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Implications of the World Health Organization definition of atypia on surgically treated functional and non-functional pituitary adenomas

  • Original Article - Brain Tumors
  • Published:
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Abstract

Background

The World Health Organization (WHO) defines atypical pituitary adenomas as tumours with a MIB-1 labelling index ≥3%, p53 positivity and increased mitotic activity. Although a few reports have described the clinical and radiological correlates of atypia in pituitary adenomas, its impact on postoperative outcomes is not clearly defined.

Method

We reviewed preoperative and postoperative records of patients undergoing surgery for pituitary adenomas. Postoperative outcomes for functional adenomas (FPAs) were assessed according to contemporary definitions of remission and recurrence. For non-functional pituitary adenomas (NFPAs), extent of resection and disease progression were defined on the basis of postoperative magnetic resonance imaging.

Results

Of 394 patients included for analysis, 29 cases (7.4%) fulfilled criteria for atypia. Patients with atypical tumours were significantly younger than those with typical adenomas. Remission was possible in 47.4% of FPAs, and was unrelated to the presence of atypia. In NFPAs, local invasiveness was negatively associated with extent of resection (OR, 0.255; 95% CI, 0.086–0.753; p < 0.001). In 93 NFPAs followed postoperatively with serial imaging over a mean duration of 37.5 months, disease progression/recurrence was significantly associated with the presence of atypia (OR, 5.058; 95% CI, 1.273–20.098; p = 0.021) on multivariate analysis.

Conclusions

Patients with atypical non-functional pituitary adenomas are at risk for postoperative recurrence and disease progression, suggesting a need for adjuvant therapy. However, only a small fraction of pituitary tumours demonstrate atypia, as defined by the WHO, limiting its clinical utility.

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Authors and Affiliations

  1. Department of Neurological Sciences, Christian Medical College, Vellore, India

    Sauradeep Sarkar, Vinu Joe Philip, Sai Kiran Cherukuri & Ari George Chacko

  2. Section of Neuropathology, Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Geeta Chacko

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  1. Sauradeep Sarkar
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Correspondence to Geeta Chacko.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

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Sarkar, S., Philip, V.J., Cherukuri, S.K. et al. Implications of the World Health Organization definition of atypia on surgically treated functional and non-functional pituitary adenomas. Acta Neurochir 159, 2179–2186 (2017). https://doi.org/10.1007/s00701-017-3223-z

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  • DOI: https://doi.org/10.1007/s00701-017-3223-z

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