Early recognition of aggressive pituitary adenomas: a single-centre experience

Ceccato, Filippo; Regazzo, Daniela; Barbot, Mattia; Denaro, Luca; Emanuelli, Enzo; Borsetto, Daniele; Rolma, Giuseppe; Alessio, L; Gardiman, Marina Paola; Lombardi, Giuseppe; Albiger, Nora; D’Avella, Domenico; Scaroni, Carla

doi:10.1007/s00701-017-3396-5

Cited by 31 publications

(22 citation statements)

References 24 publications

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“…Patients with NFPAs were older than those with functioning tumours, and the diagnosis might be delayed until mass symptoms occur as they lacked symptoms related to hormonal hypersecretion. They reported that the characteristics of aggressiveness were similar between silent adenomas and NFPAs, even separately analysing silent corticotrophinomas and gonadotrophinomas (Ceccato et al 2018).…”

Section: Endocrine-related Cancermentioning

confidence: 98%

Aggressive and malignant pituitary tumours: state-of-the-art

Dworakowska¹,

Grossman²

2018

Endocrine-Related Cancer

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Pituitary adenomas are unique in multiple ways. They are rarely malignant in terms of metastases, yet they may be aggressive. Their cancerous potential is defined in a classic oncological way by the ability to metastasise, and therefore it has been crucial to differentiate this process from aggressive behaviour, characterised as a particularly invasive and/or recurrent behaviour and resistance to common modalities of therapy. Recently, however, important changes have been introduced to the diagnosis and management of aggressive and malignant pituitary tumours including the 4th edition of the WHO classification for endocrine tumours (2017) as well as ESE Clinical Guidelines (2018), although an attempt to establish predictive and/or prognostic markers of clinical aggressiveness remains difficult. In this review, we focus on a group of pituitary tumours causing significant problems in clinical practice and requiring multidisciplinary input. We summarise updates in definitions of tumour invasiveness, aggressiveness and malignant transformation, as well as histological classification, and emphasise the new considerations regarding aggressive and malignant potential and its relationship to therapeutic strategies.

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Section: Endocrine-related Cancermentioning

confidence: 98%

Aggressive and malignant pituitary tumours: state-of-the-art

Dworakowska¹,

Grossman²

2018

Endocrine-Related Cancer

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“…Regarding hormone secretion, invasive tumors are more frequently non-functioning, silent corticotroph and silent subtype-three PAs (now defined plurihormonal PIT1-positive adenomas, according to the most recent WHO classification [21]), or PRL-secreting and GH-secreting [22][23][24][25][26][27][28][29][30]. Sphenoid invasion seems to be related to the size of the PA [31] and male gender [12].…”

Section: Epidemiologymentioning

confidence: 99%

Pituitary Adenomas and Invasiveness from Anatomo-Surgical, Radiological, and Histological Perspectives: A Systematic Literature Review

Serioli

Doglietto

Fiorindi

et al. 2019

Cancers

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Invasiveness in pituitary adenomas has been defined and investigated from multiple perspectives, with varying results when its predictive value is considered. A systematic literature review, following PRISMA guidelines, was performed, searching PubMed and Scopus databases with terms that included molecular markers, histological, radiological, anatomical and surgical data on invasiveness of pituitary adenomas. The results showed that differing views are still present for anatomical aspects of the sellar region that are relevant to the concept of invasiveness; radiological and histological diagnoses are still limited, but might improve in the future, especially if they are related to surgical findings, which have become more accurate thanks to the introduction of the endoscope. The aim is to achieve a correct distinction between truly invasive pituitary adenomas from those that, in contrast, present with extension in the parasellar area through natural pathways. At present, diagnosis of invasiveness should be based on a comprehensive analysis of radiological, intra-operative and histological findings.

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“…The decision to start TMZ in pituitary carcinomas is clear ( 66 , 76 ) but in aggressive pituitary adenomas other factors such as age, previous medical therapy, radiotherapy, number of previous surgical interventions, invasion, proliferation markers, and histologic subtype of the tumor must be considered ( 66 , 84 ). The benefits of starting TMZ must outweigh the risks of repeated surgeries, re-irradiation, and potential complications with standard treatments, and in all cases, the decision must be considered from an interdisciplinary perspective ( 74 , 76 ).…”

Section: Temozolomide Treatment Outcomementioning

confidence: 99%

Temozolomide and Pituitary Tumors: Current Understanding, Unresolved Issues, and Future Directions

et al. 2018

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Temozolomide, an alkylating agent, initially used in the treatment of gliomas was expanded to include pituitary tumors in 2006. After 12 years of use, temozolomide has shown a notable advancement in pituitary tumor treatment with a remarkable improvement rate in the 5-year overall survival and 5-year progression-free survival in both aggressive pituitary adenomas and pituitary carcinomas. In this paper, we review the mechanism of action of temozolomide as alkylating agent, its interaction with deoxyribonucleic acid repair systems, therapeutic effects in pituitary tumors, unresolved issues, and future directions relating to new possibilities of targeted therapy.

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Early recognition of aggressive pituitary adenomas: a single-centre experience

Cited by 31 publications

References 24 publications

Aggressive and malignant pituitary tumours: state-of-the-art

Aggressive and malignant pituitary tumours: state-of-the-art

Pituitary Adenomas and Invasiveness from Anatomo-Surgical, Radiological, and Histological Perspectives: A Systematic Literature Review

Temozolomide and Pituitary Tumors: Current Understanding, Unresolved Issues, and Future Directions

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