title: Nonfunctioning giant pituitary adenomas: Invasiveness and recurrence.
abstract: BACKGROUND
  We report our surgical series of 35 patients with giant nonfunctioning pituitary adenomas (GNFPA). We analyzed the rule of Ki-67 antigen expression in predicting recurrence.
  
  
  METHODS
  Thirty-five patients were operated between 2000 and 2010. Suprassellar extension of the tumors were classified according to Hardy and Mohr based on magnetic resonance (MR) studies. Pituitary endocrine function and MR scans were assessed preoperatively and at 1, 6, and 12 months postoperatively. Immunohistochemical studies were based in regard to the expression of the proliferative Ki-67 index and the hormonal receptor for luteinizing hormone, follicle stimulating hormone, growth hormone, thyroid stimulating hormone, adrenocorticotropic hormone, and prolactin. Tumors specimens were obtained from 35 patients with GNFPA. Endoscopic transsphenoidal surgery was the approach of choice.
  
  
  RESULTS
  Thirty-five patients were submitted to 49 surgeries, 44 (89.8%) were transsphenoidal and 5 (10.2%) were transcranial. The most frequent preoperative complaints were visual acuity impairment and visual field defect in 25 (71.2%) and 23 (65.7%) cases, respectively. Improvement of visual acuitiy and visual field deficit after surgery was seen in 20 (80%) and 17 (73.9%) patients, respectively. Endocrinological deficits were encountered in 20 patients (57.1%). After surgery, 18 patients (51.4%) required hormonal replacement. Three patients had visual symptoms related to pituitary apoplexy and recovered after surgery. The Ki-67 labeling index (LI) ranged from <1% to 4.8%. The rate of recurrence in tumors with Ki-67 <3% was 7.7% (2 patients), Ki-67 >3% was present in 5 patients and the recurrence committed 3 patients.
  
  
  CONCLUSIONS
  In our series, regardless the improvement of visual function and compressing symptoms, 5 patients with expression of Ki-67 LI more than 3% experienced a recurrence.
authors.affiliation: Department of Neurosurgery, Hospital Universitário Antônio Pedro, Rio de Janeiro, Brazil.
authors.forename: José Alberto
authors.initials: JA
authors.lastname: Landeiro
authors.affiliation: Department of Pathology, Hospital Universitário Antônio Pedro, Rio de Janeiro, Brazil.
authors.forename: Elissa Oliveira
authors.initials: EO
authors.lastname: Fonseca
authors.affiliation: Department of Pathology, Hospital Universitário Antônio Pedro, Rio de Janeiro, Brazil.
authors.forename: Andrea Lima Cruz
authors.initials: AL
authors.lastname: Monnerat
authors.affiliation: Department of Endrocrinology, Hospital Universitário Antônio Pedro, Rio de Janeiro, Brazil.
authors.forename: Giselle Fernandes
authors.initials: GF
authors.lastname: Taboada
authors.affiliation: Department of Neurosurgery, Galeão Air Force Hospital, Rio de Janeiro, Brazil.
authors.forename: Gustavo Augusto Porto Sereno
authors.initials: GA
authors.lastname: Cabral
authors.affiliation: Department of Pathology, Hospital Universitário Antônio Pedro, Rio de Janeiro, Brazil.
authors.forename: Felippe
authors.initials: F
authors.lastname: Antunes
keywords: Invasiveness; Ki-67; pituitary adenoma; recurrence