title: Growth patterns of pituitary adenomas and histopathological correlates.
abstract: BACKGROUND
  The factors associated with pituitary adenoma (PA) growth rate remain unclear.
  
  
  OBJECTIVE
  The objective of the study was to establish whether the preoperative growth and extension pattern of PA can predict postoperative growth rate and recurrence in addition to whether the PA growth rate correlates with proliferation and growth factor expression.
  
  
  METHODS
  One hundred fifty-three consecutive patients who underwent surgery for pituitary adenoma from 1999 to 2011 at Toronto Western Hospital were identified.
  
  
  METHODS
  The PA growth rate was measured both pre- and postoperatively, and its association with patient demographics, magnetic resonance imaging, and histolopathological parameters was determined.
  
  
  RESULTS
  The preoperative growth rate was associated with age (P = .0001), suprasellar growth (P = .003), the presence of a cyst/hemorrhage (P = .004), the mindbomb homolog-1 (P = .005), fibroblast growth factor receptor-4 positivity (P = .047), and p27 negativity (P = .007). After surgery, there were 34.6% residual volumes, which were associated with older age (P = .038) and also with growth patterns including anterior, posterior, suprasellar, and cavernous sinus extension (P = .001); 43.3% of these residuals grew and postoperative growth rate was calculated. Pre- and postoperative growth rates were correlated (r = 0.497, P = .026). Postoperative growth rate was associated with age (P = .015) and gender (P = .017).
  
  
  CONCLUSIONS
  Our data suggest that the growth rate of PAs are influenced by various patient- and tumor-specific characteristics including the age and sex of the patient, the specific subtype of PA, its hormonal activity, its immunohistochemical profile including the mindbomb homolog 1 labeling index status, and its preponderance for different growth directions relative to the pituitary fossa. Furthermore, the pre- and postoperative PA growth rates were correlated, suggesting that postoperative PA growth rates can be predicted, in part, by preoperative growth rates, thus better informing postoperative outcome.
authors.affiliation: Institute of Medical Science (E.M., S.E., G.Z.) and Department of Laboratory Medicine and Pathobiology (O.M.), University of Toronto, Toronto, Canada M5T 2S8; Divisions of Neurosurgery (E.M., S.L., B.L.G., K.J., F.C., F.G., G.Z.) and Division of Radiology (W.K.), and Departments of Medicine (S.E.) and Pathology (O.M.), University Health Network, Toronto, Canada M5G 2C4; and Division of Neurosurgery (A.K.), Hospital for Sick Children, Toronto, Canada M5G 1X8.
authors.forename: Eric
authors.initials: E
authors.lastname: Monsalves
authors.forename: Soroush
authors.initials: S
authors.lastname: Larjani
authors.forename: Bruno
authors.initials: B
authors.lastname: Loyola Godoy
authors.forename: Kyle
authors.initials: K
authors.lastname: Juraschka
authors.forename: Felipe
authors.initials: F
authors.lastname: Carvalho
authors.forename: Walter
authors.initials: W
authors.lastname: Kucharczyk
authors.forename: Abhaya
authors.initials: A
authors.lastname: Kulkarni
authors.forename: Ozgur
authors.initials: O
authors.lastname: Mete
authors.forename: Fred
authors.initials: F
authors.lastname: Gentili
authors.forename: Shereen
authors.initials: S
authors.lastname: Ezzat
authors.forename: Gelareh
authors.initials: G
authors.lastname: Zadeh
mesh_terms: D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D049109:Cell Proliferation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D018365:Neoplasm, Residual; D010911:Pituitary Neoplasms / Q000473:pathology* / Q000601:surgery; D057234:Preoperative Period; D011379:Prognosis; D047368:Tumor Burden