Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran.
Clin Neurol Neurosurg. 2021 Oct;209:106942. doi: 10.1016/j.clineuro.2021.106942. Epub 2021 Sep 10.
Pituitary adenomas (PAs) are among the most common brain tumors which characteristically become symptomatic due to the mass effect on surrounding structures and/or hormonal imbalances. This study describes 28 cases of PAs with an extrasellar invasive growth (EIG) at the early stage of tumor growth with normal sellar cavity size.
1200 cases of PAs either treated medically or via Endoscopic transsphenoidal surgery were reviewed during a 10-year period. Pre-operative imaging was analyzed to evaluate the tumor expansion pattern, tumor invasion sites and other relevant tumor properties. A comprehensive preoperative endocrinological along with postoperative histopathological studies were conducted to evaluate the subjects' homeostasis and further identify the lesions characteristics.
Of the 28 patients, patients 19, 2, 1 and 6 had a growth hormone (GH)-secreting PA, an adrenocorticotropic hormone (ACTH)-secreting PA, a nonfunctional PA (NFPA) and a mix-hormones secreting PA, respectively. There was a statistically significant difference between patients with and without EIG regarding types of PAs (P = 0.000). Post-hoc tests demonstrated that GH-secreting PAs (P = 0.0003) and mix-hormones secreting PAs (P = 0.0000) are significantly more invasive, while NFPAs (P = 0.0000) are less invasive. There was not a statistically significant difference between the invasion sites and different types of PAs (P = 0.122).
Among different histological subtypes of PAs, GH-secreting PAs revealed a remarkable tendency for EIG with normal sellar cavity size. The extra-sellar tumor extension with a normal sella did not correlate with atypical histology. Considering EIG patterns, surgeons should be vigilant to investigate and follow the tumor spreading to its enclosing boundary during surgery, the clival part of sphenoid bone should be more exposed, and both inferomedial and lateral borders of the sphenoid sinus should be carefully explored in order to remove the tumor.
垂体腺瘤（PA）是最常见的脑肿瘤之一，其特征是由于对周围结构的占位效应和/或激素失衡而出现症状。本研究描述了 28 例在肿瘤生长早期具有鞍旁侵袭性生长（EIG）且正常鞍腔大小的 PA 病例。
在 10 年期间，回顾了 1200 例接受药物或内镜经蝶窦手术治疗的 PA 患者。对术前影像学进行分析，以评估肿瘤扩张模式、肿瘤侵袭部位和其他相关肿瘤特征。进行全面的术前内分泌学检查和术后组织病理学研究，以评估患者的内环境平衡，并进一步确定病变特征。
在 28 例患者中，患者 19、2、1 和 6 分别患有生长激素（GH）分泌型 PA、促肾上腺皮质激素（ACTH）分泌型 PA、无功能 PA（NFPA）和混合激素分泌型 PA。有 EIG 和无 EIG 的患者在 PA 类型方面存在统计学差异（P=0.000）。事后检验表明，GH 分泌型 PA（P=0.0003）和混合激素分泌型 PA（P=0.0000）侵袭性更强，而 NFPA（P=0.0000）侵袭性较弱。侵袭部位与不同类型的 PA 之间无统计学差异（P=0.122）。
在不同组织学亚型的 PA 中，GH 分泌型 PA 显示出具有正常鞍腔大小的明显 EIG 倾向。具有正常蝶鞍的鞍旁肿瘤延伸与非典型组织学无关。考虑到 EIG 模式，外科医生在手术中应保持警惕，调查并跟踪肿瘤向其周围边界的扩散，应更多地暴露蝶骨的斜坡部分，并仔细探查蝶窦的内侧和外侧边界，以切除肿瘤。
