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J Neurol Surg B Skull Base 2021; 82(S 03): e94-e100
DOI: 10.1055/s-0040-1702219
Original Article

The Past, Present, and Future Statuses of Formerly Classified “Atypical Pituitary Adenomas”: A Clinicopathological Assessment of 101 Cases in a Cohort of More than 1,000 Pure Endoscopically Treated Patients in Single Center

Ercan Bal
1   Department of Neurosurgery, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
,
İbrahim Kulaç
2   Department of Pathology, Koç University Hospital, İstanbul, Turkey
,
Selim Ayhan
3   Departments of Neurosurgery and Electroneurophsiology, Vocational School of Health Sciences, Acibadem Mehmet Ali Aydınlar University, İstanbul, Turkey
,
Figen Söylemezoğlu
4   Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey
,
Mustafa Berker
5   Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey
› Author Affiliations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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Abstract

Objective This study was aimed to assess the clinical aggressiveness of pituitary neoplasms that were previously defined as atypical adenomas.

Methods A total of 1,042 pituitary adenomas were included in the study and 101 of them were diagnosed as atypical adenoma. Demographic characteristics, radiological evaluations, and clinical information were obtained from a computer-based patient database. Cases were categorized as atypical or typical using the criteria listed in 2004 Classification of Tumors of Endocrine Organs.

Results The cure and reoperation rates did not show any statistically significant difference between the typical and atypical adenomas. However, a higher Ki-67 labeling index was found to be associated with a higher rate of reoperation (p = 0.008) in atypical adenomas. Of note, cavernous sinus invasion or parasellar extension was found to be associated with lower cure rates in patients with atypical pituitary adenomas (p < 0.001 and p = 0.001, respectively).

Conclusion Although atypical pituitary adenomas are known to be more invasive, this study demonstrated that the reoperation and cure rates are the same for typical and atypical adenomas. Our findings advocate for omitting the use of atypical adenoma terminology based solely on pathological evaluation. As stated in the 4th edition of the World Health Organization (WHO) classification, accurate tumor subtyping, evaluation of proliferation by means of mitotic count and Ki-67 labeling index, and radiological and intraoperative assessments of tumor invasion should be taken into consideration in the management of such neoplasms.

Keywords

atypical pituitary adenoma - cavernous sinus invasion - Ki-67 labeling index - typical pituitary adenoma

Note

All authors have read the manuscript and have agreed to submit it in its current form for consideration for publication in the Journal. This study is not supported by grants or contracts from federal agencies, nonprofit organizations, and/or commercial entities. E.B., İ.K., and S.A. were working in Hacettepe University, Ankara, Turkey, during the preparation of the this manuscript.


Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.




Publication History

Received: 07 June 2019

Accepted: 10 January 2020

Article published online:
20 February 2020

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