title: Evaluation of Aggressive Behavior and Invasive Features of Pituitary Adenomas Using Radiological, Surgical, Clinical and Histopathological Markers.
abstract: OBJECTIVE
  Total surgical resection of pituitary macroadenomas is difficult due to the location of the adenoma and the propensity to invade surrounding tissues. The purpose of this study was to evaluate the risk factors for invasive and aggressive pituitary macroadenomas using radiological, hormonal, clinical, and immunohistochemical markers.
  
  
  METHODS
  Seventy cases of pituitary macroadenoma were examined. Age, gender, symptoms, the presence of fibrosis within the adenoma, hormonal levels, radiological findings, pathological results and immunohistochemical staining of the patients were evaluated using statistical methods.
  
  
  RESULTS
  We observed that the patients with macroadenomas in our study most frequently presented during their 5th decade. The most frequent pituitary adenomas were non-functional, GH-secreting and PRL-secreting macroadenomas. The most frequent complaint was vision loss, headache and acral growth. Based on Magnetic Resonance Imaging (MRI) results, it was observed that the degree of invasion into surrounding tissues increased as the size of the macroadenoma increased. Macroadenomas that had invaded into the cavernous sinus invasion or that had a fibrotic tumor structure had a low probability of being resectable. There were no significant relationships between invasive behavior and p53, telomerase, ghrelin and CD46.
  
  
  CONCLUSIONS
  It is not possible to identify only one factor that affects the prognosis of patients with pituitary macroadenomas. The contribution of the experience of surgeon to the treatment is surely beyond dispute. Fibrotic tumor structure, the surgical technique, the type of hormone, and cavernous sinus invasion affect the ability to perform a total resection and the overall prognosis.
authors.affiliation: Erciyes University, School of Medicine, Department of Neurosurgery, Kayseri, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kucuk
authors.forename: Fahri
authors.initials: F
authors.lastname: Bayram
authors.forename: Figen
authors.initials: F
authors.lastname: Ozturk
authors.forename: Abdulfettah
authors.initials: A
authors.lastname: Tumturk
authors.forename: Halit
authors.initials: H
authors.lastname: Diri
authors.forename: Sukru
authors.initials: S
authors.lastname: Oral
authors.forename: Bulent
authors.initials: B
authors.lastname: Tucer
authors.forename: Ahmet Candan
authors.initials: AC
authors.lastname: Durak
authors.forename: Ali
authors.initials: A
authors.lastname: Kurtsoy
mesh_terms: D000236:Adenoma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002426:Cavernous Sinus / Q000473:pathology; D005260:Female; D054439:Ghrelin / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D051916:Membrane Cofactor Protein / Q000378:metabolism; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D012307:Risk Factors; D019098:Telomerase / Q000378:metabolism; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D054439:Ghrelin; D051916:Membrane Cofactor Protein; D016159:Tumor Suppressor Protein p53; D019098:Telomerase