Amy A Swanson1, Dana Erickson2, Diane Mary Donegan2,3, Sarah M Jenkins4, Jamie J Van Gompel5, John L D Atkinson5, Bradley J Erickson6, Caterina Giannini7,8. 1. Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA. 2. Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, MN, USA. 3. Division of Endocrinology, Diabetes and Metabolism, Indiana University, Indianapolis, IN, USA. 4. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. 5. Division of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA. 6. Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA. 7. Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA. Giannini.Caterina@mayo.edu. 8. Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Giannini.Caterina@mayo.edu.
Abstract
PURPOSE: Growth hormone-producing pituitary adenomas are divided into two clinically relevant histologic subtypes, densely (DG-A) and sparsely (SG-A) granulated. Histologic subtype was evaluated in a large cohort of patients with acromegaly, separating DG-A and SG-A, and correlated with clinicopathological characteristics. METHODS: Patients with acromegaly undergoing surgery as initial therapy between 1995 and 2015 were identified. Histologic subtype was determined by keratin expression pattern with CAM5.2 and correlated with clinical and imaging parameters, somatostatin receptor subtype 2 (SST2) expression, post-surgical remission rate, and application of a prognostic scoring system incorporating proliferation and invasiveness. RESULTS: One hundred thirty-one patients were included. Tumors were classified as DG-A (75, 57.3%), SG-A (29, 22.1%), intermediate (I-A) (9, 6.9%), and unclassified (18, 13.7%) when CAM5.2 was negative. DG-A and I-A were combined for analysis (DG/I-A) and compared to SG-A. Age, gender, proliferation, and post-surgical remission did not differ. SG-A were larger [2 vs. 1.5 cm (median), p = 0.03], more frequently invasive [65.5% vs. 32.9%, p = 0.004], associated with higher MRI T2-weighted signal ratio [1.01 vs. 0.82 (median), p = 0.01], showed lower SST2 expression (p < 0.0001), and scored higher in the prognostic classification (p = 0.004). Surgical remission occurred in 41.7% DG/I-A and 41.4% SG-A (p = 1.0). On multivariate analysis, absence of invasion (p = 0.009) and lower pre-operative IGF-1 index (p = 0.0002) were associated with post-surgical remission. CONCLUSION: CAM5.2 allowed distinction between DG/I-A and SG-A in most but not all cases. Histologic subtype did not predict surgical outcome. Absence of invasion and lower pre-operative IGF-1 index were the only significant predictors of post-surgical remission in this cohort.
PURPOSE:Growth hormone-producing pituitary adenomas are divided into two clinically relevant histologic subtypes, densely (DG-A) and sparsely (SG-A) granulated. Histologic subtype was evaluated in a large cohort of patients with acromegaly, separating DG-A and SG-A, and correlated with clinicopathological characteristics. METHODS:Patients with acromegaly undergoing surgery as initial therapy between 1995 and 2015 were identified. Histologic subtype was determined by keratin expression pattern with CAM5.2 and correlated with clinical and imaging parameters, somatostatin receptor subtype 2 (SST2) expression, post-surgical remission rate, and application of a prognostic scoring system incorporating proliferation and invasiveness. RESULTS: One hundred thirty-one patients were included. Tumors were classified as DG-A (75, 57.3%), SG-A (29, 22.1%), intermediate (I-A) (9, 6.9%), and unclassified (18, 13.7%) when CAM5.2 was negative. DG-A and I-A were combined for analysis (DG/I-A) and compared to SG-A. Age, gender, proliferation, and post-surgical remission did not differ. SG-A were larger [2 vs. 1.5 cm (median), p = 0.03], more frequently invasive [65.5% vs. 32.9%, p = 0.004], associated with higher MRI T2-weighted signal ratio [1.01 vs. 0.82 (median), p = 0.01], showed lower SST2 expression (p < 0.0001), and scored higher in the prognostic classification (p = 0.004). Surgical remission occurred in 41.7% DG/I-A and 41.4% SG-A (p = 1.0). On multivariate analysis, absence of invasion (p = 0.009) and lower pre-operative IGF-1 index (p = 0.0002) were associated with post-surgical remission. CONCLUSION: CAM5.2 allowed distinction between DG/I-A and SG-A in most but not all cases. Histologic subtype did not predict surgical outcome. Absence of invasion and lower pre-operative IGF-1 index were the only significant predictors of post-surgical remission in this cohort.
Authors: Jacqueline Trouillas; Pascal Roy; Nathalie Sturm; Emmanuelle Dantony; Christine Cortet-Rudelli; Gabriel Viennet; Jean-François Bonneville; Richard Assaker; Carole Auger; Thierry Brue; Aurélie Cornelius; Henry Dufour; Emmanuel Jouanneau; Patrick François; Françoise Galland; François Mougel; François Chapuis; Laurent Villeneuve; Claude-Alain Maurage; Dominique Figarella-Branger; Gérald Raverot; A Barlier; M Bernier; F Bonnet; F Borson-Chazot; G Brassier; S Caulet-Maugendre; O Chabre; P Chanson; J F Cottier; B Delemer; E Delgrange; L Di Tommaso; S Eimer; S Gaillard; M Jan; J J Girard; V Lapras; H Loiseau; J G Passagia; M Patey; A Penfornis; J Y Poirier; G Perrin; A Tabarin Journal: Acta Neuropathol Date: 2013-02-12 Impact factor: 17.088
Authors: Diane Mary Donegan; Nicole Iñiguez-Ariza; Anu Sharma; Todd Nippoldt; William Young; Jamie Van Gompel; John Atkinson; Fredric Meyer; Bruce Pollock; Neena Natt; Nadia Laack; Dana Erickson Journal: Endocr Pract Date: 2018-07 Impact factor: 3.443
Authors: Moisés Mercado; Ana Laura Espinosa de los Monteros; Ernesto Sosa; Sonia Cheng; Victoria Mendoza; Irma Hernández; Carolina Sandoval; Gerardo Guinto; Mario Molina Journal: Horm Res Date: 2004-11-10