Somatotroph (GH) adenomas/PitNETs typically arise from adenohypophysis and are biochemically active, leading to acromegaly and gigantism. More rarely, they present with ectopic origin and do not present overt biochemical or clinical features (silent variants). Histopathological examination should consider the clinical and radiological background, and include multiple steps assessing tumor morphology, pituitary transcription factors (PTFs), hormone secretion, proliferation markers, granulation, and somatostatin receptors (STRs), aimed at depicting as better as possible tumor origin (in case of non-functioning and/or metastatic tumor), and clinical behavior, including response to treatment. GH-secreting tumors are part of the Pit-1 family tumors and can secrete GH only (pure somatotrophs) or co-secrete prolactin (mixed tumors; in this case, various histological subtypes have been identified). Each subtype presents unique radiological, biochemical, and clinical characteristic. Therefore, the integration of biochemical, clinical, radiological, and histopathological elements is fundamental for proper diagnosis and management of pituitary adenomas/PitNETs, to be performed in referral Centers. In more recent times, the importance of genetic and epigenetic evaluation in the characterization of pituitary tumors (i.e., early identification of aggressive variants) has been outlined by some large studies, with the intention of improving targeted treatments.

中文翻译：

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生长激素分泌性垂体瘤的组织病理学：最新技术和新观点

生长激素细胞 (GH) 腺瘤/PitNET 通常起源于腺垂体，具有生化活性，可导致肢端肥大症和巨人症。更罕见的是，它们具有异位起源并且不表现出明显的生化或临床特征（沉默变异）。组织病理学检查应考虑临床和放射学背景，包括评估肿瘤形态、垂体转录因子（PTF）、激素分泌、增殖标志物、肉芽形成和生长抑素受体（STR）的多个步骤，旨在尽可能更好地描述肿瘤起源。如果是无功能和/或转移性肿瘤），以及临床行为，包括对治疗的反应。分泌 GH 的肿瘤是 Pit-1 家族肿瘤的一部分，可以仅分泌 GH（纯生长激素细胞）或共同分泌催乳素（混合肿瘤；在这种情况下，已鉴定出各种组织学亚型）。每种亚型都具有独特的放射学、生化和临床特征。因此，生化、临床、放射学和组织病理学要素的整合对于在转诊中心进行的垂体腺瘤/PitNET 的正确诊断和管理至关重要。近年来，一些大型研究概述了遗传和表观遗传评估在垂体肿瘤特征（即早期识别侵袭性变异）中的重要性，旨在改善靶向治疗。