Hong-Da LinDr. Taiwan

• Consensus in Pituitary Pathology: Impact after New Classification for Japan
  Naoko InoshitaJapan Speaker Consensus in Pituitary Pathology: Impact after New Classification for JapanIn Japan, the brain tumor handling rules are essentially based on the WHO classification. However, the introduction of the term pituitary neuroendocrine tumour (PitNET) has occasionally led to misunderstanding in clinical practice, particularly regarding the implication of malignancy. In this lecture, I will present a consensus-oriented approach in pituitary pathology, focusing on practical strategies developed through multidisciplinary collaboration for the benefit of clinicians and patients. First, I will show how the addition of touch smear cytology to frozen section diagnosis during surgery can improve the accuracy of margin assessment and increase the likelihood of achieving the intended surgical goal, including adequate removal of hormone-producing tumours. Second, I will emphasize that truly malignant PitNETs are extremely rare, and that the term “NET” should not be equated with malignancy. Third, I will discuss the well-known discrepancy between hormone immunohistochemistry and clinical functionality, highlighting the importance of careful pathological interpretation. These perspectives reflect our pathology team’s commitment to accurate communication and clinically relevant pathological diagnosis.
• The Impact of the 2022 WHO PitNET Classification to the Clinical Practitioners. Does Silence Equal Acceptance?
  Szu-Tah ChenTaiwan Speaker The Impact of the 2022 WHO PitNET Classification to the Clinical Practitioners. Does Silence Equal Acceptance?The 2022 World Health Organization (WHO) Classification of Endocrine and Neuroendocrine Tumors redefined pituitary adenomas as pituitary neuroendocrine tumors (PitNETs) within the International Classification of Diseases for Oncology, 3rd Edition (ICD-O/3). This change reflects updated insights into tumor biology, recognizing a spectrum of clinical behaviors beyond the traditionally benign designation. A narrative review of the WHO 2022 classification updates was conducted, focusing on their clinical, diagnostic, and epidemiologic implications for practitioners in endocrinology, neurosurgery, and oncology. The reclassification emphasizes the potential for variability in tumor aggressiveness, recurrence, and invasiveness. Clinically, this shift necessitates more careful risk stratification, closer follow-up in selected cases, and a reassessment of treatment algorithms. From a reporting perspective, ICD-O/3 alignment may affect cancer registry data and epidemiologic tracking, altering disease burden estimates. Importantly, the new terminology presents challenges in patient communication, as the label “neuroendocrine tumor” may cause undue anxiety despite the indolent nature of most PitNETs. The WHO 2022 reclassification of pituitary adenomas as PitNETs represents a significant change for clinical practice. While it enhances awareness of potential aggressive behavior, it also requires balanced application in patient care to avoid overtreatment and misperceptions. Practitioners must adapt by refining diagnostic vigilance, tailoring follow-up strategies, and delivering clear patient-centered communication.
• Consensus in Pituitary Pathology: Impact after New Classification for Korea
  Jae Sung ParkSouth Korea Speaker Consensus in Pituitary Pathology: Impact after New Classification for KoreaThe management of pituitary neuroendocrine tumors (PitNETs) in South Korea is undergoing a significant transition following the 2022 WHO classification. While the shift from "adenoma" to "PitNET" implies a malignant potential, from a neurosurgical perspective, these tumors remain generally far more indolent than primary brain cancers such as high-grade gliomas. Identifying the specific subset of patients who require aggressive intervention is therefore paramount. Our recent institutional study indicates that high-risk non-functioning pituitary adenomas (NFPAs) are more prevalent in younger female patients and exhibit a higher incidence of cavernous sinus invasion. Consequently, a more proactive surgical approach is often warranted for these high-risk phenotypes. Beyond clinical considerations, the Korean healthcare system—characterized by government-led cost controls and supplemental private insurance—faces unique challenges. There is a growing trend of patients requesting malignancy-level ICD coding to secure broader insurance coverage, a phenomenon increasingly driven by external socio-economic factors. Although the Korean Brain Tumor Society (KBTS) previously debated this classification, a definitive consensus remains elusive. Rather than proposing a singular solution, this session aims to raise these multi-faceted issues from a neurosurgical viewpoint, inviting diverse expert perspectives to foster a collective dialogue on the nature of PitNETs within our evolving medical and socio-economic landscape.