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Early recognition of aggressive pituitary adenomas: a single-centre experience

  • Original Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

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.

Method

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).

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy

    Filippo Ceccato, Daniela Regazzo, Mattia Barbot, Nora Albiger & Carla Scaroni

  2. Neurosurgery, Department of Neurosciences DNS, University-Hospital of Padova, Padua, Italy

    Luca Denaro & Domenico D’Avella

  3. Otorhinolaryngology and Otologic Surgery, University-Hospital of Padova, Padua, Italy

    Enzo Emanuelli & Daniele Borsetto

  4. Neuroradiology Unit, University-Hospital of Padova, Padua, Italy

    Giuseppe Rolma

  5. Neurosurgical Division, University-Hospital of Padova, Padua, Italy

    Luigi Alessio

  6. Surgical Pathology and Cytopathology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padua, Italy

    Marina Paola Gardiman

  7. Department of Experimental and Clinical Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV – IRCCS, Padova, Italy

    Giuseppe Lombardi

Authors
  1. Filippo Ceccato
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  2. Daniela Regazzo
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  3. Mattia Barbot
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  4. Luca Denaro
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  7. Giuseppe Rolma
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  8. Luigi Alessio
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  9. Marina Paola Gardiman
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  10. Giuseppe Lombardi
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  11. Nora Albiger
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  12. Domenico D’Avella
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  13. Carla Scaroni
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Corresponding author

Correspondence to Filippo Ceccato.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ceccato, F., Regazzo, D., Barbot, M. et al. Early recognition of aggressive pituitary adenomas: a single-centre experience. Acta Neurochir 160, 49–55 (2018). https://doi.org/10.1007/s00701-017-3396-5

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  • DOI: https://doi.org/10.1007/s00701-017-3396-5

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