ECE2017 Eposter Presentations: Pituitary and Neuroendocrinology Pituitary - Clinical (145 abstracts)
Aggressive pituitary tumours: a multicenter study
Ana Palha 1 , Leonor Gomes 2 , João Sequeira Duarte 3 , Conceição Marques 3 , Cláudia Amaral 4 , Ana Amado 4 , Fátima Borges 4 , Isabel Ribeiro 4 , Eduardo Barreiros 5 , Luis Barreiros 5 , José Miguéns 5 , Maria João Bugalho 5 , Adriana Lages 2 , Isabel Paiva 2 , Olinda Marques 6 , Rui Almeida 6 , Teresa Martins 7 , Luisa Cortez 1 , Ana Agapito 1 & Fernando Fonseca 1
1Centro Hospitalar Lisboa Central, Lisbon, Portugal; 2Centro Hospitalar Universitário Coimbra, Coimbra, Portugal; 3Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; 4Centro Hospitalar Porto, Oporto, Portugal; 5Centro Hospitalar Lisboa Norte, Lisbon, Portugal; 6Hospital de Braga, Braga, Portugal; 7Instituto Português de Oncologia de Coimbra, Coimbra, Portugal.
Introduction: Pituitary tumours are considered benign, however some exhibit an aggressive behavior. Defining a timely treatment is challenging due to absence of accurate prognostic predictors.
Objective: To evaluate radiological and histopathological features of aggressive pituitary tumours.
Methods: Multicenter and retrospective study. Criteria for aggressiveness were: invasion to sphenoid and/or cavernous sinus; growth progression after treatment (surgery/medical/radiotherapy); early recurrence (≤12 months). Atypical features were Ki-67>3%, p53 positivity, mitoses >2/10xHPF or brain/spinal/systemic metastases.
Results: Forty-five patients (28 men) were collected from seven tertiary endocrine departments. Age at diagnosis was 41.2±12.2 years. In 35.6% of patients first symptoms occurred before 35 years. Symptoms related to tumour expansion, hypersecretion and deficiency of hormones were the first manifestations in 73.6, 13.2 and 13.2% of patients, respectively. Our cohort comprised nonfunctioning adenomas (64.4%), somatotropinomas (9.0%), corticotropinoma (13.3%) and prolactinomas (13.3%). All were macroadenomas and 82.2% showed radiological signs of invasion. Of the 44 operated patients, 56.8% required three or more surgeries. Complementary radiotherapy was used in 66.7% of patients, medical therapy in 42.2% of patients, two of these with temozolomide. Histopathology was obtained in 42 patients. Imunohistochemichal staining was GH positive in 9.5%; PRL 14.3%; ACTH 11.9%, TSH 2.4%, FSH/LH 19%; plurihormonal 14.3%; nonsecreting and null-cell 28.6%. Elevated mitotic index was observed in 20% (n=25), Ki-67 labeling index ≧3% in 44.4% (n=27) and p 53 nuclear staining in 41.2% (n=17). During a mean follow-up of 11.5±6.3 years, 8 patients died (5 ACTH-cell adenoma) one with extracranial systemic metastases (carcinoma).
Conclusions: In our cohort ACTH-secreting tumours presented a more aggressive clinical course. One limitation of our study was incomplete histopathological data, however, the majority of patients who died, presented atypical features. A continuous multicenter collaboration could help to identify prognostic markers and enable a different approach.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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