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. 2019 Sep 13;8(10):1383–1394. doi: 10.1530/EC-19-0332

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Examples of granulation and SSTR5 immunoexpression in 3 patients and correlation with the IGF-1 response to Pasireotide-LAR. Cytokeratin 18 immunohistochemistry (A, C and E, original magnification × 200). Densely granulated adenomas show perinuclear distribution of cytokeratin 18. Conversely, ‘fibrous bodies’ are typical of sparsely granulated adenomas. SSTR5 immunohistochemistry (B, D and F, original magnification × 200). Immunoexpression of SSTR5 is expressed using ImmunoReactive Score (IRS). (A and B) Densely granulated adenoma with a strong and diffuse immunoexpression of SSTR5 (IRS = 12) and poor response to Pasireotide-LAR (IGF-1 = 3.3 ULN). (C and D) Sparsely granulated adenoma with a moderate immunoexpression of SSTR5 (IRS = 6) and good response to Pasireotide-LAR (IGF-1 = 0.7 ULN). (E and F) Sparsely granulated adenoma with a strong and diffuse immunoexpression of SSTR5 (IRS = 12) and uncontrolled IGF-1 with Pasireotide-LAR (IGF-1 ULN = 1.8).