Variability and Lack of Prognostic Value Associated With Atypical Pituitary Adenoma Diagnosis: A Systematic Review and Critical Assessment of the Diagnostic Criteria

Neurosurgery ◽  
2017 ◽  
Vol 83 (4) ◽  
pp. 602-610 ◽  
Author(s):  
Kelsi Chesney ◽  
Zoe Memel ◽  
Dhiraj J Pangal ◽  
Daniel Donoho ◽  
Kyle Hurth ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pituitary Adenomas ◽  
Pituitary Tumors ◽  
World Health ◽  
Resonance Imaging ◽  
Prognostic Utility ◽  
Atypical Pituitary Adenoma ◽  
Health Organization

Abstract BACKGROUND Atypical pituitary adenomas (APAs) are a subset of pituitary adenomas (PAs) characterized by the 2004 World Health Organization (WHO) guidelines to have higher risk histopathological features than typical PAs. In July 2017, the WHO published an update to their classification of pituitary tumors and abandoned the APA terminology. OBJECTIVE To assess the prevalence and outcomes of patients diagnosed with APA through a literature review. Focus was placed on variation in the application of the previous WHO criteria and on rates of recurrence. METHODS A systematic review of PubMed (2004-July 2017) was performed to identify studies reporting prevalence and clinical characteristics/outcomes of APA. Eight studies were analyzed for prevalence. Six studies reporting histopathological details were analyzed in depth. RESULTS Of the 7105 included patients, 373 (5.2%) met criteria for APA (prevalence range: 3%-15%). Only 2 of 8 studies utilized identical grading criteria, demonstrating a lack of standardized application. Most APAs (84%) were macroadenomas, with 52% invasive on magnetic resonance imaging. Nonfunctional PAs were most common (37%), followed by prolactinomas (23%) and Growth Hormone adenomas (21%). Recurrence/progression occurred in 21% of APA patients (follow-up range 37-75 mo). Only 2 of 8 studies reported an association between APA diagnosis and recurrence/progression. CONCLUSION Based on diagnostic variability and lack of association with clinical outcomes, refinement of criteria for APA was necessary. The WHO update eliminates the ambiguity in APA diagnosis in favor of criteria that emphasize clinical behavior (invasion, recurrence, and resistance to treatment) and molecular markers. Our review supports abandonment of the previous APA designation due to limited prognostic utility.

scholarly journals Giant Cell Urothelial Carcinoma of Bladder

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Harshima Disvini Wijesinghe ◽  
Ajith Malalasekera
Keyword(s):  
Urothelial Carcinoma ◽  
Giant Cell ◽  
Early Stage ◽  
Giant Cells ◽  
World Health ◽  
World Health Organization Classification ◽  
Health Organization

Giant cell urothelial carcinoma is a rare variant of bladder cancer recognized by the current World Health Organization classification of urologic tumours. It is an aggressive tumour with a poor prognosis that usually presents at an advanced stage. It is characterized histologically by pleomorphic giant cells. We discuss a case of giant cell urothelial carcinoma presenting at an early stage in a previously well 62-year-old woman. Histology showed a tumour comprising pancytokeratin positive bizarre mononuclear and multi-nuclear giant cells admixed with areas of conventional urothelial carcinoma and carcinoma in situ. Three-month follow-up cystoscopy and magnetic resonance imaging showed no evidence of recurrence or pelvic lymphadenopathy.

scholarly journals The effectiveness of aspirin for migraine prophylaxis: a systematic review

2017 ◽  
Vol 135 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Cristina Pellegrino Baena ◽  
Raíssa Campos D’Amico ◽  
Helena Slongo ◽  
André Russowsky Brunoni ◽  
Alessandra Carvalho Goulart ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Population ◽  
Combined Treatment ◽  
Risk Of Bias ◽  
World Health ◽  
Optimal Dosage ◽  
Health Organization ◽  
The University

ABSTRACT CONTEXT AND OBJECTIVE: Many researchers have suggested that aspirin prevents migraines. However, the evidence is unclear. The aim of this study was to analyze the available evidence on the effect of aspirin as a migraine prophylactic. DESIGN AND SETTING: Systematic review, conducted at the Pontifícia Universidade Católica do Paraná, Brazil, and at the University of São Paulo, Brazil. METHODS: We performed electronic searches in the databases of MEDLINE/PubMed, Embase, WEB OF SCIENCE, the World Health Organization, CENTRAL and OpenGrey, and we also searched manually for interventional studies published before April 2016 that compared the effects of aspirin with a control, in adults. Two authors independently extracted data on the publication, population recruited, intervention (aspirin dosage, follow-up and combined treatment) and main outcomes (frequency, severity and duration of migraine). We evaluated the quality of the studies using the Cochrane risk-of-bias tool. RESULTS: Our search retrieved 1,098 references, of which 8 met the selection criteria for this systematic review. The total population was 28,326 participants (18-64 years old); most (96%) were men. The dosage varied from 50 to 650 mg/day across the studies. The risk of bias was generally low or unclear. The only outcome for which most of the studies included (6/8) reported a significant reduction was frequency of migraine, which was reduced at an aspirin dosage of at least 325 mg/day. CONCLUSION: Aspirin can reduce the frequency of migraines. However, the optimal dosage is unclear.

scholarly journals Unclassifiable Isolated Monoclonal Lymphocytosis: Comprehensive Description of a Retrospective Cohort

Cancers ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 1495
Author(s):  
Degaud ◽  
Baseggio ◽  
Grange ◽  
Manzoni ◽  
Huet ◽  
...  
Keyword(s):  
Who Classification ◽  
High Throughput Sequencing ◽  
Variable Region ◽  
Lymphocytic Leukemia ◽  
World Health ◽  
Trisomy 12 ◽  
Royal Marsden Hospital ◽  
Health Organization

According to the World Health Organization (WHO) classification, the nosology of B-cell neoplasms integrates clinical, morphological, phenotypic, and genetic data. In this retrospective analysis, we identified 18 patients with isolated neoplastic lymphocytosis that could not be accurately classified within the WHO classification. Most of them were asymptomatic at the time of diagnosis and the evolution was relatively indolent, as only five patients required treatment after a median follow-up of 48 months. The neoplastic B-cells expressed CD5 in most cases, but the Royal Marsden Hospital score was strictly below 3. Trisomy 12 was the most frequent cytogenetic abnormality. High-throughput sequencing highlighted mutations found in both chronic lymphocytic leukemia (CLL) and marginal zone lymphoma (MZL). Similarly, the immunoglobulin heavy chain variable region repertoire was distinct from those reported in CLL or MZL. However, as treatment choice is dependent on the correct classification of the lymphoproliferative disorder, a histological diagnosis should be performed in case patients need to be treated.

Odontogenic Carcinoma With Dentinoid in Long-Term Follow-up With 2 Recurrences

2019 ◽  
Vol 28 (2) ◽  
pp. 181-187 ◽  
Author(s):  
Fernanda Viviane Mariano ◽  
Rogério Oliveira Gondak ◽  
João Figueira Scarini ◽  
Eduardo Caetano Albino da Silva ◽  
Gisele Caravina ◽  
...  
Keyword(s):  
World Health Organization ◽  
World Health ◽  
Odontogenic Tumors ◽  
Ossifying Fibroma ◽  
Histological Classification ◽  
Cytological Evidence ◽  
Odontogenic Carcinoma ◽  
Health Organization

Dentinoid has been mentioned as a frequent component in several types of benign odontogenic tumors; however, there are some other very rare dentinoid-producing odontogenic tumors that have been described, which are not recognized in the current World Health Organization Histological Classification of Odontogenic Tumours. In this context, we report an unusual malignant odontogenic tumor containing dentinoid located in the left maxilla of a 41-year-old man. The lesion was initially diagnosed and treated as a cemento-ossifying fibroma. After 7 years, a tumor was noted at the same location and was diagnosed as pleomorphic adenoma. The patient developed a new lesion 2 years later. Histological features included an epithelial proliferation of basaloid and clear cells, some with peripheral palisading, which were scattered both in a fibrous stroma and within an amorphous eosinophilic dentinoid product. Because of doubts about the first 2 diagnoses and the current situation, all histopathological slides were reviewed in our service as a consultation case, and the findings were consistent with the diagnosis of an odontogenic carcinoma with dentinoid. Immunohistochemical analysis was performed and an ultrastructural study by scanning electronic microscopy and energy-dispersive X-ray microanalysis was made to characterize dentinoid material. After 1 year of follow-up, the patient is alive and free of the disease. This case highlights the wide variability regarding cytological evidence of malignancy, and adds a new case of odontogenic carcinoma with dentinoid, which represents a distinct entity with locally aggressive behavior and should be considered be included in a future World Health Organization Histological Classification of Tumours.

USE OF TEMOZOLOMIDE IN AGGRESSIVE PITUITARY TUMORS

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. E773-E774 ◽  
Author(s):  
Safraz Mohammed ◽  
Kalman Kovacs ◽  
Warren Mason ◽  
Harley Smyth ◽  
Michael D. Cusimano
Keyword(s):  
Pituitary Adenomas ◽  
Clinical Presentation ◽  
Pituitary Tumors ◽  
Clinical State ◽  
Resonance Imaging ◽  
First Line ◽  
Cell Variant ◽  
Potential Use ◽  
Pituitary Macroadenomas

Abstract OBJECTIVE The management of aggressive pituitary macroadenomas represents a challenge to neurosurgeons. These tumors are very difficult to treat, owing mainly to their invasive nature, thus resulting in incomplete resections and propensity for recurrence. Multiple surgical procedures (transsphenoidal, transcranial, or a combination of both) are the first line management, followed by radiotherapy and chemotherapy. CLINICAL PRESENTATION Three cases of patients with pituitary adenomas who underwent temozolomide treatment are presented. The first 2 patients had corticotroph macroadenoma of the Crooke's cell variant. Deterioration occurred in both cases despite multiple surgeries and adjuvant therapy. The third patient had a glioblastoma multiforme with an incidental pituitary tumor. INTERVENTION All 3 patients had temozolomide administered orally on the first 5 days of a 28-day cycle for 12 cycles. Magnetic resonance imaging, endocrinological, and clinical follow-up were performed at monthly intervals. CONCLUSION The marked improvement in clinical state of the first 2 patients accompanied by radiological evidence of tumor shrinkage in all patients demonstrates the potential use of temozolomide in treating aggressive pituitary macroadenomas. The usefulness of temozolomide in aggressive pituitary adenomas should be studied in larger trials.

scholarly journals Queratocisto odontogênico: uma abordagem cirúrgica

2020 ◽  
Vol 8 (11) ◽  
Author(s):  
Francielly Thomas Figueiredo ◽  
Alana Oswaldina Gavioli Meira Dos Santos ◽  
Julio Cesar Leite Da Silva ◽  
José Carlos Garcia De Mendonça ◽  
Gustavo Silva Pelissaro ◽  
...  
Keyword(s):  
Head And Neck ◽  
Odontogenic Tumor ◽  
World Health ◽  
Odontogenic Cysts ◽  
Keratocystic Odontogenic Tumor ◽  
Head And Neck Tumours ◽  
Keratocystic Odontogenic Tumour ◽  
Health Organization

O queratocisto odontogênico é uma neoplasia benigna onde lesões únicas ou múltiplas são encontradas em ossos ou cavidades. O objetivo deste trabalho é relatar um caso clínico de uma lesão de queratocisto odontogênico, evidenciando corretos diagnóstico e terapêutica. O relato de caso trata-se de um paciente de 32 anos, sexo feminino, melanoderma, que deu entrada à faculdade de odontologia da Universidade Federal de Mato Grosso do Sul, no ano de 2017, apresentando lesão radiolúcida com halo esclerótico em região de ângulo de mandíbula do lado esquerdo, sem envolvimento de dentes e/ou raízes adjacentes. Foi realizada uma tomografia computadorizada, constando hipótese diagnóstica radiográfica da mencionada patologia. O plano de tratamento adotado preconizou uma intervenção conservadora de descompressão e acompanhamento pós-operatório. A paciente se encontra em pós-operatório de 19 meses cirúrgico sem queixas álgicas e/ou funcionais.Descritores: Cistos Ósseos; Descompressão; Terapêutica.ReferênciasShuster A, Shlomi B, Reiser V, Kaplan I. Solid keratocystic odontogenic tumor report of a non agressive case. J Oral Maxillofac Surg. 2012;70(4):865-70.Tsukamoto G, Sasaki A, Akiyama T, Ishikawa T, Kishimoto K, Nishiyama A, et al. A radiologic analysis of dentigerous cysts and odontogenic keratocysts associated with a mandibular third molar. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91(6):743-47.Chan JKC, El-Naggar AK, Grandis JR, Takata T, Slootweg PJ. Who classification of head and neck tumours. World Health Organization 2017, 4th edition.Wright JM, Vered M. Update from the 4th edition of the world health organization classification of head and neck tumours: odontogenic and maxillofacial bone tumors. Head Neck Pathology. 2017; 11(1): 68-77.Gil JN, Rau Lh, Manfro R, Gasperini G, Dunker C, Chiarelli M. Ceratocisto odontogênico - caso clínico. Rev Port Estomatol Med Dent Cir Maxilofac. 2003;44(3):59-69.Regezi JÁ, Sciubba JJ. Patologia bucal: correlações clinicopatológicas. 3. ed. Rio de Janeiro: Guanabara Koogan; 2000.Larsen PE. Marsupialization for odontogenic keratocysts: Long-term follow-up analysis of the effects and changes in growth characteristics. 2002;94(5):543-53.Gambhir A, Rani G. Conservative management of keratocystic odontogenic tumour with enucleation, excision of the overlying mucosa and electrocauterization: a case report. West Indian Med J. 2014;63(7):775-78.Núñez-Urrutia S, Figueiredo R, Gay-Escoda C. Retrospective clinicopathological study of 418 odontogenic cysts. Med Oral Patol Oral Cir Bucal. 2010;15(5):e767-73.González-Alva P, Tanaka A, Oku Y, Yoshizawa D, Itoh S, Sakashita H, et al. Keratocystic odontogenic tumor: a retrospective study of 183 cases. J Oral Sci. 2008; 50(2):205-12.Jones AV, Craig GT, Franklin CD. Range and demographics of odontogenic cysts diagnosed in a UK population over a 30-year period. J Oral Pathol Med. 2006;35(8):500-7.Zhao YF, Wei JX, Wang SP. Treatment of odontogenic Keratocysts: a follow-up of 255 Chinese patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endodo. 2002;94(2):151-56 .Meara JG, Shah S, Li KK, Cunningham MJ. The odontogenic keratocyst: a 20-year clinicophatologic review. Laryngoscope. 1998;108(2):280-83Kulkarni GH, Khaji SI, Metkari S, Kulkarni HS, Kulkarni R. Multiple keratocysts of the mandible in association with Gorlin-Goltz syndrome: A rare case report. Contemp Clin Dent. 2014;5(3):419-21.Speight PM, Takata T. New tumour entities in the 4th edition of the world health organization classification of head and neck tumours: odontogenic and maxillofacial bone tumours. Virchows Arch. 2018;472(3):331-39.Wright JM. The odontogenic keratocyst: orthokeratinized variant. Oral Surg. 1981;51(1):609-18.Hupp JR, Ellis III E, Tucker MR. Cirurgia oral e maxillofacial contemporânea. 5. ed. Rio de Janeiro: Elsevier; 2009.Dammer R, Niederdellmann H, Dammer P, Nuebler-Moritz M. Conservative or radical tretment of keratocysts: a retrospective review. Br J Oral Maxillofac Surg. 1997;35(1):46-8.Browne RM. The pathogeneses of odontogenic cysts: a review. J Oral Pathol. 1975;4(1):31-46.de Molon RS, Verzola MH, Pires LC, Mascarenhas VI, da Silva RB, Cirelli JA et al. Five years follow-up of a keratocyst odontogenic tumor treated by marsupialization and enucleation: A case report and literature review. Contemp Clin Dent. 2015;6(Suppl 1):S106-10.Neville BW, Damm DD, Allen CM, Bouquot JE. Patologia oral e maxilofacial. 3.ed. Rio de Janeiro: Elsevier; 2009.de Souza LB, Gordón-Núñez MAG, Nonaka CFW, de Medeiros MC, Torres TF, Emiliano GBG. Odontogenic cysts: Demographic profile in a Brazilian population over a 38-year period. Med Oral Patol Oral Cir Bucal. 2010;15(4):e583-90.EL-Gehani R, Orafi M, Elarbi M, Subhashraj K: Benign tumours of orofacial region at Benghazi, Libya: a study of 405 cases. J Craniomaxillofac Surg 2009;37(7):370-75.Moura BS, Cavalcante MA, Hespanhol W. Tumor odontogênico ceratocístico.  Keratocystic odontogenic tumor. Rev Col Bras Cir. 2016;43(6):466-71.Kaczmarzyk T, Mojsa I, Stypulkowska J. A systematic review of the recurrence rate for keratocystic odontogenic tumour in relation to treatment modalities. Int J Oral Maxillofac Surg. 2012;41(6):756-67.Lima GM, Nogueira RLM, Rabenhorst SHB. Considerações atuais sobre o comportamento biológico dos queratocistos odontogênicos. Rev Cir Traumatol Buco-Maxilo-fac. 2006;6(2):9-16.Madras J, Lapointe H. Keratocystic odontogenic tumour: reclassification of the odontogenic keratocyst from cyst to tumour. J Canad Dent Assoc. 2008; 74(2):165-165h.

scholarly journals How Valuable Is the RT-qPCR of Pituitary-Specific Transcription Factors for Identifying Pituitary Neuroendocrine Tumor Subtypes According to the New WHO 2017 Criteria?

Cancers ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 1990 ◽  
Author(s):  
María Eugenia Torregrosa-Quesada ◽  
Araceli García-Martínez ◽  
Sandra Silva-Ortega ◽  
Sebastián Martínez-López ◽  
Rosa Cámara ◽  
...  
Keyword(s):  
Transcription Factors ◽  
Pituitary Tumors ◽  
World Health ◽  
Null Cell ◽  
Tumor Subtypes ◽  
Esr1 Gene ◽  
Gene And Protein Expression ◽  
Health Organization ◽  
Immunohistochemical Studies

The classification of pituitary neuroendocrine tumors (PitNETs) subtypes continues generating interest. In 2017, the World Health Organization (WHO) proposed considering the immunohistochemical (IHC) analysis of pituitary-specific transcription factors (TF) for their typification. The present study targeted the quantification of pituitary-specific TF (TPIT, PIT-1, SF-1, GATA2, ESR1) gene expression by RT-qPCR to overcome the shortcomings of IHC and to complement it. We analyzed 251 tumors from our collection of PitNETs and performed additional IHC studies in a subset of 56 samples to analyze the concordance between gene and protein expression of the TF. The molecular and IHC studies allowed us to significantly reduce the percentage of null cell tumors in our series, most of which were reclassified as gonadotroph tumors. The concordance between the molecular and the immunohistochemical studies was good for tumors coming from the corticotroph and Pit-1 lineages but worsened for the rest of the tumors. Indeed, the RT-qPCR helped to improve the typification of plurihormonal Pit-1 and unusual tumors. Overall, our results suggest that the RT-qPCR of pituitary-specific TF and hormone genes could help pathologists, endocrinologists, and neurosurgeons to improve the management of patients with pituitary tumors.

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