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Atypical pituitary adenoma: a clinicopathologic case series.

Publication ,  Journal Article
Rutkowski, MJ; Alward, RM; Chen, R; Wagner, J; Jahangiri, A; Southwell, DG; Kunwar, S; Blevins, L; Lee, H; Aghi, MK
Published in: J Neurosurg
April 2018

OBJECTIVE In 2004, the WHO classified atypical pituitary adenoma as a distinct adenoma subtype. However, the clinical significance of this distinction remains undetermined. The authors sought to define patient characteristics, tumor features, and treatment outcomes associated with atypical pituitary adenoma. METHODS The authors reviewed records of patients who underwent resection of pituitary adenoma at the University of California, San Francisco, between 2007 and 2014. Per institutional protocol, adenomas exhibiting mitotic activity underwent evaluation for all 3 markers of atypicality (mitotic index, extensive p53 staining, and MIB-1 index ≥ 3%). Statistical analyses were performed using χ2, Fisher's exact test, t-test, log-rank, and logistic regression. RESULTS Between 2007 and 2014, 701 patients underwent resection for pituitary adenoma. Among these patients, 122 adenomas exhibited mitotic activity and therefore were evaluated for all 3 markers of atypicality, with 36 tumors (5%) proving to be atypical. There were 21 female patients (58%) and 15 male patients (42%) in the atypical cohort, and 313 female patients (47%) and 352 male patients (53%) in the nonatypical cohort (p = 0.231). The mean age of patients in the atypical cohort was 37 years (range 10-65 years), which was significantly lower than the mean age of 49 years (range 10-93 years) for patients in the nonatypical cohort (p < 0.001). The most common presenting symptoms for patients with atypical adenomas were headaches (42%) and visual changes (33%). Atypical adenomas were more likely to be functional (78%) than nonatypical adenomas (42%; p < 0.001). Functional atypical adenomas were significantly larger than functional nonatypical adenomas (mean diameter 2.2 vs 1.4 cm; p = 0.009), as were nonfunctional atypical adenomas compared with nonfunctional nonatypical adenomas (mean diameter 3.3 vs 2.3 cm; p = 0.01). Among the entire adenoma cohort, larger presenting tumor size was associated with cavernous sinus invasion (p < 0.001), and subtotal resection was associated with cavernous sinus invasion (p < 0.001) and larger size (p < 0.001) on binomial multivariate regression. The median time until recurrence was 56 months for atypical adenomas, 129 months for functional nonatypical adenomas, and 204 months for nonfunctional nonatypical adenomas (p < 0.001). Functional atypical adenomas recurred more frequently and significantly earlier than functional nonatypical adenomas (p < 0.001). When accounting for extent of resection, cavernous sinus invasion, size, age, sex, and functional subtype, atypicality remained a significant predictor of earlier recurrence among functional adenomas (p = 0.002). CONCLUSIONS When compared with nonatypical pituitary adenomas, atypical adenomas are more likely to present in younger patients at a larger size, are more often hormonally hypersecretory, and are associated with earlier recurrence. These features lend credence to atypical pituitary adenomas being a distinct clinical entity in addition to a discrete pathological diagnosis.

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Published In

J Neurosurg

DOI

EISSN

1933-0693

Publication Date

April 2018

Volume

128

Issue

4

Start / End Page

1058 / 1065

Location

United States

Related Subject Headings

  • Young Adult
  • Retrospective Studies
  • Predictive Value of Tests
  • Pituitary Neoplasms
  • Pituitary Hormones
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Neoplasm Recurrence, Local
  • Neoplasm Invasiveness
  • Mitosis
 

Citation

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Chicago
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Rutkowski, M. J., Alward, R. M., Chen, R., Wagner, J., Jahangiri, A., Southwell, D. G., … Aghi, M. K. (2018). Atypical pituitary adenoma: a clinicopathologic case series. J Neurosurg, 128(4), 1058–1065. https://doi.org/10.3171/2016.12.JNS162126
Rutkowski, Martin J., Ryan M. Alward, Rebecca Chen, Jeffrey Wagner, Arman Jahangiri, Derek G. Southwell, Sandeep Kunwar, Lewis Blevins, Han Lee, and Manish K. Aghi. “Atypical pituitary adenoma: a clinicopathologic case series.J Neurosurg 128, no. 4 (April 2018): 1058–65. https://doi.org/10.3171/2016.12.JNS162126.
Rutkowski MJ, Alward RM, Chen R, Wagner J, Jahangiri A, Southwell DG, et al. Atypical pituitary adenoma: a clinicopathologic case series. J Neurosurg. 2018 Apr;128(4):1058–65.
Rutkowski, Martin J., et al. “Atypical pituitary adenoma: a clinicopathologic case series.J Neurosurg, vol. 128, no. 4, Apr. 2018, pp. 1058–65. Pubmed, doi:10.3171/2016.12.JNS162126.
Rutkowski MJ, Alward RM, Chen R, Wagner J, Jahangiri A, Southwell DG, Kunwar S, Blevins L, Lee H, Aghi MK. Atypical pituitary adenoma: a clinicopathologic case series. J Neurosurg. 2018 Apr;128(4):1058–1065.

Published In

J Neurosurg

DOI

EISSN

1933-0693

Publication Date

April 2018

Volume

128

Issue

4

Start / End Page

1058 / 1065

Location

United States

Related Subject Headings

  • Young Adult
  • Retrospective Studies
  • Predictive Value of Tests
  • Pituitary Neoplasms
  • Pituitary Hormones
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Neoplasm Recurrence, Local
  • Neoplasm Invasiveness
  • Mitosis