Clinical, biological, radiological, and pathological comparison of sparsely and densely granulated somatotroph adenomas: a single center experience from a cohort of 131 patients with acromegaly

Swanson, Amy A.; Erickson, Dana; Donegan, Diane; Jenkins, Sarah M.; Gompel, Jamie J. Van; Atkinson, John L.D.; Erickson, Bradley J.; Giannini, Caterina

doi:10.1007/s11102-020-01096-2

Cited by 33 publications

(25 citation statements)

References 51 publications

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“…In addition, Swanson et al [32] reported that they did not find any difference in post-surgical remission rate between two groups of patients (densely vs. sparsely; 41.7 vs. 41.4 %). However, in certain studies [33,34] lower remission rates were reported among patients with the sparsely granulated adenomas.…”

Section: Discussionmentioning

confidence: 97%

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Novel Classification of Acromegaly in Accordance with Immunohistochemical Subtypes: Is There Really a Clinical Relevance?

et al. 2021

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According to the recent studies, immunohistochemical subtypes of growth hormone (GH) secreting adenomas have been considered as a predictive factor in determining the clinical outcomes including biochemical, radiologic, and endocrine remission. In a 20 year-of time period, acromegaly patients who were treated and followed at the Endocrinology Department of our University Hospital were screened for the study. Of total 98 patients, 65 patients who had been operated by transsphenoidal surgery and having postoperative specimens were included. Postoperative specimens of the surgery of the patients were classified into 3 groups based on the histochemical characteristics (densely, sparsely, and mixed). Parasellar extensions of pituitary tumors were classified into the five grades according to Knosp classification. The patients were investigated and evaluated for postoperative clinical progress, remission rates, comorbidities regarding with the histopathological patterns. Of total 65 patients, 31 were classified as densely granulated (group 1), 32 were classified as sparsely granulated (group 2), and 2 patients were assessed as mixed granulated (group 3). There was no difference between groups for age and gender. Pre-treatment of adenoma size in all groups was correlated with each other and the frequency of macroadenoma (1 vs. 2, 77.4 vs. 84.3%) was higher in two groups. Although mean initial GH levels in group 1 was higher than the other groups (p=0.03), IGF1 levels (age and gender matched) were similar in each group. Adenomas in all groups demonstrated noninvasive radiological characteristics (Knosp grade 0–1–2). Ki-67 proliferation index of both groups (64.5 vs. 50%) was predominantly 1%. With a similar follow-up period, the endocrine remission rates (GH<1 μg/l) in groups were 64 vs. 69%, respectively. In conclusion, classification according to immunohistochemical subtypes of growth hormone secreting adenomas may not be a qualified parameter to evaluate patients with patterns of aggressiveness, clinical outcomes, or treatment response.

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Section: Discussionmentioning

confidence: 97%

“…In many studies [29][30][31][32], it was reported that those patients with sparsely granulated pituitary adenomas have a tendency to become macroadenoma/larger tumor volume and more invasive to the adjacent pituitary tissues.…”

Section: Discussionmentioning

confidence: 99%

Novel Classification of Acromegaly in Accordance with Immunohistochemical Subtypes: Is There Really a Clinical Relevance?

et al. 2021

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“…The value of AOT as a predictor of response to fg-SRL is matter of debate and is not supported by all studies ( 70 , 71 ). On the other hand, T2 signal intensity in the adenoma is a reliable biomarker, as tumors with higher T2 signal seem to show lower SST2 expression and respond worst to fg-SRL, which has been demonstrated in several studies ( 72-75 ).…”

Section: Future Perspectives For Currently Available Injectable Srlsmentioning

confidence: 85%

The Future of Somatostatin Receptor Ligands in Acromegaly

Gadelha

Wildemberg

2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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Currently, first-generation somatostatin receptor ligands (fg-SRLs), octreotide LAR and lanreotide autogel, are the mainstays of acromegaly treatment and achieve biochemical control in approximately 40% of patients and tumor shrinkage in over 60% of patients. Pasireotide, a second-generation SRL, shows higher efficacy with respect to both biochemical control and tumor shrinkage but has a worse safety profile. In this review, we discuss the future perspectives of currently available SRLs, focusing on the use of biomarkers of response and precision medicine, new formulations of these SRLs and new drugs, which are under development. Precision medicine, which is based on biomarkers of response to treatment, will help guide the decision-making process by allowing physicians to choose the appropriate drug for each patient and improving response rates. New formulations of available SRLs, such as oral, subcutaneous depot and nasal octreotide, may improve patients’ adherence to treatment and quality of life since there will be more options available that better suit each patient. Finally, new drugs, such as paltusotine, somatropin, ONO-5788 and ONO-ST-468, may improve treatment adherence and present higher efficacy than currently available drugs.

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“…They were classified as densely granular SAs (DGSAs) and sparsely granular SAs (SGSAs). In contrast, SGSAs were more aggressive, had a high tendency to recur and were less manageable ( 27 ). Thus, for patients with pathological diagnosis of SGSAs, a standardized and individualized treatment plan should be formulated, and adjuvant treatment should be adopted after total or subtotal tumor resection with appropriate postoperative follow-up intervals, along with reasonable treatment modalities for early intervention in response to signs of recurrence.…”

Section: Literature Review and Discussionmentioning

confidence: 99%

A Pituitary Carcinoma Patient With Cerebrospinal Fluid Dissemination Showing a Good Response to Temozolomide Combined With Whole-Brain and Spinal Cord Radiotherapy: A Case Report and Literature Review

et al. 2022

Front. Oncol.

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Pituitary carcinoma (PC) is extremely rare, with its incidence only accounting for 0.1%-0.2% of pituitary tumor (PT). Existing histological features, including invasiveness, cellular pleomorphism, nuclear atypia, mitosis, necrosis, etc., can be observed in pituitary adenoma (PA), invasive PA (IPA) and PC. Invasion is not the basis for the diagnosis of PC. The diagnosis of PC is often determined after the metastases are found, hence early diagnosis is extraordinarily difficult. Owing to the conventional treatment for PC may not be effective, a large portion of patients survived less than one year after diagnosis. Therefore, it is of great significance to find an efficacious treatment for PC. We report a rare case of sparsely granulated somatotroph carcinoma with cerebrospinal fluid dissemination showing a favorable treatment response to temozolomide (TMZ) combined with whole-brain and spinal cord radiotherapy.

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Clinical, biological, radiological, and pathological comparison of sparsely and densely granulated somatotroph adenomas: a single center experience from a cohort of 131 patients with acromegaly

Cited by 33 publications

References 51 publications

Novel Classification of Acromegaly in Accordance with Immunohistochemical Subtypes: Is There Really a Clinical Relevance?

Novel Classification of Acromegaly in Accordance with Immunohistochemical Subtypes: Is There Really a Clinical Relevance?

The Future of Somatostatin Receptor Ligands in Acromegaly

A Pituitary Carcinoma Patient With Cerebrospinal Fluid Dissemination Showing a Good Response to Temozolomide Combined With Whole-Brain and Spinal Cord Radiotherapy: A Case Report and Literature Review

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