title: Clinicopathological correlates of extrasellar growth patterns in pituitary adenomas.
abstract: We reviewed clinical, imaging and histopathology details of 297 patients who underwent surgery for pituitary adenomas, with an equal distribution of functional and non-functioning tumors, to examine clinicopathological correlates of extrasellar growth. Knosp grades of 3 and 4 on MRI defined cavernous sinus invasion, Hardy grades of C and D defined significant suprasellar/subfrontal extension, and intraoperative evidence of tumor eroding through the clivus or sellar floor defined infrasellar invasion. Disease status at follow-up was known in 246 patients overall, including 35 patients who were evaluated for progression of residual disease on serial imaging. On univariate analysis, we found several statistically significant associations (p < 0.05) including adenoma size with age, sex and tumor protein p53 reactivity; cavernous sinus invasion with size, non-functional status, increased mitotic activity, an elevated MIB-1 proliferation index and p53 reactivity; suprasellar/subfrontal extension with p53 reactivity; and infrasellar invasion with age and tumor size. When adjusting for confounders with logistic regression, several significant associations were evident including adenoma size with male sex and p53 reactivity; cavernous sinus invasion with size and elevated MIB-1 proliferation index; suprasellar/subfrontal extension with p53 reactivity; and infrasellar invasion with adenoma size alone. Patients with early progression of postoperative residual tumor were younger with a non-significant trend towards higher MIB-1 proliferation indices. Individual patterns of extrasellar growth in pituitary adenomas are associated with unique clinical and immunohistochemical profiles. Younger patients with elevated MIB-1 values are probably at high risk for early recurrence of non-functioning tumors. Definitions of atypia must be standardized before more robust assumptions about tumor biology can be established.
authors.affiliation: Neurosurgery Section, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Sauradeep
authors.initials: S
authors.lastname: Sarkar
authors.affiliation: Neurosurgery Section, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Ari G
authors.initials: AG
authors.lastname: Chacko
authors.affiliation: Neuropathology Section, Department of Neurological Sciences, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India. Electronic address: geetachacko@cmcvellore.ac.in.
authors.forename: Geeta
authors.initials: G
authors.lastname: Chacko
mesh_terms: D000236:Adenoma / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000375:Aging; D002426:Cavernous Sinus / Q000473:pathology; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D018365:Neoplasm, Residual; D010911:Pituitary Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D012658:Sella Turcica / Q000473:pathology; D012727:Sex Characteristics; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000235:genetics
chemical_list: D016159:Tumor Suppressor Protein p53
keywords: Atypical adenoma; Biological aggression; Extrasellar invasion; MIB-1; Mitotic activity; p53