Department of Neurosurgery, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
World Neurosurg. 2019 Oct;130:e765-e774. doi: 10.1016/j.wneu.2019.06.217. Epub 2019 Jul 8.
Plurihormonal pituitary adenomas (PPAs) have recently been divided into 2 subtypes: pituitary specific transcription factor 1-positive plurihormonal pituitary adenomas (PIT-1+ PPAs) and plurihormonal adenomas with unusual immunohistochemical combinations (PAwUIC). The purpose of this study was to review patients with PPAs, elucidate their clinicopathologic characteristics, and present the surgical results.
Records were analyzed for 665 patients who underwent endoscopic endonasal transsphenoidal surgery for pituitary adenomas between 2007 and 2018. Data were reviewed for 27 patients who met the definition of PPAs and delineated regarding clinical, radiologic, pathologic features, and surgical outcomes.
Of the 27 patients, 18 had PAwUIC, and 9 patients were diagnosed with PIT-1+ PPAs. Twenty-four patients (88.8%) had macroadenomas, including 6 giant adenomas (≥4 cm) (22.2%). Cavernous sinus invasion was found in 12 patients (44.4%). Pathologic examinations showed high aggressivity in nearly half of the patients. Most patients with PAwUIC (77.8%) had features of nonfunctioning pituitary adenomas, and only 4 had features of hormone-secreting pituitary adenomas. Gross total resection rates were 57.1% for PAwUIC and 77.8% for PIT-1+ PPAs. The remission rate for hormone-secreting pituitary adenomas was 100% in this case series. Mean follow-up was 74.4 ± 33 months (range, 6-121 months) for overall groups.
To our knowledge, this is the first study to describe the clinicopathologic features of newly classified PPAs, which are characterized by aggressive behavior with higher values of percentage of cavernous sinus invasion. Relevant pathologic diagnosis of PPAs is crucial for appropriate management and follow-up.
多激素分泌垂体腺瘤（PPA）最近被分为 2 个亚型：垂体特异性转录因子 1 阳性多激素分泌垂体腺瘤（PIT-1+ PPA）和具有不常见免疫组织化学组合的多激素分泌腺瘤（PAwUIC）。本研究的目的是回顾 PPA 患者，阐明其临床病理特征，并介绍手术结果。
分析了 2007 年至 2018 年间接受内镜经鼻蝶窦入路垂体腺瘤切除术的 665 例患者的记录。对符合 PPA 定义的 27 例患者进行了回顾性分析，对其临床、影像学、病理学特征和手术结果进行了描述。
27 例患者中，18 例为 PAwUIC，9 例诊断为 PIT-1+ PPA。24 例（88.8%）患者为大腺瘤，包括 6 例（22.2%）巨型腺瘤（≥4cm）。12 例（44.4%）患者存在海绵窦侵袭。病理检查显示近一半的患者具有高度侵袭性。大多数 PAwUIC 患者（77.8%）具有无功能垂体腺瘤的特征，仅有 4 例具有激素分泌性垂体腺瘤的特征。PAwUIC 的大体全切除率为 57.1%，PIT-1+ PPA 的为 77.8%。在本病例系列中，激素分泌性垂体腺瘤的缓解率为 100%。总体随访时间为 74.4±33 个月（范围 6-121 个月）。
据我们所知，这是第一项描述新分类的 PPA 的临床病理特征的研究，其特征为侵袭性行为，具有更高的海绵窦侵袭百分比。PPA 的相关病理诊断对于适当的管理和随访至关重要。
