SURG-15. PITUITARY SPINDLE CELL ONCOCYTOMA: A CASE REPORT AND LITERATURE REVIEW

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi197-vi198
Author(s):  
Taha Taka ◽  
Chen Yi Yang ◽  
Joshua Limbo ◽  
Alvin Chan ◽  
Jordan Davies ◽  
...  
Keyword(s):  
Literature Review ◽  
Spindle Cell ◽  
Normal Pressure ◽  
Who Grade ◽  
Risk Of Recurrence ◽  
Abnormal Gait ◽  
Pubmed Database ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Spindle Cell Oncocytoma

Abstract BACKGROUND Spindle cell oncocytoma (SCO) of the pituitary gland is an extremely rare non-functional WHO grade 1 tumor. SCO are often misdiagnosed as nonfunctional pituitary adenomas on pre-operative imaging. They are often hypervascular and locally adherent, which increases hemorrhage risk and limits surgical resection, leading to increased risk of recurrence. We report a case of SCO treated at our institution and provide a review of the current literature. METHODS A 75-year-old male with a history of hypertension, left thalamic stroke, Parkinson’s disease, and normal pressure hypertension presented to neurosurgery clinic with bitemporal hemianopsia, hyponatremia, and abnormal gait and mobility. Imaging showed an enhancing intra- and suprasellar, hyperdense tumor mass measuring 3.0 cm in diameter. We performed a systemic literature search in the PubMed database to identify previous reports of spindle cell oncocytoma. After exclusion of studies that did not meet criteria, 32 publications were selected for critical reading. RESULTS The patient underwent an endoscopic transsphenoidal resection of the tumor via a multi-disciplinary team. The tumor was fibrous and adherent to the intrasellar dura, with gross invasion of the diaphragm sella, necessitating partial resection of the diaphragm. The defect was repaired, and the patient made an uncomplicated recovery. Post-operatively, the patient experienced improved vision. Upon literature review, SCO present in older adults with an average age of 56.2 ± 14.7 with visual deficits (67.9%), headache (33.3%), hypopituitarism (24.7%), and nausea (11.1%). Full resection was achieved in 38.6% of cases leading to recurrence rate of 23.5% with an average time until recurrence of 32.5 months (range 1-120 months). CONCLUSION Careful surgical technique is needed due to SCO hypervascularity and strong adherence to minimize risk of injury to surrounding neurovascular structures. Long-term follow up is recommended due risk of recurrence.

Poor prognosis associated with TERT gene alterations in meningioma is independent of the WHO classification: an individual patient data meta-analysis

2020 ◽  
Vol 91 (4) ◽  
pp. 378-387 ◽  
Author(s):  
Christian Mirian ◽  
Anne Katrine Duun-Henriksen ◽  
Tareq Juratli ◽  
Felix Sahm ◽  
Sabine Spiegl-Kreinecker ◽  
...  
Keyword(s):  
Who Classification ◽  
Meta Analysis ◽  
Incidence Rates ◽  
Who Grade ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
Individual Participant ◽  
Registration Number ◽  
Meta Analyses ◽  
Gene Alterations

BackgroundTERT gene alterations (TERT-alt) have been linked to increased risk of recurrence in meningiomas, whereas the association to mortality largely remain incompletely investigated. As incongruence between clinical course and WHO grade exists, reliable biomarkers have been sought.MethodsWe applied the Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data Statement. We compiled data from eight studies and allocated patients to TERT-alt (n=59) or TERT promoter wild-type (TERTp-wt; n=618). We compared the two groups stratified for WHO grades as: incidence rates, survival probabilities and cumulative recurrences. We estimated the effects of WHO grade, age at diagnosis and sex as HRs.ResultsTERT-alt occurred in 4.7%, 7.9% and 15.4% of WHO-I/WHO-II/WHO-III meningiomas, respectively. The median recurrence-free survival was 14 months for all TERT-alt patients versus 101 months for all TERTp-wt patients. The HR for TERT-alt was 3.74 in reference to TERTp-wt. For all TERT-alt patients versus all TERTp-wt patients, the median overall survival was 58 months and 160 months, respectively. The HR for TERT-alt was 2.77 compared with TERTp-wt. TERT-alt affected prognosis independent of WHO grades. Particularly, the recurrence rate was 4.8 times higher in WHO-I/-II TERT-alt patients compared with WHO-III TERTp-wt patients. The mortality rate was 2.7 times higher in the WHO-I and WHO-II TERT-alt patients compared with WHO-III TERTp-wt patients.ConclusionsTERT-alt is an important biomarker for significantly higher risk of recurrence and death in meningiomas. TERT-alt should be managed and surveilled aggressively. We propose that TERT-alt analysis should be implemented as a routine diagnostic test in meningioma and integrated into the WHO classification.Trial registration numberPROSPERO: CRD42018110566.

scholarly journals Use of metoclopramide associated with the risk of developing extrapyramidal symptoms: a literature review

2021 ◽  
Author(s):  
Daniela Videira Botton ◽  
Daisi Sanches Moraes ◽  
Rafaela Tavares Mendes ◽  
Letícia Pereira Mourão ◽  
Wilson Roberto Malfará
Keyword(s):  
Literature Review ◽  
Adverse Effects ◽  
Dopamine D2 Receptor ◽  
D2 Receptor ◽  
Positive Association ◽  
The Elderly ◽  
Extrapyramidal Symptoms ◽  
High Exposure ◽  
Pubmed Database ◽  
Increased Risk

Background: Parkinsonism is an extrapyramidal syndrome characterized by the presence of tremor, akinesia and stiffness. Metoclopramide is a substance with antiemetic properties, and the mechanism of action is an antagonism of the dopamine D2 receptor. Thus, it presents adverse effects, such as dyskinesia, dystonia, hypertonia and tremor. Accordingly, studies associate the use of metoclopramide with an increased risk of developing extrapyramidal effects. Objectives: The aimed is describe the association between the use of metoclopramide and the risk of developing extrapyramidal symptoms. Methods: A literature review was carried out based on articles from the PubMed database, totaling 10 articles. The keywords used for the selection of articles were: metoclopramide, extrapyramidal and parkinsonism. Results: A case study noted that the use of metoclopramide leads to a dopamine deficiency, which may be involved in the etiology of parkinsonism, as a patient already diagnosed with Parkinson’s disease developed an exacerbation after using metoclopramide. Another study showed that the use of metoclopramide in the elderly population was considered a risk factor for adverse effects such as involuntary movements. A cohort study described a positive association between the use of oral metoclopramide and an increased risk of developing parkinsonism, considered as an important side effect in high-exposure, older users and with other morbidities. Conclusions: Therefore, it was evident that an association between metoclopramide and the development of extrapyramidal symptoms is strongly indicated by the studies analyzed, which suggests caution in the prescription of this pharmacological class.

scholarly journals H3K27me3 loss indicates an increased risk of recurrence in the Tübingen meningioma cohort

2020 ◽  
Author(s):  
Felix Behling ◽  
Christina Fodi ◽  
Irina Gepfner-Tuma ◽  
Kristina Kaltenbach ◽  
Mirjam Renovanz ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Utility ◽  
Univariate Analysis ◽  
University Hospital ◽  
Rank Test ◽  
Subtotal Resection ◽  
Who Grade ◽  
Risk Of Recurrence ◽  
Increased Risk

Abstract Background A loss of the trimethylation of lysine 27 of histone H3 (H3K27me3) in meningioma has been recently suggested as an adjunct to identify subsets of higher risk of recurrence. The aim of the present study was to assess the prognostic value of H3K27 histone trimethylation and its potential clinical utility in the “Tübingen meningioma cohort”. Methods Patients who underwent meningioma resection between 10/2003 and 1/22015 at the University Hospital Tübingen were included. Immunohistochemical stainings for H3K27me3 and the proliferation marker MIB1 were assessed and correlated with clinical parameters using univariate and multivariate cox regressions as well as Pearson’s chi-squared and log-rank test. Results Overall, 1268 meningiomas were analyzed with a female to male ratio of 2.6 and a mean age of 58.7 years (range 8.3 – 91.0). With 163 cases lost to follow up, 1103 cases were available for further analysis with a mean follow-up of 40.3 months (range 1.1 – 186.3). Male gender, younger age, intracranial tumor localization, progressive tumor, subtotal resection, higher WHO grade, increased MIB1 rate and loss of H3K27me3 were significant negative prognostic factors in the univariate analysis. H3K27me3 status and all other prognostic factors, except age and tumor location, remained significant in the multivariate model. Furthermore, adjuvant radiotherapy was an independent positive prognostic factor. Conclusions Loss of H3K27me3 combined with MIB1 labeling index are independent prognostic factors in meningioma. These data from the Tübingen meningioma cohort support the clinical utility of H3K27me3 immunohistochemical staining in meningioma and its integration into the routine histopathological workup.

scholarly journals Value of Ki-67 Labeling Index in Predicting Recurrence of WHO Grade I Cranial Base Meningiomas

2018 ◽  
Vol 80 (03) ◽  
pp. 287-294 ◽  
Author(s):  
Jose Gabrielle Matias ◽  
Ignacio Jusue-Torres ◽  
Brendan Martin ◽  
Ankush Bajaj ◽  
Ewa Borys ◽  
...  
Keyword(s):  
Survival Rates ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Cranial Base ◽  
Labeling Index ◽  
Ki 67 ◽  
Who Grade ◽  
Risk Of Recurrence ◽  
Time To Recurrence ◽  
Increased Risk

Objectives Assess impact of Ki-67 labeling index (LI; Ki-67 LI) on risk of recurrence or progression of WHO grade I meningiomas. Study Design Retrospective study of adult patients who underwent resection of cranial base meningioma between 2004 and 2016. Results 272 patients fulfilled criteria for inclusion in the study. Average age was 61.8 years; 196 (72%) were females. Simpson's grade 1 resection was noted in 77 patients (32%), grade 2 in 39 (16%), grade 3 in 36 (15%), and grade 4 in 88 (37%). The Ki-67 LI was low (1–4%) in 214 (78.7%), intermediate (5–9%) in 44 (16.2%), and high (>10%) in 14 (5.2%). Median follow-up was 39 months (IQR: 16–71 months); 221 (87.1%) tumors remained stable or did not recur, 19 (7.4%) recurred, and 14 (5.5%) progressed. Compared with tumors with low Ki-67 LI, those with intermediate Ki-67 LI had 2.47 times (2.47 [1.09–5.59], p = 0.03), and those with high Ki-67 LI had 3.38 times (3.38 [1.16–9.89], p = 0.03) higher risk of recurrence or progression. Tumors with Ki-67 LI > 4% had a shorter time to recurrence or progression (p = 0.01). Recurrence or progression-free survival rates at 3, 5, and 10 years for tumors with low Ki-67 LI were 95%, 89%, and 75%, respectively; tumors with intermediate Ki-67 LI, 87%, 69%, and 52%, respectively; tumors with high Ki-67 LI, 78%, 49%, and 49%, respectively. Conclusions Following surgical resection of a WHO grade I cranial base meningioma, Ki-67 LI > 4% may predict an increased risk of recurrence or progression of residual tumor.

scholarly journals Pituitary spindle cell oncocytoma: illustrative case

2021 ◽  
Vol 2 (14) ◽  
Author(s):  
Taha M. Taka ◽  
Chen Yi Yang ◽  
Joshua N. Limbo ◽  
Alvin Y. Chan ◽  
Jordan Davies ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Spindle Cell ◽  
Pituitary Tumors ◽  
World Health ◽  
Preoperative Imaging ◽  
Illustrative Case ◽  
Structure Damage ◽  
Secondary Hypothyroidism ◽  
Increased Risk ◽  
Spindle Cell Oncocytoma

BACKGROUND Spindle cell oncocytoma (SCO) of the pituitary gland is an extremely rare nonfunctional World Health Organization grade I tumor. SCOs are often misdiagnosed as nonfunctional pituitary adenomas on the basis of preoperative imaging. They are often hypervascular and locally adherent, which increases hemorrhage risk and limits resection, leading to increased risk of recurrence. The authors report a case of SCO treated at their institution and provide a review of the current literature. OBSERVATIONS SCO of the pituitary gland can be a rare cause of progressively growing pituitary tumors that presents similarly to nonfunctional pituitary adenoma. Endoscopic transsphenoidal resection of the tumor by a multidisciplinary team allowed total resection despite local adherence of the tumor. Postoperatively, the patient’s visual symptoms improved with persistence of secondary adrenal insufficiency and secondary hypothyroidism. LESSONS Careful resection is needed due to SCO’s characteristic hypervascularity and strong adherence to minimize local structure damage. Long-term follow-up is recommended due to the tendency for recurrence.

scholarly journals Spindle cell oncocytoma, a misdiagnosed rare entity of the pituitary – A case report with review of literature and special emphasis on the morphological differentials

2021 ◽  
Vol 8 (4) ◽  
pp. 533-537
Author(s):  
Gittwa Vatsaraj Kottangal ◽  
Lilly Madhavan ◽  
Shalini Kuruvilla ◽  
Kavitha Kanjirakadu Parameswaran ◽  
Shehla Basheer Kollathodi
Keyword(s):  
Spindle Cell ◽  
Adult Population ◽  
Rare Entity ◽  
Review Of Literature ◽  
Who Grade ◽  
Suprasellar Region ◽  
Spindle Cell Oncocytoma ◽  
Older Adult Population ◽  
Temporal Field

Spindle cell oncocytoma (SCO) of the pituitary is a rare tumor of the adenohypophysis occurring in the sellar/suprasellar region. This tumor has been recognized as a distinct entity by the  WHO Classification of CNS tumor in 2007. Spindle cell oncocytoma of the pituitary gland accounts for 0.1–0.4% of all sellar region tumors and is predominantly seen in the older adult population. This rare entity simulates clinical and radiological features of pituitary adenoma and is often misdiagnosed. Though WHO grade 1, the tumor can recur and have invasive properties. Herein, we report a 61-year-old woman with panhypopituitarism and temporal field cut, clinically and radiologically diagnosed as pituitary macroadenoma, while the histomorphological and immunohistochemistry features helped in arriving at a diagnosis of Spindle Cell Oncocytoma. The clinicopathological, histomorphological, immunohistochemical, and molecular properties of the tumor are further discussed.

Multiple recurrences of spindle cell oncocytoma: A case report and literature review

2020 ◽  
Vol 39 (01) ◽  
pp. 32-39
Author(s):  
Jonathan Chainey ◽  
Vivien Ka-Ying Chan ◽  
Karolyn Au ◽  
Sumit Das
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Spindle Cell ◽  
Spindle Cell Oncocytoma ◽  
Multiple Recurrences

Thrombophilia and risk of VTE recurrence according to the age at the time of first VTE manifestation

VASA ◽  
2015 ◽  
Vol 44 (4) ◽  
pp. 313-323 ◽  
Author(s):  
Lea Weingarz ◽  
Marc Schindewolf ◽  
Jan Schwonberg ◽  
Carola Hecking ◽  
Zsuzsanna Wolf ◽  
...  
Keyword(s):  
Factor V Leiden ◽  
Cox Proportional Hazards ◽  
First Episode ◽  
Factor V ◽  
Factor V Leiden Mutation ◽  
Younger Patients ◽  
Risk Of Recurrence ◽  
G20210a Mutation ◽  
Increased Risk ◽  
The Impact

Abstract. Background: Whether screening for thrombophilia is useful for patients after a first episode of venous thromboembolism (VTE) is a controversial issue. However, the impact of thrombophilia on the risk of recurrence may vary depending on the patient’s age at the time of the first VTE. Patients and methods: Of 1221 VTE patients (42 % males) registered in the MAISTHRO (MAin-ISar-THROmbosis) registry, 261 experienced VTE recurrence during a 5-year follow-up after the discontinuation of anticoagulant therapy. Results: Thrombophilia was more common among patients with VTE recurrence than those without (58.6 % vs. 50.3 %; p = 0.017). Stratifying patients by the age at the time of their initial VTE, Cox proportional hazards analyses adjusted for age, sex and the presence or absence of established risk factors revealed a heterozygous prothrombin (PT) G20210A mutation (hazard ratio (HR) 2.65; 95 %-confidence interval (CI) 1.71 - 4.12; p < 0.001), homozygosity/double heterozygosity for the factor V Leiden and/or PT mutation (HR 2.35; 95 %-CI 1.09 - 5.07, p = 0.030), and an antithrombin deficiency (HR 2.12; 95 %-CI 1.12 - 4.10; p = 0.021) to predict recurrent VTE in patients aged 40 years or older, whereas lupus anticoagulants (HR 3.05; 95%-CI 1.40 - 6.66; p = 0.005) increased the risk of recurrence in younger patients. Subgroup analyses revealed an increased risk of recurrence for a heterozygous factor V Leiden mutation only in young females without hormonal treatment whereas the predictive value of a heterozygous PT mutation was restricted to males over the age of 40 years. Conclusions: Our data do not support a preference of younger patients for thrombophilia testing after a first venous thromboembolic event.

Sign in / Sign up

Export Citation Format

Share Document