in sellar region. We report here the first case of isolated sellar SCC with aggressive features in Peking Union Medical College Hospital. This patient was referred to our hospital on September 9,2015 and discharged on October 16,2015. We described the clinical manifestations,imaging findings,and pathological features of this rare disease.

Objective To explore the influence of the iodine disinfection on nasal bacterial colonization through the transsphenoidal approach. Methods Totally 133 pituitary adenoma patients who underwent transsphenoidal surgery in our department from January to August 2017 were enrolled in this study. Before disinfection,pharyngeal swabs of inferior turbinate root secretions were taken for bacterial culture. After iodine disinfection,pharyngeal swabs were taken again at the same site. Changes in the nasal bacterial spectrum before and after disinfection were compared. Patients were followed up for three months after the surgery,during which any intracranial infection/bacteraemia was recorded,and its correlation with nasal bacteria colonization was analyzed. Results Nasal bacterial colonization was detected in 45 (33.8%) of 133 patients before iodine disinfection and in only 6 cases (4.5%) after iodine disinfection (χ 2 =34.5,P=0.000). Thus,iodine disinfection eliminated 86.7%(39/45) of the colonized bacteria. The most common nasal bacterium was Staphylococcus aureus (24.4%,11/45),followed by Klebsiella pneumoniae (24.4%,11/45),and Staphylococcus epidermidis (13.3%,6/45). One patient had high fever and chills 2 days after surgery,but blood culture and cerebrospinal fluid culture showed negative Results . After the administration of third-generation cephalosporins,the symptoms disappeared after two days. Conclusion sThere are colonized bacteria in nasal cavity. Iodine disinfection of nasal cavity can effectively clear most of the nasal bacteria. The possibility of intracranial infection/bacteremia after transsphenoidal approach is low.

Objective: To investigate the correlation between signal transducer and activator of transcription 3 (STAT3) expression and pituitary adenoma subtypes., Method: The STAT3 expression profiles in different pituitary adenomas from 74 patients were determined using quantificational real-time polymerase chain reaction,Western blot,and immunohistochemistry., Results: Expression of STAT3 was observed in all pituitary adenoma subtypes. The STAT3 expression level was highest in growth hormone adenoma when compared with other tumors including prolactin,follicle-stimulating hormone/luteinizing hormone-secreting adenoma,and adrenocorticotrophic hormone-secreting adenoma. The follicle-stimulating hormone/luteinizing hormone adenomas exhibited the lowest STAT3 expression levels., Conclusion: STAT3 is differentially expressed in pituitary adenoma subtypes, suggesting the cell-specific features of STAT3 regulation,although further investigations are still warranted to clarify the underlying mechanisms.

The early diagnosis and treatment of pituitary carcinoma is difficult. The diagnosis is often delayed, and the confirmation of a diagnosis requires the presence of distant subarachnoid,brain or systemic metastasis from the primary pituitary tumor in the sella and also needs the evidences of pathology and imaging of the primary pituitary carcinoma and metastases. Treatment of pituitary carcinoma includes surgery, radiation therapy ,hormone therapy, chemotherapy, and molecularly targeted therapy; however, these methods are mainly palliative and can not prolong the survival. The prognosis remains poor. Efforts should be made to develop more effective diagnosis and treatment options.

Objective: To study the effectiveness of treating giant pituitary adenomas invading cavernous sinus with neuroendoscopy assisted by multiple techniques., Methods: A total of 72 patients who underwent neuroendoscopic surgery and 55 patients who underwent microscopic surgery for giant pituitary adenomas were enrolled in this retrospective analysis. Both groups received expanded endoscopic endonasal transsphenoidal approach, intraoperative application of navigation, and Doppler.The clinical data of two groups were compared., Results: The two groups were significantly different in total tumor removal rate, operation time, postoperative nasal patency, and postoperative recurrence rate (P=0.004, P=0.0003, P=0.000, and P=0.002, respectively), whereas the cerebrospinal fluid leakage, postoperative diabetes insipidus, and cranial nerve injury were not significantly different (P > 0.05)., Conclusions: Expanded neuroendoscopic endonasal transsphenoidal approach assisted by multiple techniques is the preferred surgical method for giant invasive pituitary adenomas invading cavernous sinus.The lateral cavernous sinus approach and the further molecular biology research will bring more options for the treatment of invasive pituitary adenomas.

Objective: To explore the significance of pseudocapsule in the excision of pituitary adenomas in transsphenoidal surgery., Methods: For 22 patients with pituitary adenomas over a period of 2 years at Peking Union Medical College Hospital, resection of pseudocapsule was applied for complete tumor removal. Pituitary function test and radiological imaging were performed at pre-operation, 3 months post-operation and at subsequent 6-12 months intervals postoperatively., Results: All pituitary adenomas were totally removed under microscope. The symptoms of headache, disorder of sight and visual field disappeared postoperatively in nonfunctional pituitary adenomas. The GH levels of 2/5 growth hormone secreting adenoma patients were 4.2 and 7.7 µg/L while it was under 1 µg/L for another 3. The postoperative level of prolactin was 4.3 µg/L in prolactin secreting adenoma. The level of adrenocorticotropic hormone decreased under 5 ng/L except one was 15.7 ng/L. Leakage of cerebrospinal fluid occurred intraoperatively in 3 patients and postoperatively in 1. No leakage was found after repair. Diabetes insipidus occurred in one patient and was controlled with Minirin. Pseudocapsule was confirmed by pathological examination. Special staining revealed reticulum fibers in pseudocapsule., Conclusion: Resection of pseudocapsule may achieve a higher remission rate without deteriorating pituitary function.

Familial isolated pituitary adenoma (FIPA) is an autosomal dominant disease, characterized by low penetrance, early-onset disease, more invasive tumor growth, as well as somatotroph and lactotroph adenomas in most cases. It has been indicated that the aryl hydrocarbon receptor interacting protein (AIP) gene is a tumor suppressor gene. Many heterozygous mutations have been discovered in AIP in about 20% of FIPA families. However, the exact molecular mechanism by which its disfunction promotes tumorigenesis of pituitary is unclear.

To investigate influences of mining activities on heavy metal contamination and health risk in vegetable of mining-affected area, the present study was undertaken as a preliminary survey of As, Cd, Co, Cr, Cu, Ni, Pb and Zn concentrations of majority vegetables and soils in area affected by an ancient tin ore, Yunnan province. Based on the soil heavy metals investigated, average Nemero index of soil heavy metals reach 50.1, showed that vegetable fields were contaminated by heavy metals, especially As: average As concentration of soils could reach 1225 mg x kg(-1). Heavy metal concentrations in the edible portions of majority vegetables exceeded the national standards of China seriously, especially As and Pb, and the maximum of As and Pb concentrations (DW) could reach 856 mg x kg(-1) and 506 mg x kg(-1), respectively. Heavy metal concentrations among 3 kinds of vegetables decreased in following order: leaf vegetables > fruit vegetables > rhizome vegetables. Consumption of vegetables from the mining-affected area may pose extremely high health risk of As and Pb to local residents, which the exposed risk indexes could reach 158 and 13.3, respectively.