Ceccato Filippo, Regazzo Daniela, Barbot Mattia, Denaro Luca, Emanuelli Enzo, Borsetto Daniele, Rolma Giuseppe, Alessio Luigi, Gardiman Marina Paola, Lombardi Giuseppe, Albiger Nora, D'Avella Domenico, Scaroni Carla
Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy.
Neurosurgery, Department of Neurosciences DNS, University-Hospital of Padova, Padua, Italy.
Acta Neurochir (Wien). 2018 Jan;160(1):49-55. doi: 10.1007/s00701-017-3396-5. Epub 2017 Nov 23.
Pituitary adenomas are usually considered benign tumours, although some of them can exhibit an aggressive behaviour. Patients with clinically aggressive pituitary adenomas are frequently diagnosed with larger masses, and may present an earlier recurrence (or persistence) after surgery. Our aim was to characterise the clinical, histopathological and radiological features of patients with aggressive pituitary adenoma, in order to correlate their clinical behaviour with the response to treatment plan.
We considered an aggressive pituitary adenoma on the basis of radiological features (size, local invasion), pathological reports (atypical adenoma: MIB-1 >3%, p53 immunoreactivity, increased mitotic activity) and clinical aspects (response to surgery, radiotherapy and medical treatment).
Among our cohort of 582 patients, we considered 102 subjects with aggressive pituitary adenomas (18%, 56 male and 46 female): 14 adrenocorticotrophic hormone (ACTH)-secreting, 18 growth hormone (GH)-secreting, 23 prolactin (PRL)-secreting and 47 non-secreting, with a median follow-up of 5 years. In the whole cohort, 75% of patients with aggressive pituitary adenomas presented invasion of surrounding structure, especially GH-secreting, PRL-secreting and non-secreting. Besides invasion, their remission rate after surgery, radiotherapy or medical treatment was similar, irrespective of hormonal secretion. Surgery was the most performed treatment (overall remission rate of 24%), especially in those patients with ACTH- or GH-secreting adenoma, and 22% of patients were submitted to radiotherapy, with a remission rate of 45% after a median of 3 years. Two consecutive years of medical treatment, in patients with secreting pituitary adenoma, achieved disease control in 41% of them. Considering pathological reports, 24% of cases were defined as atypical adenomas; radiological characteristics, responses to medical treatment and remission rates were similar among patients with typical and atypical adenoma.
We proposed a new and comprehensive definition of aggressive pituitary adenoma, based upon radiological, clinical and pathological features. In a selected cohort of patients, radiological invasion resulted in the most common marker to describe the aggressive behaviour of pituitary adenoma. Surgery, radiotherapy and medical treatment (the latter only in secreting adenoma) achieved disease control in half of the patients with aggressive adenoma, especially surgery in those with ACTH-oma and medical treatment in those with GH- and PRL-secreting adenoma. Nevertheless, radiological, clinical or atypical features did not affect the outcome.
垂体腺瘤通常被认为是良性肿瘤，尽管其中一些可能表现出侵袭性。临床侵袭性垂体腺瘤患者常被诊断为肿瘤较大，且术后可能较早复发（或持续存在）。我们的目的是描述侵袭性垂体腺瘤患者的临床、组织病理学和放射学特征，以便将其临床行为与治疗方案的反应相关联。
我们根据放射学特征（大小、局部侵袭）、病理报告（非典型腺瘤：MIB-1＞3%、p53免疫反应性、有丝分裂活性增加）和临床情况（对手术、放疗和药物治疗的反应）来判定侵袭性垂体腺瘤。
在我们的582例患者队列中，我们认定102例为侵袭性垂体腺瘤患者（18%，男性56例，女性46例）：14例分泌促肾上腺皮质激素（ACTH）、18例分泌生长激素（GH）、23例分泌催乳素（PRL）以及47例无功能性，中位随访时间为5年。在整个队列中，75%的侵袭性垂体腺瘤患者出现周围结构侵犯，尤其是分泌GH、PRL和无功能性的腺瘤。除侵犯外，无论激素分泌情况如何，他们在手术、放疗或药物治疗后的缓解率相似。手术是最常用的治疗方法（总体缓解率为24%），尤其是在分泌ACTH或GH的腺瘤患者中，22%的患者接受了放疗，中位3年后缓解率为45%。分泌性垂体腺瘤患者连续两年的药物治疗使41%的患者病情得到控制。考虑病理报告，24%的病例被定义为非典型腺瘤；典型和非典型腺瘤患者的放射学特征、药物治疗反应和缓解率相似。
我们基于放射学、临床和病理特征提出了侵袭性垂体腺瘤的新的综合定义。在选定的患者队列中，放射学侵犯是描述垂体腺瘤侵袭行为最常见的指标。手术、放疗和药物治疗（后者仅用于分泌性腺瘤）使一半的侵袭性腺瘤患者病情得到控制，尤其是ACTH瘤患者采用手术治疗，GH和PRL分泌性腺瘤患者采用药物治疗。然而，放射学、临床或非典型特征并不影响治疗结果。
