GATA3-positive silent corticotroph adenomas are characterized by large size and massive infrasellar invasion

A subgroup of GATA3-positive silent corticotroph adenomas (SCA) was identified by transcriptomics. We aimed to compare clinical, radiological and surgical outcomes of SCA with and without GATA3.

Tumor volume calculated using Di Chiro-Nelson formula; microcystic appearance defined as small areas of marked hyperintensity on T2W. Cavernous sinus invasion was assessed with Knosp (grades 3-4 considered invasive), and sellar floor invasion by Hardy-Wilson (grade E as massive invasion). Three to six months after surgery, MRI was repeated to evaluate the extent of the surgical resection, and then annually to assess recurrence or tumor progression, and the need for reoperation or radiotherapy.

Among 45 SCA, 11 (24.4%) were GATA3-positive. The GATA3 patients were more frequently male (72.7% vs. 29.4%, p = 0.016) and had larger tumor volume [34.8 cm³ (2.8-130.8) vs. 11.2 cm³ (3.4-89.8), p = 0.023]. Notably, 81.8% of the GATA3-positive SCA were giant adenomas compared to 24.2% in the other group (p = 0.001), with higher frequency of sphenoid invasion (60% vs. 10.3%, p = 0.004), but with no difference in cavernous sinus invasion (p = 0.299). Gross total resection was less frequent in the GATA3-positive SCA (0% vs. 32.2%, p = 0.041). No difference was seen regarding age, microcystic aspect, granulation pattern, Ki-67, mitoses and post-surgical outcome.

About one quarter of SCA displayed GATA3-positivity and was seen more frequently in men. GATA3-positive SCA are characterized by large tumor size and massive infrasellar invasion, but not aggressive features as no differences in post-surgical outcomes were detected in our cohort.