title: Aggressive Pituitary Adenomas: The Dark Side of the Moon.
abstract: BACKGROUND
  Although pituitary adenomas are considered benign lesions, a small group may show clinically aggressive behavior, sometimes independently from the classic markers of aggressiveness, including the Ki67 labeling index or p53 expression.
  
  
  METHODS
  We selected 7 patients harboring a pituitary tumor with clinical features of aggressiveness. Patients underwent a full preoperative and postoperative endocrinologic and neuroradiologic workup. Two were nonfunctioning, 2 prolactin-secreting, 2 adrenocorticotrophic hormone-secreting, and 1 a growth hormone-secreting adenoma.
  
  
  RESULTS
  The 7 patients underwent a total of 17 surgical procedures. At the first surgical procedure, gross total removal was achieved in none of the patients, whereas subtotal removal (>90% of tumor removed) was achieved in 4/7 cases and partial removal (<90% of tumor removed) in 3/7 cases. At first operation, 4/7 patients showed a Ki67 index ≤3% and 2/7 >3%; this information was not available for 1 patient. Postoperatively, all patients underwent radiation therapy. Three patients received chemotherapy with temozolomide. Three patients underwent peptide receptor radionuclide therapy. To date, 1 patient has died of tumor progression, and 2 patients are in a poor general condition. The remaining 4 patients are in a fair/good condition, without any major complaints. The mean follow-up is 43.42 months.
  
  
  CONCLUSIONS
  Aggressive pituitary adenomas represent a specific and still underestimated entity, often diagnosed late. Clinical and neuroradiologic rapid progression is often the only marker of aggressiveness. Surgical debulking remains the first therapeutic option. Multidisciplinary management is mandatory to offer these patients targeted therapeutic options.
authors.affiliation: Division of Neurosurgery, Department of Biomedical and Dental Sciences, and Morpho-Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Stefano M
authors.initials: SM
authors.lastname: Priola
authors.affiliation: Division of Neurosurgery, Department of Biomedical and Dental Sciences, and Morpho-Functional Imaging, University of Messina, Messina, Italy. Electronic address: felice.esposito@unime.it.
authors.forename: Felice
authors.initials: F
authors.lastname: Esposito
authors.affiliation: Division of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cannavò
authors.affiliation: Division of Neurosurgery, Department of Biomedical and Dental Sciences, and Morpho-Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Conti
authors.affiliation: Division of Neurosurgery, Department of Biomedical and Dental Sciences, and Morpho-Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Rosaria V
authors.initials: RV
authors.lastname: Abbritti
authors.affiliation: Division of Pathology, Department of Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Barresi
authors.affiliation: Division of Nuclear Medicine, Department of Biomedical and Dental Sciences, and Morpho-Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Baldari
authors.affiliation: Division of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ferraù
authors.affiliation: Division of Neurosurgery, Department of Biomedical and Dental Sciences, and Morpho-Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Germanò
authors.affiliation: Division of Neurosurgery, Department of Biomedical and Dental Sciences, and Morpho-Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tomasello
authors.affiliation: Division of Neurosurgery, Department of Biomedical and Dental Sciences, and Morpho-Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Filippo F
authors.initials: FF
authors.lastname: Angileri
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D019394:Ki-67 Antigen / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011183:Postoperative Complications; D011878:Radiotherapy; D012189:Retrospective Studies; D000077204:Temozolomide; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism
chemical_list: D018906:Antineoplastic Agents, Alkylating; D019394:Ki-67 Antigen; D016159:Tumor Suppressor Protein p53; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Aggressive adenomas; Chemotherapy; Endoscopic endonasal approach; Multidisciplinary management; Pituitary tumors; Radiotherapy