The long-term significance of microscopic dural invasion in 354 patients with pituitary adenomas treated with transsphenoidal surgery

Abstract

The principal significance of dural invasion by pituitary adenoma is the persistence of tumor tissue after transsphenoidal surgery (incomplete adenomectomy; 20% in primary pituitary tumor resections). The increase in adenoma size with time and the concurrent development of dural invasion are the major factors that determine an incomplete adenomectomy. When the adenoma remains restricted to the sellar compartment or shows only moderate suprasellar extension, dural invasion may not yet have developed and conditions for complete selective adenomectomy are improved.

Long-term Survival With Non-functioning Pituitary Carcinoma -Case Report-

“…Microscopic dural invasion was recognized in 45.5% of patients after sellar dura excision at transsphenoidal surgery for pituitary adenoma. 11) In our case, the primary pituitary adenoma recurred repeatedly, but we did not search the sellar dura. Our case was similar to a previous case of pituitary adenoma with multiple dural metastases.…”

“…2,3,15) Pituitary adenoma is occasionally aggressive, as histological examination of surgically excised sellar dura frequently shows tumor invasion. 11) Pituitary carcinoma is rare with an incidence of less than 1%. The presence of metastatic lesion rather than histological findings is the basis for the diagnosis of pituitary carcinoma.…”

Matrix Metalloproteinase-9 Is Differentially Expressed in Nonfunctioning Invasive and Noninvasive Pituitary Adenomas and Increases Invasion in Human Pituitary Adenoma Cell Line

“…Approximately 40% of PAs have macroscopic evidence of local invasion, and as much as 80% are invasive on microscopic examination. 1,2 Complete resection of PA is unlikely when there is extensive local invasion, and surgery for invasive tumors carries increased risks of complications. Failure to achieve surgical cure, incidence of recurrence, and poor outcome are all related to PA invasiveness.…”

Análise da expressão da filamina A nos tumores hipofisários e suas implicações clínicas e terapêuticas

“…Ainda que a definição dessas características não seja uniforme (20,24) , muitos autores consideram os sinais de invasão parasselar e infrasselar, nos exames de imagem e achados intra-operatórios, como invasividade e a presença de múltiplos tratamentos, necessidade de radioterapia e índice de proliferação celular Ki-67 acima de 3% como características de agressividade tumorais (26) . Notch, que regula o "destino" das células, através da inibição lateral, permitindo a formação de "barreiras" entre células de um mesmo tipo ou não (178) , participa do processo de tumorigênese dos tumores hipofisários (179)(180)(181) , inclusive em corticotropinomas (182) .…”

“…A invasividade pode ser uma das características de agressividade tumoral (24) . Em geral, tumores hipofisários agressivos são definidos pela dificuldade no manejo devido ao seu tamanho, invasividade, rápido crescimento, recorrência e múltiplas modalidades terapêuticas (20) .…”