Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Strategy for Management of Giant Invasive Pituitary Adenoma

  • Yang, Hee-Seok (Department of Neurosurgery, College of Medicine, Yeungnam University) ;
  • Kim, Oh-Lyong (Department of Neurosurgery, College of Medicine, Yeungnam University) ;
  • Kim, Min-Soo (Department of Neurosurgery, College of Medicine, Yeungnam University) ;
  • Kim, Sang-Woo (Department of Neurosurgery, College of Medicine, Yeungnam University) ;
  • Chang, Chul-Hun (Department of Neurosurgery, College of Medicine, Yeungnam University) ;
  • Cho, Soo-Ho (Department of Neurosurgery, College of Medicine, Yeungnam University)
  • Published : 2005.01.31
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Abstract

Objective: Giant invasive pituitary adenoma looks histologically benign, but these tumors have an aggressive clinical course. The authors review 10 cases and discuss the results obtained and the strategy to use for the management of giant invasive pituitary adenoma. Methods: Out of a series of 155 pituitary adenomas treated surgically between 1994 and 2002, ten patients with giant invasive pituitary adenoma were selected and their clinical problems, radiologic findings, extent and invasiveness, hormonal and histologic findings and surgical results were analyzed retrospectively. Results: There were 4 male and 6 female patients, with an average age of 47 years and an average follow-up period of 42 months. The average size of tumor was 50.7mm. These tumors revealed severe invasions into surrounding structures. 8 patients underwent transsphenoidal approach(TSA) operations, 1 patient with transcranial operation and 1 patient with combined TSA and transcranial operation. In all cases, subtotal resection was performed. The histologic findings were 2 prolactinomas and 3 hormonal non-function adenomas. The therapies administered after surgical removal consisted of conventional fractionated radiotherapy (2 patients), treatment with dopamine agonists to control hyperprolactinemia (2 patients), and treatment with hormone replacement (2 patients). Conclusion: Giant invasive pituitary adenomas are characterized by different forms of expansion and invasiveness and variable clinical problems. Because of their aggressive expansion and invasiveness, there are many different strategies which can be considered for their management. The authors obtain good results by choosing conservative surgical removal and multidisciplinary treatments with serial radiological and hormonal follow-up.

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References

  1. Ali FK : Pituitary disorders : comprehensive management. Baltimore : Lippincott Williams & Wilkins, 1999, pp 287-294
  2. Bjorn PM, Maria-Beatriz SL, Dilantha BE, Tord DA, Edward RL : The long-term significance of microscopic dural invasion in 354 patients with pituitary adenomas treated with transsphenoidal surgery. J Neurosurgery 96 : 195-208, 2002 https://doi.org/10.3171/jns.2002.96.2.0195
  3. Comtois R, Beauregard H, Somma M : The clinical and endocrine outcome to transsphenoidal microsurgery of nonsecreting pituitary adenomas. Cancer 68 : 860-866, 1991 https://doi.org/10.1002/1097-0142(19910815)68:4<860::AID-CNCR2820680431>3.0.CO;2-4
  4. Goel A, Nadkarni T, Muzumdar D, Desai K, Phalke U, Sharma P : Giant pituitary tumors : a study based on surgical treatment of 118 cases. Surg Neurol 61 : 436-445, 2004 https://doi.org/10.1016/j.surneu.2003.08.036
  5. Hardy J : Transsphenoidal surgery of hypersecreting pituitary tumors, in Kohler PO, Ross GT(eds) : Diagnosis and Treatment of pituitary Tumors. Amsterdam : Excepta Medica, 1973, pp179-194
  6. Hashimoto N, Handa H, Yamashita J, Yamagami T : Long-term follow-up of large or invasive pituitary adenoma. Surg Neurol 25 : 49-54, 1986 https://doi.org/10.1016/0090-3019(86)90109-6
  7. Jefferson G : Extrasella extensions of pituitary adenomas. Proc Roy Soc Med 33 : 433-458, 1939
  8. LEE DH, Jeon BC : Deliberate two-staged endoscopic endonasal transsphenoidal surgery in large pituitary adenomas. J Korean Neurosurg Soc 31 : 435-444, 2002
  9. Pernicone PJ, Scheithauer BW : Invasive pituitary adenomas and pituitary carcinomas, in Lloyd RV(ed) : Surgical Pathology of the pituitary gland. Philadelphia : WB Saunders, 1993, pp 121-136
  10. Pia HW, Grote E, Hilderbrandt G : Giant pituitary adenomas. Neurosurg Rev 8 : 207-220, 1985 https://doi.org/10.1007/BF01815445
  11. Sautner D, Saeger W : Invasiveness of pituitary adenomas. Pathol Res Pract 187 : 632-636, 1991 https://doi.org/10.1016/S0344-0338(11)80161-5
  12. Scheithauer BW, Kovasc KT, Laws ER Jr : Pathology of invasive pituitary tumors with special reference to functional classification. J Neurosurg 65 : 733-744, 1986 https://doi.org/10.3171/jns.1986.65.6.0733
  13. Selman ER, Laws ER Jr, Scheithauer BW : The occurrence of dural invasion in pituitary adenomas. J Neurosurg 64 : 402-407, 1986 https://doi.org/10.3171/jns.1986.64.3.0402