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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Correlation between histological subtypes and MRI findings in clinically nonfunctioning pituitary adenomas
Hiroshi Nishioka1, Naoko Inoshita, Toshiaki Sano
1Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan. nishioka@tokyo-med.ac.jp
Endocrine Pathology
|May 10, 2012
Summary
Clinically nonfunctioning pituitary adenomas (CNFPAs) subtypes like silent corticotroph adenomas (SCA) and other silent adenomas (OSA) are more frequent in large, invasive tumors and younger patients. These subtypes are less common in older patients without specific MRI findings.
Area of Science:
- Endocrinology
- Neurosurgery
- Radiology
Background:
- Clinically nonfunctioning pituitary adenomas (CNFPAs) encompass diverse histological subtypes, including null cell adenoma (NCA), silent gonadotroph cell adenoma (SGA), silent corticotroph adenoma (SCA), and other silent adenomas (OSA).
- Understanding the relationship between imaging characteristics and histological subtypes is crucial for diagnosis and treatment planning.
Purpose of the Study:
- To investigate correlations between specific magnetic resonance imaging (MRI) findings and the histological subtypes of clinically nonfunctioning pituitary adenomas (CNFPAs).
Main Methods:
- Retrospective analysis of 390 consecutive CNFPA patients who underwent surgery between 2008 and 2010.
- Classification of adenomas into NCA/SGA, SCA, and OSA groups.
- Evaluation of MRI findings such as tumor size, cavernous sinus invasion (Knosp grade), suprasellar configuration, and MIB-1 index.
Main Results:
- Giant adenoma (>40 mm), marked cavernous sinus invasion (Knosp grade 4), and lobulated suprasellar configuration were significantly less common in NCA/SGA compared to SCA and OSA (P < 0.0001).
- In patients over 40 years old with negative specific MRI findings, 91.0% were diagnosed with NCA/SGA.
- SCA frequently exhibited these MRI findings despite a low MIB-1 index, while OSA showed a high MIB-1 index and a higher prevalence in younger patients.
Conclusions:
- While SCA and OSA constitute 20% of CNFPAs, their incidence increases significantly with large, invasive, lobulated tumors and in patients younger than 40 years.
- Specific MRI features can help differentiate less common CNFPA subtypes (SCA, OSA) from more frequent ones (NCA/SGA), particularly in younger individuals.
