Turkish Neurosurgery 2016 , Vol 26 , Num 5
Evaluation of Aggressive Behavior and Invasive Features of Pituitary Adenomas Using Radiological, Surgical, Clinical and Histopathological Markers
Ahmet KUCUK1, Fahri BAYRAM2, Figen OZTURK3, Abdulfettah TUMTURK1, Halit DIRI2, Sukru ORAL1, Bulent TUCER1, Ahmet Candan DURAK4, Ali KURTSOY1
1Erciyes University, School of Medicine, Department of Neurosurgery, Kayseri, Turkey
2Erciyes University, School of Medicine, Department of Endocrinology, Kayseri, Turkey
3Erciyes University, School of Medicine, Department of Pathology, Kayseri, Turkey
4Erciyes University, School of Medicine, Department of Radiology, Kayseri, Turkey
DOI : 10.5137/1019-5149.JTN.13161-14.2 AIM: 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.

MATERIAL and 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.

CONCLUSION: 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. Keywords : Pituitary adenoma, Aggressive behavior, Invasion, Immunohistochemical marker

Corresponding author : Ahmet Kucuk, drahmetkucuk@hotmail.com