scholarly journals Clinicopathologic Factors Related to Post-Operative Outcome of Pituitary Adenoma: a Meta-Analysis

2021 ◽  
Author(s):  
Tri Juli Edi Tarigan ◽  
Hasan Ali Alhabsyi ◽  
Juferdy Kurniawan
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Meta Analysis ◽  
Mitotic Rate ◽  
Ki 67 ◽  
Independent Variables ◽  
Operative Outcome ◽  
Clinicopathologic Factors ◽  
Size Type

Abstract Purpose: About 30% to 40% of patients with pituitary adenoma require surgery. About 25% to 40% of those who have had surgery will have an aggressive outcome. The purpose of this study was to see if certain clinicopathologic factors such as size, type/subtype, invasiveness, proliferative (ki-67, mitotic rate, and p53), and grade influenced the aggressiveness of postoperative pituitary adenomas. Methods: The factors mentioned in the research objectives were examined as independent variables. Ten studies out of 736 were chosen. The 10 studies had 2727 participants and 632 cases. The monitoring lasted 3-11 years. The studies' quality ranged from fair to excellent. Results: The results of the meta-analysis were: size ≥10mm OR 1,79 (1,29-2,48), corticotroph OR 1,91 (1,41-2,58), invasive OR 3,67 (1,95-6,90), proliferative OR 4,78(3,61-6,32), Ki-67 ≥ 3% OR 4,13 (2,94-5,81), mitotic rate > 2 OR 3,91 (2,74-5,57), p53 positive OR 1,92 (1,28-2,90), and grade 2b OR 4,56 (3,0-6,91). Conclusions: Size, type/subtype, invasiveness, proliferative (ki-67, mitotic rate, and p53), and grade of postoperative pituitary adenoma influenced the postoperative aggressiveness outcome.

Ki-67/MIB-1 and Recurrence in Pituitary Adenoma

2021 ◽  
Author(s):  
Kent Tadokoro ◽  
Colten Wolf ◽  
Joseph Toth ◽  
Cara Joyce ◽  
Meharvan Singh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pituitary Adenoma ◽  
Recurrence Rate ◽  
Pituitary Adenomas ◽  
Cellular Proliferation ◽  
Published Data ◽  
Ki 67 ◽  
Institutional Data ◽  
Mib 1

Abstract Objectives Ki-67/MIB-1 is a marker of cellular proliferation used as a pathological parameter in the clinical assessment of pituitary adenomas, where its expression has shown utility in predicting the invasiveness of these tumors. However, studies have shown variable results when using Ki-67/MIB-1 association with recurrence. The purpose of this study is to determine if a high Ki-67/MIB-1 labeling index (LI) is predictive of recurrence in pituitary adenomas. Methods A retrospective chart review was performed for patients undergoing pituitary adenoma resection with at least 1 year of follow-up. Additionally, systematic data searches were performed and included studies that correlated recurrence rate to Ki-67/MIB-1 LI. Our institutional data were included in a synthesis with previously published data. Results Our institutional review included 79 patients with a recurrence rate of 26.6%. We found that 8.8% of our patients had a high Ki-67/MIB-1 LI (>3%); however, high Ki-67/MIB-1 was not associated with recurrence. The systematic review identified 244 articles and 49 full-text articles that were assessed for eligibility. Quantitative analysis was performed on 30 articles including our institutional data and 18 studies reported recurrence by level of Ki-67/MIB-1 LI. Among studies that compared Ki-67/MIB-1 ≥3 vs. <3%, 10 studies reported odds ratios (OR) greater than 1 of which 6 were statistically significant. A high Ki-67/MIB-1 had higher odds of recurrence via the pooled odds ratio (OR = 4.15, 95% confidence interval [CI]: 2.31–7.42). Conclusion This systematic review suggests that a high Ki-67/MIB-1 should prompt an increased duration of follow-up due to the higher odds of recurrence of pituitary adenoma.

scholarly journals Association of Ki-67 Labelling Index and IL-17A with Pituitary Adenoma

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Brigita Glebauskiene ◽  
Rasa Liutkeviciene ◽  
Alvita Vilkeviciute ◽  
Inga Gudinaviciene ◽  
Aurelija Rocyte ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Immunohistochemical Analysis ◽  
Serum Levels ◽  
Labelling Index ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Ki 67 ◽  
Tissue Samples ◽  
Median Serum

The aim of the present study was to determine if the Ki-67 labelling index reflects invasiveness of pituitary adenoma and to evaluate IL-17A concentration in blood serum of pituitary adenoma patients. The study was conducted in the Hospital of Lithuanian University of Health Sciences. All pituitary adenomas were analysed based on magnetic resonance imaging findings. The suprasellar extension and sphenoid sinus invasion by pituitary adenoma were classified according to Hardy classification modified by Wilson. Knosp classification system was used to quantify the invasion of the cavernous sinus. The Ki-67 labelling index was obtained by immunohistochemical analysis with the monoclonal antibody, and serum levels of IL-17A were determined by enzyme-linked immunosorbent assay (ELISA). Sixty-nine PA tissue samples were investigated. Serum levels of IL–17A were determined in 60 patients with PA and 64 control subjects. Analysis revealed statistically significantly higher Ki-67 labelling index in invasive compared to noninvasive pituitary adenomas. Median serum IL-17A level was higher in the pituitary adenoma patients than in the control group. Conclusion. IL-17A might be a significant marker for patients with pituitary adenoma and Ki-67 labelling index in case of invasive pituitary adenomas.

Aggressive Cushing disease five years after the treatment of a nonfunctional pituitary adenoma

2016 ◽  
Vol 62 (5) ◽  
pp. 77-78
Author(s):  
Minodora Betivoiu ◽  
Sorina Martin ◽  
Iulia Soare ◽  
Alexandra Nila ◽  
Simona Fica
Keyword(s):  
Pituitary Adenoma ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Histopathological Examination ◽  
Case Reports ◽  
Dependent Diabetes Mellitus ◽  
Ki 67 ◽  
The Right ◽  
Gamma Knife Therapy

Introduction. Cushing's disease (CD) represents 10%–12% of all pituitary adenomas and is seen predominantly in women, with a female-to-male ratio of 8:1. Although most patients with ACTH-secreting adenomas present with benign, small tumors, some have invasive macroadenomas. Rarely, nonfunctional pituitary adenomas (NFPAs) may gain secretory function, but there have been a few case reports of metamorphosis to CD.Case report. We report the case of a 59-year-old female diagnosed in 2007 with a NFPA and panhypopituitarism. She had two transsphenoidal surgeries and Gamma Knife therapy and started replacement treatment with levothyroxine 75mcg/day and prednisone 5mg/day. The postoperative course was favorable and imagistic follow-up between 2007-2014 showed progressive reduction of the residual tumor and empty sella. From personal history we note noninsulin-dependent diabetes mellitus, postmenopausal osteoporosis treated with bisphosphonates. In January 2015 she suffered visual loss on the right eye. Pituitary MRI showed supra and parasellar tumor recurrence of 27/24/17mm, infiltrating the right side of the cavernous sinus, extending around the right internal carotid artery and optic nerve, compressing the optic chiasm. In March 2015 a third transsphenoidal partial excision of the tumor was performed and in August Gamma Knife therapy was repeated. The histopathological examination was consistent with a pituitary adenoma but immunohistochemical staining for ACTH was positive, with Ki-67=25%. She had no non-specific cushingoid features. Laboratory test: glucose=116mg/dl, HbA1c=7.5%, FSH=3.34mIU/ml, LH=0.585mIU/ml TSH=0.044mcIU/ml, FT4=1.13ng/dl. Prednisone replacement therapy was stopped and CD was confirmed: 8AMcortisol=13.3mcg/dl, 23PMcortisol=11.3mcg/dl, ACTH=70.2pg/ml, 8AMcortisol after 1mg dexamethasone overnight=13.8mcg/dl. Ophthalmic exam: blindness in the right eye, slightly decreased visual field in the left eye. Pituitary MRI 8-month postsurgery revealed a 28/31/28mm invasive tumor. We started treatment with Cabergoline 3mg/week and recommended closely biological and imagistic follow-up, hoping for a good response to radiotherapy.Conclusions: Our case stresses the importance of regular, lifelong follow-up of patients with NFPAs. Chiloiro et al have reported that pituitary adenomas with Ki-67≥1.5% have a higher risk of recurrence. Although the characteristics of patients with CD have been well known for decades, the diagnosis and management of this disease are often challenging.

scholarly journals How to deal pituitary Adenomas: A Retro prospective Study

2018 ◽  
Vol 2 (4) ◽  
pp. 01-02
Author(s):  
Kreiter Gomari
Keyword(s):  
Pituitary Adenoma ◽  
General Population ◽  
Pituitary Adenomas ◽  
Incidental Finding ◽  
Meta Analysis ◽  
Poor Quality ◽  
Intracranial Neoplasms ◽  
Common Cause ◽  
Non Invasive ◽  
Pituitary Macroadenomas

Pituitary adenoma (PA) is a benign primary tumor that arises from the pituitary gland and is associated with ophthalmological, neurological and endocrinological abnormalities. However, causes that increase tumor progressing recurrence and invasiveness are still undetermined. Most adenomas are benign, approximately 35% are invasive and just 0.1% to 0.2% are carcinomas.Pituitary adenomas represent from 10% to 25% of all intracranial neoplasms and the estimated prevalence rate in the general population is approximately 17% Non-invasive and non-secreting pituitary adenomas are considered to be benign in the literal as well as the clinical sense; however a recent meta-analysis of available research has shown there are to date scant studies – of poor quality – to either support or refute this assumption. Etiology Adenomas which exceed 10 millimetres (0.39 in) in size are defined as macroadenomas, with those smaller than 10 mm referred to as microadenomas. Most pituitary adenomas are microadenomas, and have an estimated prevalence of 16.7% (14.4% in autopsy studies and 22.5% in radiologic studies). A majority of pituitary microadenomas often remain undiagnosed and those that are diagnosed are often found as an incidental finding, and are referred to as incidentalomas. Pituitary macroadenomas are the most common cause of hypopituitarism, and in the majority of cases they are non-secreting adenomas.While pituitary adenomas are common, affecting approximately one in 6 of the general population, clinically active pituitary adenomas that require surgical treatment are more rare, affecting approximately one in 1000 of the general population.

scholarly journals Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Constantine L. Karras ◽  
Isaac Josh Abecassis ◽  
Zachary A. Abecassis ◽  
Joseph G. Adel ◽  
Esther N. Bit-Ivan ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Frozen Section ◽  
Elevated Serum ◽  
Serum Prolactin ◽  
Ki 67 ◽  
Case Presentation ◽  
Tumor Pathology ◽  
Direct Extension ◽  
Internal Carotid Arteries

Background. Purely ectopic pituitary adenomas are exceedingly rare. Here we report on a patient that presented with an incidental clival mass thought to be a chordoma. Endonasal resection, tumor pathology, and endocrinology workup revealed a prolactinoma.Case Presentation. A 41-year-old male presented with an incidental clival lesion presumed to be a chordoma. On MRI it involved the entire clivus, extended laterally to the petroclival junction, and invaded the cavernous sinuses bilaterally, encasing both internal carotid arteries, without direct extension into the sella. Intraoperatively, it was clear that the tumor originated from the clivus and that the sellar dura was completely intact. Frozen-section pathology was consistent with a pituitary adenoma. Immunostaining was positive for synaptophysin and prolactin with a low Ki-67 index, suggestive of a prolactinoma. Additional immunohistochemical stains seen in chordomas (EMA, S100, and Brachyury) and other metastatic tumors were negative. A postoperative endocrine workup revealed an elevated serum prolactin of 881.3 ng/mL (normal < 20).Conclusions. In conclusion, it is crucial to maintain an extensive differential diagnosis when evaluating a patient with a clival lesion. Ectopic clival pituitary adenomas, although rare, may warrant an endocrinological workup preoperatively as the majority may respond to medical treatment.

Oncocytic Transformation in Pituitary Adenomas: Immunohistochemical Analyses of 65 Cases

2004 ◽  
Vol 128 (7) ◽  
pp. 776-780
Author(s):  
María Niveiro ◽  
Francisco Ignacio Aranda ◽  
Artemio Payá ◽  
Evangelina Boix ◽  
Gloria Peiró ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Proliferative Activity ◽  
Older Patients ◽  
Null Cell ◽  
Ki 67 ◽  
Antimitochondrial Antibody ◽  
Clinicopathologic Factors ◽  
Pattern Versus ◽  
Corticotroph Adenomas ◽  
Immunohistochemical Analyses

Abstract Context.—Oncocytic change in pituitary adenomas has been evaluated by electron microscopy and more recently by immunohistochemistry. The clinical significance of this change is not well known, although some reports suggest a relationship with more aggressive behavior. Objective.—To assess the frequency of oncocytic change in pituitary adenomas and to correlate this finding with clinicopathologic factors. Design.—We studied oncocytic change in a series of 65 pituitary adenomas by immunohistochemistry. According to the percentage of oncocytic cells stained by antimitochondrial antibody, adenomas were classified in 3 groups: 50% or more, 10% to 49%, and 1% to 9% of oncocytic cells. Results.—Eight cases (12.3%) showing at least 50% of oncocytic cells were classified as oncocytic adenomas: 6 were gonadotroph adenomas and 2 were null-cell adenomas. Among the remaining cases, 9 (14%; all gonadotroph adenomas) showed 10% to 49% oncocytic cells, and in 14 cases (21.5%; 5 gonadotroph adenomas, 6 somatotroph adenomas, 2 corticotroph adenomas, and 1 thyrotroph adenoma) between 1% and 9% were shown. Patients with adenomas that showed oncocytic change presented more frequently at a higher average age (P = .05), but no relationship with extrasellar extension or proliferative activity measured by Ki-67 was observed. In somatotroph adenomas, cases with oncocytic change showed higher percentages of Ki-67 (P = .05) but no correlation with extrasellar extension or cytokeratin staining (dot pattern versus perinuclear) was found. Conclusion.—Adenomas with oncocytic change present more frequently in older patients, but they are not clinically more aggressive. In addition, somatotroph adenomas with oncocytic cells show similar cytokeratin pattern and higher proliferative activity, which is not correlated with local aggressiveness.

scholarly journals Evaluation of 06-methylguanine-DNA methyltransferase expression in children and adolescent pituitary adenoma

2020 ◽  
Author(s):  
Xueming Shen ◽  
Yakun Yang ◽  
Zuocheng Yang ◽  
Ning Liu ◽  
Xueling Qi ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Children And Adolescents ◽  
Pituitary Adenomas ◽  
Dna Methyltransferase ◽  
Tumor Type ◽  
Treatment Needs ◽  
Ki 67 ◽  
Children And Adolescent ◽  
Methylguanine Dna Methyltransferase ◽  
Mgmt Protein

Abstract BackgroundTemozolomide can be used in the treatment of pituitary adenoma. Its efficacy can be evaluated by the expression of 06-methylguanine-DNA methyltransferase (MGMT). However, the previous study population was mainly adult. This study was the first to evaluate the expression of MGMT in children and adolescents with pituitary adenomas.MethodsThe clinical features and biological characteristics of 38 cases of pituitary adenoma in children and adolescents were analyzed retrospectively. The expression of MGMT, Ki-67, p53 was marked by immunohistochemical staining.ResultsIn this cohort, the expression of MGMT protein is 16/38 (42.11%). The low expression rate of MGMT in children and adolescent somatotroph adenomas was only 11.11%, which was much lower than that of adults. Ki-67 expression range of 1% -10%（mean 4.24 ± 2.71%）. The positive rate of p53 was 22/38 (57.89%). The statistical analysis showed that the expression of MGMT was related to the diameter of the tumor (P=0.01), the diameter of the tumor was large, and the expression of MGMT was high. The expression of MGMT was not associated with age, sex, tumor type, invasiveness, texture, apoplexy, recurrence, and expression of p53 and Ki-67.ConclusionSomatotroph adenomas, large-diameter children and adolescent pituitary adenomas may be not suitable for temozolomide treatment. To determine whether temozolomide responds to salvage therapy in children and adolescents with pituitary adenomas, MGMT expression should be assessed in all pituitary adenomas, the time span between specimen collection and temozolomide treatment needs to be considered because of the instability of MGMT protein expression.

scholarly journals Matrix Metalloproteinase 9 for Evaluating Invasiveness and Recurrence in Pituitary Adenoma Patients: A Meta-analysis

2020 ◽  
Author(s):  
bowen sun ◽  
Congxin Dai ◽  
Xiaohai Liu ◽  
Renzhi Wang ◽  
Jun Kang
Keyword(s):  
Pituitary Adenoma ◽  
Matrix Metalloproteinase ◽  
Pituitary Adenomas ◽  
Meta Analysis ◽  
Matrix Metalloproteinase 9 ◽  
Clear Correlation ◽  
Hazard Ratios ◽  
Funnel Plots ◽  
Metalloproteinase 9 ◽  
Diagnostic Index

Abstract Background: In recent years, matrix metalloproteinase 9 (MMP-9) has been consideredto be an indicator of the aggressiveness and recurrence of pituitary adenomas, especially in China. However, some results have led to many conflicts. Therefore, it is necessary to perform a meta-analysis to obtain a clear correlation between MMP-9 and invasiveness and recurrence. Methods: Eligible studies obtained through multiple searches were included, and the odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were estimated. Funnel plots were used to evaluate publication bias. In the current meta-analysis, 23 articles with a total of 1,213 patients were included, including three studies conducted in Europe and China. Results: High MMP-9 expression and invasiveness of pituitary adenomas (n = 22, OR = 4.75, 95% CI = 3.53-6.39, p<0.05) and tumour recurrence (n = 3, OR = 4.38, 95% CI = 1.76-10.94, p = 0.002) were closely related. In addition, the expression of MMP-9 in patients with functional and non-functional pituitary adenomas was also significantly different (n = 3, OR = 2.07, 95% CI = 1.03-4.16, p = 0.041). Conclusion: MMP-9 is closely related to the invasiveness, functional status and recurrence of pituitary adenoma and should be used as a routine diagnostic index for surgical treatment of pituitary adenoma.

PTTG has a Dual Role of Promotion-Inhibition in the Development of Pituitary Adenomas

2019 ◽  
Vol 26 (11) ◽  
pp. 800-818
Author(s):  
Zujian Xiong ◽  
Xuejun Li ◽  
Qi Yang
Keyword(s):  
Cell Cycle ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Cell Cycle Progression ◽  
Key Factors ◽  
Cycle Progression ◽  
Sister Chromatids ◽  
Regulation Of Cell Cycle ◽  
Late Stages

Pituitary Tumor Transforming Gene (PTTG) of human is known as a checkpoint gene in the middle and late stages of mitosis, and is also a proto-oncogene that promotes cell cycle progression. In the nucleus, PTTG works as securin in controlling the mid-term segregation of sister chromatids. Overexpression of PTTG, entering the nucleus with the help of PBF in pituitary adenomas, participates in the regulation of cell cycle, interferes with DNA repair, induces genetic instability, transactivates FGF-2 and VEGF and promotes angiogenesis and tumor invasion. Simultaneously, overexpression of PTTG induces tumor cell senescence through the DNA damage pathway, making pituitary adenoma possessing the potential self-limiting ability. To elucidate the mechanism of PTTG in the regulation of pituitary adenomas, we focus on both the positive and negative function of PTTG and find out key factors interacted with PTTG in pituitary adenomas. Furthermore, we discuss other possible mechanisms correlate with PTTG in pituitary adenoma initiation and development and the potential value of PTTG in clinical treatment.

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