Priola Stefano M, Esposito Felice, Cannavò Salvatore, Conti Alfredo, Abbritti Rosaria V, Barresi Valeria, Baldari Sergio, Ferraù Francesco, Germanò Antonino, Tomasello Francesco, Angileri Filippo F
Division of Neurosurgery, Department of Biomedical and Dental Sciences, and Morpho-Functional Imaging, University of Messina, Messina, Italy.
Division of Neurosurgery, Department of Biomedical and Dental Sciences, and Morpho-Functional Imaging, University of Messina, Messina, Italy.
World Neurosurg. 2017 Jan;97:140-155. doi: 10.1016/j.wneu.2016.09.092. Epub 2016 Oct 3.
Although pituitary adenomas are considered benign lesions, a small group may show clinically aggressive behavior, sometimes independently from the classic markers of aggressiveness, including the Ki67 labeling index or p53 expression.
We selected 7 patients harboring a pituitary tumor with clinical features of aggressiveness. Patients underwent a full preoperative and postoperative endocrinologic and neuroradiologic workup. Two were nonfunctioning, 2 prolactin-secreting, 2 adrenocorticotrophic hormone-secreting, and 1 a growth hormone-secreting adenoma.
The 7 patients underwent a total of 17 surgical procedures. At the first surgical procedure, gross total removal was achieved in none of the patients, whereas subtotal removal (>90% of tumor removed) was achieved in 4/7 cases and partial removal (<90% of tumor removed) in 3/7 cases. At first operation, 4/7 patients showed a Ki67 index ≤3% and 2/7 >3%; this information was not available for 1 patient. Postoperatively, all patients underwent radiation therapy. Three patients received chemotherapy with temozolomide. Three patients underwent peptide receptor radionuclide therapy. To date, 1 patient has died of tumor progression, and 2 patients are in a poor general condition. The remaining 4 patients are in a fair/good condition, without any major complaints. The mean follow-up is 43.42 months.
Aggressive pituitary adenomas represent a specific and still underestimated entity, often diagnosed late. Clinical and neuroradiologic rapid progression is often the only marker of aggressiveness. Surgical debulking remains the first therapeutic option. Multidisciplinary management is mandatory to offer these patients targeted therapeutic options.
尽管垂体腺瘤被认为是良性病变，但一小部分可能表现出临床侵袭性行为，有时与侵袭性的经典标志物无关，包括Ki67标记指数或p53表达。
我们选择了7例具有侵袭性临床特征的垂体肿瘤患者。患者接受了完整的术前和术后内分泌及神经放射学检查。其中2例为无功能腺瘤，2例为泌乳素分泌型腺瘤，2例为促肾上腺皮质激素分泌型腺瘤，1例为生长激素分泌型腺瘤。
7例患者共接受了17次手术。在首次手术中，没有患者实现肿瘤全切，4/7的病例实现了次全切除（切除肿瘤>90%），3/7的病例实现了部分切除（切除肿瘤<90%）。在首次手术时，4/7的患者Ki67指数≤3%，2/7的患者>3%；1例患者的该信息未获得。术后，所有患者均接受了放射治疗。3例患者接受了替莫唑胺化疗。3例患者接受了肽受体放射性核素治疗。迄今为止，1例患者死于肿瘤进展，2例患者全身状况较差。其余4例患者状况尚可/良好，无任何主要不适。平均随访时间为43.42个月。
侵袭性垂体腺瘤是一种特殊且仍被低估的实体，常被诊断较晚。临床和神经放射学的快速进展往往是侵袭性的唯一标志。手术减瘤仍然是首要的治疗选择。多学科管理对于为这些患者提供有针对性的治疗选择至关重要。
