Clinicopathological predictive factors in the early remission of corticotroph pituitary macroadenomas in a tertiary referral centre

Witek, Przemysław; Zieliński, Grzegorz; Szamotulska, Katarzyna; Maksymowicz, Maria; Kamiński, Grzegorz

doi:10.1530/eje-15-1226

Cited by 22 publications

(39 citation statements)

References 39 publications

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“…We assessed the Ki-67 labeling index in corticotroph tumors with sufficient samples only. Despite slightly higher averages of Ki-67 in SGCTs, the difference was not statistically significant; and similar results were shown in the study reported by Witek et al (12). However, the eye-balling method we used to evaluate Ki-67 is no longer accepted in the field of neuroendocrine neoplasms including those of pituitary origin and also a minimum of 500 tumor cells should be counted for this examination.…”

supporting

confidence: 80%

“…It is reported in the literature that the majority of corticotroph tumors were densely granulated (3,(6)(7)(8)10,12). However, in a recent study, Mete et al (13) reported the frequency of SGCTs and DGCTs in their cohort as 29% and 47%, respectively and interpreted this result as an…”

Section: Discussionmentioning

confidence: 95%

“…Some indexes such as Ki-67, p53, an loss of p27 are used for behavioral detection of pituitary tumors (12,13,21,22). We assessed the Ki-67 labeling index in corticotroph tumors with sufficient samples only.…”

mentioning

confidence: 99%

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Clinical significance of granulation pattern in corticotroph pituitary adenomas

Dogansen

Bılgıç²,

Yalin³

et al. 2018

TJPATH

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Objective: The granulation pattern of pituitary tumors may be important to predict tumor behavior, treatment outcomes, and recurrences. Therefore, we compared densely granulated corticotroph tumor (DGCT) and sparsely granulated corticotroph tumor (SGCT) in terms of clinicopathologic findings. Material and Method:A total of 41 patients (31 females/10 males) were assessed in the study. The granulation patterns were detected by Periodic Acid-Schiff (PAS) and adrenocorticotropic hormone (ACTH) immunoreactivity. Diffuse and strong staining by PAS and ACTH were identified as DGCT, whereas faint staining by PAS and focal, weak staining by ACTH were identified as SGCT. Perinuclear ring-like patterns with low molecular weight keratin were identified as Crooke's cell tumors. DGCTs and SGCTs were compared in terms of clinical findings and treatment outcomes. Results:The majority of the patients (71%) had DGCTs (n=29); whereas 24% of the patients had SGCTs (n=10) and 5% of the patients had Crooke's cell tumors (n=2). DGCTs and SGCTs were similar in terms of age, sex, estimated duration of disease, baseline cortisol and ACTH levels. SGCTs were larger than DGCTs (p=0.034). The remissions with surgery rates were similar between the groups; however, hypothalamic-pituitaryadrenal axis recovery time was longer in SGCTs (p=0.033). Persistent disease after surgery was slightly higher in DGCTs and recurrences were frequent in SGCTs; however, the differences were not statistically significant. Conclusion:DGCTs are often small microadenomas, while SGCTs are larger. Recurrences were slightly more common in SGCTs; however, further studies including larger series are needed to be able to obtain more significant results.

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confidence: 80%

Section: Discussionmentioning

confidence: 95%

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Clinical significance of granulation pattern in corticotroph pituitary adenomas

Dogansen

Bılgıç²,

Yalin³

et al. 2018

TJPATH

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“…8,9,14,18 Utilization of the pseudocapsule among macroadenomas, howev-er, has been discussed only in limited series and with little to no emphasis on surgical technique and with contrasting conclusions regarding the efficacy of pseudocapsular resection. 12,19,23 Instead, traditional resection of macroadenomas, via either an endoscopic or microscopic approach, has typically used a piecemeal resection technique. 1,6 The piecemeal technique, however, results in reduced visibility of the tumor margins as the tumor is centrally decompressed and the remaining tumor descends and the normal gland expands.…”

Section: Discussionmentioning

confidence: 99%

Resection of pituitary macroadenomas via the pseudocapsule along the posterior tumor margin: a cohort study and technical note

Taylor¹,

Jane²,

Oldfield³

2018

Journal of Neurosurgery

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OBJECTIVE Extracapsular resection of pituitary microadenomas improves remission rates, but the application of pseudocapsular techniques for macroadenomas has not been well described. In larger tumors, the extremely thin, compressed normal gland or its complete absence along the tumor's anterior surface limits the application of the traditional pseudocapsular technique that can be used for microadenomas. However, in the authors' experience, the interface between the pseudocapsule at the posterior margin of the adenoma and the compressed normal gland behind it is universally present, providing a surgical dissection plane. In mid-2010, the authors began using a new surgical technique to identify and use this interface for the resection of larger macroadenomas, a technique that can be used with the microscope or the endoscope. METHODS The authors performed a cohort study using prospectively collected preoperative imaging reports and operative details and retrospectively reviewed postoperative images and clinical follow-up of patients with a pituitary macroadenoma 20-40 mm in maximum diameter undergoing microscopic transsphenoidal resection. Since dissection of the tumor capsule only pertains to encapsulated tumor within the sella and not to tumor invading the cavernous sinus, assessment of tumor removal of noninvasive tumors emphasized the entire tumor, while that of invasive tumors emphasized the intrasellar component only. The incidence of residual tumor on postoperative imaging, new-onset endocrinopathy, and recovery of preoperative pituitary deficits was compared between patients who underwent surgery before (Group A) and after (Group B) implementation of the new technique. RESULTS There were 34 consecutive patients in Group A and 74 consecutive patients in Group B. Tumors in 18 (53%) Group A and 40 (54%) Group B patients had no evidence of cavernous sinus invasion on MRI. Use of the posterior pseudocapsule technique reduced the incidence of intrasellar residual tumor on postoperative MRI for tumors without cavernous sinus invasion (39% [Group A] vs 10%, p < 0.05) and in all tumors regardless of invasion (50% vs 18%, p < 0.005). The incidence of new endocrinopathy was less likely (25% vs 12%, p = 0.098) and the recovery of prior deficits more likely (13% vs 27%, p = 0.199) among patients treated using the pseudocapsule approach, although the differences are not statistically significant. CONCLUSIONS Use of the posterior pseudocapsule dissection plane can enhance the resection of pituitary macroadenomas.

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“…[3,8–12] While macroadenomas have relatively lower remission rates of 12.5% to 71.1%, with more operative complications and higher recurrence rates. [8,9,13–19] Cavernous sinus invasion is another unfavorable prognostic factor for transsphenoidal surgery. [3] Specifically, the reported remission rates among ACTH-secreting pituitary adenomas with cavernous sinus invasion range from 0% to 60%.…”

Section: Introductionmentioning

confidence: 99%

Invasive ACTH-secreting pituitary macroadenoma in remission after transsphenoidal resection

et al. 2018

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Rationale:Knosp grade 4 adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma is a rare cause of Cushing disease. After the 1st surgery, the remission rate among these patients is extremely low.Patient concerns:We presented a case of a 33-year-old female with classical Cushingoid symptoms. Further investigations revealed ATCH-dependent hypercortisolemia, as well as a Knosp grade 4 pituitary macroadenoma.Diagnosis:Cushing disease, caused by a Knosp grade 4 pituitary macroadenoma.Interventions:The patient underwent endoscopic endonasal transsphenoidal surgery with the assistance of intraoperative transsphenoidal Doppler and image-guidance devices.Outcomes:Pathologic examinations confirmed that the lesion was an ACTH-secreting pituitary adenoma. The patient was in biochemical remission after surgery. Her postoperative magnetic resonance imaging showed gross-total tumor resection. There was no evidence of recurrence during the 1-year follow-up.Lessons:With intraoperative Doppler and image-guidance, gross-total resection and biochemical remission can be achieved in Cushing disease when the internal carotid artery is completely encased by the pituitary adenoma.

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Clinicopathological predictive factors in the early remission of corticotroph pituitary macroadenomas in a tertiary referral centre

Cited by 22 publications

References 39 publications

Clinical significance of granulation pattern in corticotroph pituitary adenomas

Clinical significance of granulation pattern in corticotroph pituitary adenomas

Resection of pituitary macroadenomas via the pseudocapsule along the posterior tumor margin: a cohort study and technical note

Invasive ACTH-secreting pituitary macroadenoma in remission after transsphenoidal resection

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