Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases

2014 ◽  
Vol 121 (6) ◽  
pp. 1462-1473 ◽  
Author(s):  
Shozo Yamada ◽  
Noriaki Fukuhara ◽  
Kentaro Horiguchi ◽  
Mitsuo Yamaguchi-Okada ◽  
Hiroshi Nishioka ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Tumor Size ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Case Series ◽  
Clinicopathological Characteristics ◽  
Single Center ◽  
Total Removal ◽  
Cavernous Sinus Invasion ◽  
Clinical Series

Object The aim of this study was to analyze clinicopathological characteristics and treatment outcomes in a large single-center clinical series of cases of thyrotropin (TSH)–secreting pituitary adenomas. Methods The authors retrospectively reviewed clinical, pathological, and treatment characteristics of 90 consecutive cases of TSH-secreting pituitary adenomas treated with transsphenoidal surgery between December 1991 and May 2013. The patient group included 47 females and 43 males (median age 42 years, range 11–74 years). Results Sixteen tumors (18%) were microadenomas and 74 (82%) were macroadenomas. Microadenomas were significantly more frequent in the more recent half of our case series (12 of 45 cases) (p = 0.0274). Cavernous sinus invasion was confirmed in 21 patients (23%). In 67 cases (74%), the tumors were firm elastic or hard in consistency. Acromegaly and hyperprolactinemia were observed, respectively, in 14 (16%) and 11 (12%) of the 90 cases. Euthyroidism was achieved in 40 (83%) of 48 patients and tumor shrinkage was found in 24 (55%) of 44 patients following preoperative somatostatin analog treatment. Conventional transsphenoidal surgery, extended transsphenoidal surgery, and a simultaneous combined supra- and infrasellar approach were performed in 85, 2, and 3 patients, respectively. Total removal with endocrinological remission was achieved in 76 (84%) of 90 patients, including all 16 (100%) patients with microadenomas, 60 (81%) of the 74 with macroadenomas, and 8 (38%) of the 21 with cavernous sinus invasion. None of these 76 patients experienced tumor recurrence during a median follow-up period of 2.8 years. Stratifying by Knosp grade, total removal with endocrinological remission was achieved in 34 of 36 patients with Knosp Grade 0 tumors, all 24 of those with Grade 1 tumors, 12 of the 14 with Grade 2 tumors, 6 of the 8 with Grade 3 tumors, and none of the 8 with Grade 4 tumors. Cavernous sinus invasion and tumor size were significant independent predictors of surgical outcome. Immunoreactivity for growth hormone, prolactin, or both hormones was present in 32, 9, and 24 patients, respectively. The Ki-67 labeling index was less than 3% in 71 (97%) of 73 tumors for which it was obtained and 3% or more in 2. Postsurgery pituitary dysfunction was found in 15 patients (17%) and delayed hyponatremia was seen in 9. Conclusions TSH-secreting adenomas, particularly those in the microadenoma stage, have increased in frequency over the past 5 years. The high surgical success rate achieved in this series is due to relatively early diagnosis and relatively small tumor size. In addition, the surgical strategies used, such as extracapsular removal of hard or solid adenomas, aggressive resction of tumors with cavernous sinus invasion, or extended transsphenoidal surgery or a simultaneous combined approach for large/giant multilobulated adenomas, also may improve remission rate with a minimal incidence of complications.

Microscopic endonasal transsphenoidal pituitary adenomectomy in the pediatric population

2011 ◽  
Vol 7 (5) ◽  
pp. 501-509 ◽  
Author(s):  
Phiroz E. Tarapore ◽  
Michael E. Sughrue ◽  
Lewis Blevins ◽  
Kurtis I. Auguste ◽  
Nalin Gupta ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Cavernous Sinus ◽  
Medical Therapy ◽  
Pituitary Adenomas ◽  
Pediatric Population ◽  
Case Series ◽  
Endocrine Function ◽  
Transsphenoidal Approach ◽  
Cavernous Sinus Invasion ◽  
Suprasellar Extension

Object Pituitary adenomas are uncommon in childhood. Although medical treatment can be effective in treating prolactinomas and some growth hormone (GH)–secreting tumors, resection is indicated when visual function is affected or the side effects of medical therapy are intolerable. The authors of this report describe their 10-year experience in managing pituitary adenomas via the microscopic endonasal transsphenoidal approach in a pediatric population. Methods They performed a retrospective review of a surgical case series based at a single institution and consisting of 34 consecutive pediatric patients with endocrine-active (32 patients) and endocrine-inactive (2 patients) adenomas. These patients were surgically treated via an endonasal transsphenoidal approach between 1999 and 2008. Patient charts were reviewed, and clinical data were compiled and analyzed using the chi-square and Kaplan-Meier tests. Results The patient cohort consisted of 20 girls and 14 boys, with ages ranging from 9 to 18 years and a median age of 16 years. Thirty-two patients (94%) underwent surgery for endocrine-active tumors, including 10 (29%) with Cushing disease, 21 (62%) with prolactinomas, and 1 (3%) with GH-secreting tumors. Two patients with nonsecreting adenomas underwent surgery for apoplexy. The mean tumor volume was 5.4 cm3, and 13 patients (38%) had suprasellar extension and 7 (21%) had cavernous sinus invasion. Gross-total resection was achieved in 26 patients (76%), although it was significantly less likely to be achieved in the setting of cavernous sinus invasion (p < 0.001) but was unaffected by suprasellar extension. Residual tumor was treated with radiation therapy in 6 patients (18%). The average duration of hospital stay was 1.6 days. The median follow-up time was 18 months. After surgery, 19 patients (56%) had normal hormone function without adjuvant therapy, 8 (24%) had normal function with adjuvant therapy, and 5 (15%) had persistently elevated hormone levels. Patients with a macroprolactinoma were significantly more likely to require postoperative adjuvant therapy than were those with a microprolactinoma (p < 0.03). Conclusions Endonasal transsphenoidal resection is a safe, well-tolerated, and potentially curative treatment option for pituitary adenomas in children. Despite the technical challenges associated with this approach in the pediatric population, these tumors can be effectively managed with minimal morbidity. Endocrine function is usually preserved, and the majority of patients will not require lifelong medical therapy.

Internal carotid arterial shift after transsphenoidal surgery in pituitary adenomas with cavernous sinus invasion

Pituitary ◽  
2013 ◽  
Vol 16 (4) ◽  
pp. 465-470 ◽  
Author(s):  
Yasuo Sasagawa ◽  
Osamu Tachibana ◽  
Mariko Doai ◽  
Takuya Akai ◽  
Hisao Tonami ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Internal Carotid ◽  
Cavernous Sinus Invasion ◽  
Carotid Arterial

scholarly journals Characterization of Gonadotroph Pituitary Adenomas Based on the Recent 2017 WHO Pituitary Tumor Classification

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A640-A641
Author(s):  
Aviva Cohn ◽  
Chloe Yang Ling Li ◽  
Samantha Elena Hoffman ◽  
Ana Paula Abreu-Metzger ◽  
Joseph Castlen ◽  
...  
Keyword(s):  
Transcription Factor ◽  
Transcription Factors ◽  
Cavernous Sinus ◽  
Tumor Size ◽  
Pituitary Adenomas ◽  
World Health ◽  
Pituitary Hormone ◽  
Pituitary Insufficiency ◽  
Null Cell ◽  
Cavernous Sinus Invasion

Abstract Introduction: More than 20% of pituitary adenomas are nonfunctional, the majority of which are of gonadotroph origin. Whereas previously, immunohistochemistry of pituitary hormones was used to classify adenoma subtypes, in 2017 the World Health Organization (WHO) reclassified pituitary adenomas using transcription factor expression in addition to immunohistochemistry. With this change, clinically nonfunctional gonadotroph adenomas can be distinguished among: (1) those staining for the transcription factor SF-1 and gonadotropins FSH and/or LH (FSH/LH+), (2) those that stain for SF-1 but not for FSH or LH (FSH/LH- SF1+), and (3) true null cell adenomas. It is unclear whether these three subgroups behave similarly clinically, or if they have distinct manifestations or outcomes. Our aim was to characterize these subgroups in regard to tumor size, recurrence and pituitary insufficiency. Methods: In a retrospective chart review, 71 patients from 2017-2020 who presented to the hospital for transsphenoidal resection of clinically nonfunctioning pituitary adenomas were reviewed. All patients with pituitary adenomas that stained positive for SF-1 and negative for T-PIT and PIT-1, and tumors that were negative for all three transcription factors were evaluated. Those lacking clinical data were excluded. Clinical characteristics examined include: demographics, tumor size, invasion of cavernous sinus, and hormone deficiencies. Results: Of the 71 pituitary tumors, 45% (n=32) stained positive for the beta subunit FSH and/or LH (FSH/LH+) and SF-1, 44% (n=31) stained for SF-1 with negative pituitary hormone stains (FSH/LH- SF1+), and 11% (n=8) were negative for all transcription factors and hormones (true null). All tumors were macroadenomas (&gt;1 cm). While there were &gt;50% males in the FSH/LH+ and FSH/LH- SF1+ groups, in the true null group only 25% of patients were male. Most patients were &gt;50 years old in all 3 groups (81% FSH/LH+, 75% FSH/LH- SF1+, 88% true null). The prevalence of cavernous sinus involvement was 36% in both groups that stained for SF-1, but was 62% in the true null group. Both SF-1+ groups had similar tumor sizes and prevalence of panhypopituitarism (15-21%), but there were more episodes of recurrence since last known follow up in the FSH/LH- SF1+ group (20%), compared to FSH/LH+ tumors (7%). The true null group had ≥50% rates for both panhypopituitarism and recurrence. Conclusions: In this study, we highlighted the category of FSH/LH- SF1+ gonadotroph adenomas and compared these to FSH/LH+ and true null cell tumors. Based on clinical features, FSH/LH- SF1+ gonadotroph adenomas are similar to FSH/LH+ staining pituitary adenomas in regard to age, sex, size, and degree of cavernous sinus invasion, although there were more recurrences in the FSH/LH- SF1+ group. Though less common, our cohort suggests more aggressive tendencies in the true null group compared to SF-1 staining tumors.

scholarly journals Gastric Mixed Neuroendocrine Non-Neuroendocrine Neoplasms: A Western Center Case Series

2021 ◽  
Vol 9 (3) ◽  
pp. 47
Author(s):  
Marcus Fernando Kodama Pertille Ramos ◽  
Marina Alessandra Pereira ◽  
Arthur Youssif Mota Arabi ◽  
Melissa Mello Mazepa ◽  
Andre Roncon Dias ◽  
...  
Keyword(s):  
Gastric Adenocarcinoma ◽  
Tumor Size ◽  
Lymphovascular Invasion ◽  
Comparison Group ◽  
Case Series ◽  
Clinicopathological Characteristics ◽  
Neuroendocrine Neoplasms ◽  
Rare Tumor ◽  
Term Survival

Background: Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) represent a rare tumor composed of adenocarcinoma and neuroendocrine carcinoma components. This study reports a case series of gastric MiNEN and discusses issues related to its diagnosis, management, and outcomes. Methods: We retrospectively analyzed data from patients with gastric MiNEN who underwent surgical resection at our service from 2009 to 2020. Patients with gastric adenocarcinoma served as a comparison group. Clinical, pathologic, and surgical characteristics were compared. Results: During the selected period, 5 gastric MiNEN patients and 597 patients with gastric adenocarcinoma were included. Among the clinical variables, age, sex, BMI, and laboratory exams were similar between the two groups. Only ASA classification was different (p = 0.015). Pathological variables such as tumor size, lymphovascular invasion, number of retrieved lymph nodes, and pTNM staging were also similar between both groups. Lastly, early surgical outcomes and long-term survival did not differ between gastric MiNEN and adenocarcinoma patients. Conclusion: A MiNEN is a rare tumor that represents less than 1% of GC patients undergoing curative treatment, and demonstrated clinicopathological characteristics and outcomes similar to gastric adenocarcinoma.

Endoscopic Endonasal Management of Nonfunctioning Pituitary Adenomas with Cavernous Sinus Invasion: Our Experience

2013 ◽  
Vol 149 (2_suppl) ◽  
pp. P48-P48
Author(s):  
Fabio Ferreli ◽  
Mario Turri-Zanoni ◽  
Stefania Gallo ◽  
Maurizio Bignami ◽  
Giustino Tomei ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Endoscopic Endonasal ◽  
Cavernous Sinus Invasion ◽  
Nonfunctioning Pituitary Adenomas

scholarly journals Association of different pathologic subtypes of growth hormone producing pituitary adenoma and remission in acromegaly patients: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maryam Dehghani ◽  
Zahra Davoodi ◽  
Farahnaz Bidari ◽  
Amin Momeni Moghaddam ◽  
Davood Khalili ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Cohort Study ◽  
Cavernous Sinus ◽  
Retrospective Cohort Study ◽  
Pituitary Adenomas ◽  
Retrospective Cohort ◽  
Remission Rate ◽  
Cavernous Sinus Invasion ◽  
Dual Staining

Abstract Background Regarding the inconclusive results of previous investigations, this study aimed to determine the association between pathology, as a possible predictor, with remission outcomes, to know the role of pathology in the personalized decision making in acromegaly patients. Methods A retrospective cohort study was performed on the consecutive surgeries for growth hormone (GH) producing pituitary adenomas from February 2015 to January 2021. Seventy-one patients were assessed for granulation patterns and prolactin co-expression as dual staining adenomas. The role of pathology and some other predictors on surgical remission was evaluated using logistic regression models. Results Among 71 included patients, 34 (47.9%) patients had densely granulated (DG), 14 (19.7%) had sparsely granulated (SG), 23 (32.4%) had dual staining pituitary adenomas. The remission rate was about 62.5% in the patients with SG and DG adenomas named single staining and 52.2% in dual staining groups. Postoperative remission was 1.53-folds higher in the single staining adenomas than dual staining-one (non-significant). The remission rate was doubled in DG group compared to two other groups (non-significant). By adjusting different predictors, cavernous sinus invasion and one-day postoperative GH levels decreased remission rate by 91% (95% CI: 0.01–0.67; p = 0.015) and 64% (95% CI: 0.19–0.69; p < 0.001), respectively. Responses to the medications were not significantly different among three groups. Conclusion Various pathological subtypes of pituitary adenomas do not appear to have a predictive role in estimating remission outcomes. Cavernous sinus invasion followed by one-day postoperative GH is the strongest parameter to predict biochemical remission.

Sign in / Sign up

Export Citation Format

Share Document