Incidence and clinical outcomes of atypical pituitary adenomas

Ahmad A Moussa,Hosam A Yousef,Mohamed E Mahmoud

doi:10.1186/s41984-018-0011-x

Abstract

BackgroundAtypical pituitary adenoma has a high rate of recurrence and most of them need further treatment after surgery. This is why early detection is very important.MethodsIn this study we examined the incidence and outcome of large atypical pituitary adenoma in our patient cohort. The study was a retrospective review of fifty consecutive patients at Assiut university hospital. They all had a large adenoma with supracellar and parasellar extension. They were considered unsuitable for transphenoidal approach. They all had craniotomy. This study was carried out during a thirty eight month period. Pathology reports were reviewed. All patients had MIB-1 immunohistochemical data. Patients with lesions showing excessive MIB-1immunoreactivity and mitotic features had p53 immunohistochemical data.ResultsTen (20%) of our patients had lesions that met all the criteria for atypical adenoma.ConclusionAtypical pituitary adenoma tend to be aggressive and invasive macroadenomas. Following surgery, further treatment such as radiotherapy should be considered.

Highlights

Atypical pituitary adenoma has a high rate of recurrence and most of them need further treatment after surgery
On imaging, all 50 patients had a macroadenoma with suprasellar extension, and 11 (22%) out of the 50 patients had evidence of basal surrounding invasion
Diagnostic criteria, according to the 2004 World Health Organisation (WHO) Classification, of atypical adenoma are having elevated MIB-1 proliferative index greater than 3%, high p53 immune activity, increase mitotic activity and pleomorphism

Summary

Introduction

Atypical pituitary adenoma has a high rate of recurrence and most of them need further treatment after surgery. This is why early detection is very important. The study was a retrospective review of fifty consecutive patients at Assiut university hospital. They all had a large adenoma with supracellar and parasellar extension. Patients with lesions showing excessive MIB-1immunoreactivity and mitotic features had p53 immunohistochemical data. The diagnostic criteria for an atypical pituitary adenoma, according to the latest WHO classification, includes excess p53 immunoreactivity, MIB-1 proliferative index greater than 3%, and increased mitotic activity [1]. There is a need to develop new biomarkers to facilitate the earlier detection of clinically atypical adenomas and there have been many attempts to develop such markers [2].

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