Prognosis of pituitary adenomas with arteriographic abnormal vascularization

A case report and five additional cases from the literature of angiographically demonstrated abnormal vascularization of chromophobe adenomas are presented. The appearance is that of a fine network of vessels appearing in the arterial phase and a homogeneous blush beginning in the capillary phase and lasting throughout the venous phase. The network is derived from dilated branches of the extradural internal carotid artery and is seen in the arterial phase. The stain, appearing in the venous phase, is due to filling of tiny sinusoidal channels and thin-walled vessels throughout the stroma. All the patients had large, actively growing tumours which compressed and infiltrated surrounding structures. Complete tumour removal was not possible in the patients operated upon. The combined morbidity-mortality rate was 83% and was due to the large tumour size, adherence to vital centres, extreme vascularity during surgical removal, and propensity to bleed spontaneously. The appearance of abnormal vascularity in a pituitary adenoma suggests a poor prognosis.