title: Aggressive pituitary adenomas--diagnosis and emerging treatments.
abstract: The WHO categorizes pituitary tumours as typical adenomas, atypical adenomas and pituitary carcinomas, with typical adenomas constituting the major class. However, the WHO classification does not provide an accurate correlation between histopathological findings and clinical behaviour. Tumours lacking typical histological features are classified as atypical, but not all are clinically atypical or exhibit aggressive behaviour. Pituitary carcinomas, by definition, have craniospinal or systemic metastases, although not all display classical cytological features of malignancy. Aggressive pituitary adenomas, defined from a clinical perspective, have earlier and more frequent recurrences and can be resistant to conventional treatments. Specific biomarkers have not yet been identified that can distinguish between clinically aggressive and nonaggressive pituitary adenomas, although the antigen Ki-67 proliferation index might be of value. This Review highlights the need to develop new biomarkers to facilitate the early detection of clinically aggressive pituitary adenomas and discusses emerging markers that hold promise for their identification. Defining aggressiveness is of crucial importance for improving the management of patients by enhancing prognostic predictions and effectiveness of treatment. New drugs, such as temozolomide, have potential use in the management of these patients; anti-VEGF therapy, mTOR and tyrosine kinase inhibitors are also potentially useful in managing selected patients.
authors.affiliation: Department of Surgery, Division of Neurosurgery, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Ieva
authors.affiliation: Department of Laboratory Medicine, Division of Pathology, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
authors.forename: Fabio
authors.initials: F
authors.lastname: Rotondo
authors.affiliation: Department of Neurosurgery, Hospital Pablo Tobón Uribe and Clínica Medellín, Calle 54 #46-27, Cons 501, Medellín, Colombia.
authors.forename: Luis V
authors.initials: LV
authors.lastname: Syro
authors.affiliation: Department of Surgery, Division of Neurosurgery, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cusimano
authors.affiliation: Department of Laboratory Medicine, Division of Pathology, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
authors.forename: Kalman
authors.initials: K
authors.lastname: Kovacs
mesh_terms: D000236:Adenoma / Q000473:pathology; D014408:Biomarkers, Tumor / Q000032:analysis; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D019394:Ki-67 Antigen / Q000032:analysis; D009361:Neoplasm Invasiveness; D009389:Neovascularization, Pathologic / Q000503:physiopathology; D010911:Pituitary Neoplasms / Q000235:genetics / Q000473:pathology* / Q000628:therapy*; D000077204:Temozolomide; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen; D016159:Tumor Suppressor Protein p53; D003606:Dacarbazine; D000077204:Temozolomide