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Updated: Aug 21, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Endoscopic Surgical Characteristics of Clinically Nonfunctioning Pituitary Neuroendocrine Tumors: Comparison of
Hirokazu Fukuhara1, Masahiko Tosaka2, Noriaki Fukuhara2
1Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan; Department of Human Pathology, Institute of Science Tokyo, Tokyo, Japan.
Objective:
Clinically nonfunctioning pituitary neuroendocrine tumors (PitNETs) may exhibit lineage-specific radiological and intraoperative features. This study compared the radiological and intraoperative characteristics of T-box pituitary transcription factor (TPIT)-lineage and steroidogenic factor 1 (SF1)-lineage tumors.
Methods:
Transcription factor immunohistochemistry was used to classify 164 clinically nonfunctioning PitNETs, consisting of 46 TPIT-lineage tumors and 118 SF1-lineage tumors. Clinical variables, preoperative neuroradiological findings including multiple microcysts, as well as intraoperative findings including tumor color, consistency, and invasiveness, were evaluated.
Results:
The TPIT-lineage group showed a higher proportion of female patients and a higher frequency of Knosp high-grade tumors than the SF1-lineage group. Magnetic resonance imaging demonstrated that high signal intensity on T2-weighted images and multiple microcysts were more frequently observed in the TPIT-lineage group. Intraoperative findings showed that the TPIT-lineage group more frequently exhibited cavernous sinus invasion, soft aspiratable (SA)-type consistency, dark-red color, sellar dural defects, and sphenoid sinus extension (with local bone defect). Multivariable logistic regression analysis found that female sex, presence of multiple microcysts, and SA-type tumor consistency were independently associated with the TPIT-lineage group.
Conclusions:
Clinically nonfunctioning TPIT-lineage PitNETs, which correspond to silent corticotroph PitNETs, are characterized by radiological and intraoperative features that are readily identifiable. Although TPIT-lineage tumors may show locally invasive growth and frequently lack a distinct pseudocapsule, their soft consistency may facilitate aspiration-assisted endoscopic resection.