USC Brain Tumor Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Pituitary. 2022 Jun;25(3):480-485. doi: 10.1007/s11102-022-01217-z. Epub 2022 Mar 25.
Patterns of extension of pituitary adenomas (PA) may vary according to PA subtype. Understanding extrasellar extension patterns in growth hormone PAs (GHPA) vis-a-vis nonfunctional PAs (NFPAs) may provide insights into the biology of GHPA and future treatment avenues.
Preoperative MR imaging (MRI) in 179 consecutive patients treated surgically for NFPA (n = 139) and GHPA (n = 40) were analyzed to determine patterns of extrasellar growth. Extension was divided into two principal directions: cranio-caudal (measured by infrasellar/suprasellar extension), and lateral cavernous sinus invasion (CSI) determined by Knosp grading score of 3-4. Suprasellar extension was defined as tumor extension superior to the tuberculum sellae- dorsum sellae line, and inferior extension as invasion through the sellar floor into the sphenoid sinus or clivus. Categorical analysis was performed using Fisher's exact test.
GHPAs were overall more likely to remain purely intrasellar compared to NFPA (50% vs 26%, p < 0.001). GHPAs, however, were 7 times more likely to exhibit isolated infrasellar extension compared to NFPA (20% vs 2.8%, p = 0.001). Conversely, NFPAs were twice as likely to exhibit isolated suprasellar extension compared to GHPA (60% vs 28%, p < 0.001), as well as combined suprasellar/infrasellar extension (25% vs 3%, p = 0.011). There were no overall differences in CSI between the two subgroups.
GHPA and NFPA demonstrate distinct extrasellar extension patterns on MRI. GHPAs show proclivity for inferior extension with bony invasion, whereas NFPAs are more likely to exhibit suprasellar extension through the diaphragmatic aperture. These distinctions may have implications into the biology and future treatment of PAs.
垂体腺瘤（PA）的扩展模式可能根据 PA 亚型而有所不同。了解生长激素 PA（GHPA）与非功能性 PA（NFPAs）之间的 extrasellar 扩展模式可能为 GHPA 的生物学和未来的治疗途径提供深入了解。
对 179 例连续接受手术治疗的 NFPA（n=139）和 GHPA（n=40）患者的术前磁共振成像（MRI）进行分析，以确定 extrasellar 生长的模式。扩展分为两个主要方向：颅尾（通过 infrasellar/suprasellar 扩展测量），以及 lateral 海绵窦侵犯（通过 Knosp 分级评分 3-4 确定）。Suprasellar 扩展定义为肿瘤延伸超过鞍结节-鞍背线，而下部扩展则定义为通过鞍底侵犯蝶窦或斜坡。使用 Fisher 精确检验进行分类分析。
与 NFPA 相比，GHPA 总体上更有可能保持纯粹的 intrasellar（50%比 26%，p<0.001）。然而，与 NFPA 相比，GHPA 更有可能单独出现 infrasellar 扩展（20%比 2.8%，p=0.001）。相反，与 GHPA 相比，NFPAs 更有可能单独出现 suprasellar 扩展（60%比 28%，p<0.001），以及联合 suprasellar/infrasellar 扩展（25%比 3%，p=0.011）。两组之间在 CSI 方面没有总体差异。
GHPA 和 NFPAs 在 MRI 上表现出不同的 extrasellar 扩展模式。GHPA 表现出倾向于下方的扩展，并伴有骨质侵犯，而 NFPAs 更有可能通过膈孔出现 suprasellar 扩展。这些区别可能对 PA 的生物学和未来治疗有影响。
