title: Atypical pituitary adenomas: clinical characteristics and role of ki-67 and p53 in prognostic and therapeutic evaluation. A series of 50 patients.
abstract: The aim of the study was to assess incidence rate, hormonal activity, and local invasiveness and evaluate outcomes of so-diagnosed atypical pituitary adenomas that underwent endoscopic endonasal surgery at the Division of Neurosurgery of Università degli Studi di Napoli Federico II. According to the 2004 WHO classification, atypical pituitary adenomas are defined by an invasive growth, Ki-67/MIB-1 proliferative index greater than 3 %, high p53 immunoreactivity, and increased mitotic activity. A retrospective analysis of a series of 434 pituitary adenomas that underwent endoscopic endonasal surgery at our department between March 2007 and February 2013 was performed. Fifty adenomas (11.5 %) met the criteria of diagnosis of atypical lesions; 10 (21.6 %) of the 50 patients were recurrent tumors with a previous transsphenoidal surgery. Forty-one (82 %) were macroadenomas, and 21/50 (42 %) showed a clear invasion of the cavernous sinus. Histotype of atypical adenomas figured out to be nonfunctioning in 23 cases (46 %), PRL secreting in 10 cases (20 %), ACTH secreting and GH secreting each apart in 8 patients (16 %), and in a single case a GH/PRL secreting adenoma (2 %). The Ki-67 labeling index ranged from 3.5 to 22.5 % (mean 5.6 %). Tumor recurrence was observed in six cases (12 %) after a mean time of 18 months (range 9-24 months). Mean follow-up was 36.5 months (range 2-80 months). Atypical pituitary adenomas account for ca. 10 % of all pituitary adenomas; these lesions have peculiar features. It should be considered that a strong immunopositivity of p53 and higher Ki-67 LI could predict an increased risk of tumor recurrence, but more studies and larger series are expected to confirm and enlarge the diagnostic and therapeutic management process of these lesions.
authors.affiliation: Department of Biomorphological and Functional Sciences, Division of Pathology and Cytopathology, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Marialaura
authors.initials: M
authors.lastname: Del Basso De Caro
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy. domenico.solari@unina.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: Solari
authors.affiliation: Department of Biomorphological and Functional Sciences, Division of Pathology and Cytopathology, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pagliuca
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Villa
authors.affiliation: Department of Biomorphological and Functional Sciences, Division of Pathology and Cytopathology, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Elia
authors.initials: E
authors.lastname: Guadagno
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Luigi Maria
authors.initials: LM
authors.lastname: Cavallo
authors.affiliation: Department of Clinical Medicine and Surgery, Division of Endocrinology, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
authors.affiliation: Department of Biomorphological and Functional Sciences, Division of Pathology and Cytopathology, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Pettinato
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism; D055815:Young Adult
chemical_list: D019394:Ki-67 Antigen; C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53
keywords: Atypical pituitary adenoma; Endoscopic endonasal approach; Ki-67; Transsphenoidal surgery; p53