Bal Ercan, Kulaç İbrahim, Ayhan Selim, Söylemezoğlu Figen, Berker Mustafa
Department of Neurosurgery, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey.
Department of Pathology, Koç University Hospital, İstanbul, Turkey.
J Neurol Surg B Skull Base. 2021 Jul;82(Suppl 3):e94-e100. doi: 10.1055/s-0040-1702219. Epub 2020 Feb 20.
This study was aimed to assess the clinical aggressiveness of pituitary neoplasms that were previously defined as atypical adenomas. A total of 1,042 pituitary adenomas were included in the study and 101 of them were diagnosed as atypical adenoma. Demographic characteristics, radiological evaluations, and clinical information were obtained from a computer-based patient database. Cases were categorized as atypical or typical using the criteria listed in 2004 Classification of Tumors of Endocrine Organs. The cure and reoperation rates did not show any statistically significant difference between the typical and atypical adenomas. However, a higher K -67 labeling index was found to be associated with a higher rate of reoperation ( = 0.008) in atypical adenomas. Of note, cavernous sinus invasion or parasellar extension was found to be associated with lower cure rates in patients with atypical pituitary adenomas ( < 0.001 and = 0.001, respectively). Although atypical pituitary adenomas are known to be more invasive, this study demonstrated that the reoperation and cure rates are the same for typical and atypical adenomas. Our findings advocate for omitting the use of atypical adenoma terminology based solely on pathological evaluation. As stated in the 4th edition of the World Health Organization (WHO) classification, accurate tumor subtyping, evaluation of proliferation by means of mitotic count and K -67 labeling index, and radiological and intraoperative assessments of tumor invasion should be taken into consideration in the management of such neoplasms.
本研究旨在评估先前被定义为非典型腺瘤的垂体肿瘤的临床侵袭性。该研究共纳入1042例垂体腺瘤，其中101例被诊断为非典型腺瘤。人口统计学特征、影像学评估和临床信息均来自基于计算机的患者数据库。根据2004年《内分泌器官肿瘤分类》中列出的标准，将病例分为非典型或典型。典型和非典型腺瘤的治愈率和再次手术率在统计学上没有显著差异。然而，在非典型腺瘤中，较高的Ki-67标记指数与较高的再次手术率相关（P = 0.008）。值得注意的是，在非典型垂体腺瘤患者中，海绵窦侵犯或鞍旁扩展与较低的治愈率相关（分别为P < 0.001和P = 0.001）。尽管已知非典型垂体腺瘤更具侵袭性，但本研究表明，典型和非典型腺瘤的再次手术率和治愈率相同。我们的研究结果主张仅基于病理评估而省略使用非典型腺瘤术语。正如世界卫生组织（WHO）第4版分类中所述，在这类肿瘤的管理中，应考虑准确的肿瘤亚型分类、通过有丝分裂计数和Ki-67标记指数评估增殖情况，以及对肿瘤侵袭的影像学和术中评估。
