Joao Paulo Almeida1, Corbin C Stephens2, Jennifer M Eschbacher3, Michelle M Felicella3, Kevin C J Yuen4, William L White2, Michael A Mooney2, Anne Laure Bernat1, Ozgur Mete5, Gelareh Zadeh1, Fred Gentili1, Andrew S Little6,7. 1. Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. 2. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA. 3. Department of Neuropathology, Barrow Neurological Institute, Phoenix, AZ, USA. 4. Department of Neuroendocrinology, Barrow Neurological Institute, Phoenix, AZ, USA. 5. Laboratory Medicine Program, Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada. 6. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA. Neuropub@barrowneuro.org. 7. c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA. Neuropub@barrowneuro.org.
Abstract
PURPOSE: The 2017 World Health Organization classification of pituitary tumors redefined pituitary null cell adenomas (NCAs) by restricting this diagnostic category to pituitary tumors that are negative for pituitary transcription factors and adenohypophyseal hormones. The clinical behavior of this redefined entity has not been widely studied, and this is a major shortcoming of the classification. This study evaluated the imaging and clinical features of NCAs from two pituitary centers and compared them with those of gonadotroph adenomas (GAs). METHODS: Imaging, pathologic, and clinical characteristics of NCAs and GAs were retrospectively reviewed. Tumor immunohistochemistry was performed to confirm absence of adenohypophyseal hormones and pituitary transcription factor expression. RESULTS: Thirty-one NCAs were compared with 38 GAs. NCAs were more likely to invade the cavernous sinus (15/31 [48%] vs. 5/38 [13%], P = .003) and had a higher proliferative index (i.e., MIB-1 > 3%, 11/31 [35%] vs. 5/38 [13%], P = .04). Gross total resection was less likely in the NCA group (19/31 [61%] vs. 33/38 [87], P = .02). Progression-free survival was worse in the NCA cohort (5-year progression-free survival, 0.70 vs. 1.00; P = .011, by log-rank test). CONCLUSIONS: Compared with GAs, NCAs are more invasive at the time of presentation and have a more aggressive clinical course. This study provides evidence that NCAs represent a distinct clinicopathologic entity with behavior that differs adversely from that of GAs. This may inform clinical decision-making, including frequency of postoperative tumor surveillance and timing of adjunctive treatments.
PURPOSE: The 2017 World Health Organization classification of pituitary tumors redefined pituitary null cell adenomas (NCAs) by restricting this diagnostic category to pituitary tumors that are negative for pituitary transcription factors and adenohypophyseal hormones. The clinical behavior of this redefined entity has not been widely studied, and this is a major shortcoming of the classification. This study evaluated the imaging and clinical features of NCAs from two pituitary centers and compared them with those of gonadotroph adenomas (GAs). METHODS: Imaging, pathologic, and clinical characteristics of NCAs and GAs were retrospectively reviewed. Tumor immunohistochemistry was performed to confirm absence of adenohypophyseal hormones and pituitary transcription factor expression. RESULTS: Thirty-one NCAs were compared with 38 GAs. NCAs were more likely to invade the cavernous sinus (15/31 [48%] vs. 5/38 [13%], P = .003) and had a higher proliferative index (i.e., MIB-1 > 3%, 11/31 [35%] vs. 5/38 [13%], P = .04). Gross total resection was less likely in the NCA group (19/31 [61%] vs. 33/38 [87], P = .02). Progression-free survival was worse in the NCA cohort (5-year progression-free survival, 0.70 vs. 1.00; P = .011, by log-rank test). CONCLUSIONS: Compared with GAs, NCAs are more invasive at the time of presentation and have a more aggressive clinical course. This study provides evidence that NCAs represent a distinct clinicopathologic entity with behavior that differs adversely from that of GAs. This may inform clinical decision-making, including frequency of postoperative tumor surveillance and timing of adjunctive treatments.
Authors: Leonardo Vieira; Cesar L Boguszewski; Luiz Antônio de Araújo; Marcello D Bronstein; Paulo Augusto C Miranda; Nina R de C Musolino; Luciana A Naves; Lucio Vilar; Antônio Ribeiro-Oliveira; Mônica R Gadelha Journal: Arch Endocrinol Metab Date: 2016-08 Impact factor: 2.309
Authors: Leonard Y M Cheung; Shannon W Davis; Michelle L Brinkmeier; Sally A Camper; María Inés Pérez-Millán Journal: Mol Cell Endocrinol Date: 2016-09-17 Impact factor: 4.102
Authors: William C McDonald; Nilanjana Banerji; Kelsey N McDonald; Bridget Ho; Virgilia Macias; Andre Kajdacsy-Balla Journal: Arch Pathol Lab Med Date: 2016-05-26 Impact factor: 5.534
Authors: Ajay Chatrath; Jacob Kosyakovsky; Parantap Patel; Jungeun Ahn; Mazin Elsarrag; Lena C Young; Angela Wu; Jennifer D Sokolowski; Davis Taylor; John A Jane; M Beatriz S Lopes Journal: Pituitary Date: 2022-10-19 Impact factor: 3.599
Authors: Ashley B Grossman; Shereen Ezzat; Sylvia L Asa; Ozgur Mete; Michael D Cusimano; Ian E McCutcheon; Arie Perry; Shozo Yamada; Hiroshi Nishioka; Olivera Casar-Borota; Silvia Uccella; Stefano La Rosa Journal: Mod Pathol Date: 2021-05-21 Impact factor: 7.842