TY - JOUR
T1 - Clinical, pathologic, and imaging characteristics of pituitary null cell adenomas as defined according to the 2017 World Health Organization criteria
T2 - a case series from two pituitary centers
AU - Almeida, Joao Paulo
AU - Stephens, Corbin C.
AU - Eschbacher, Jennifer M.
AU - Felicella, Michelle M.
AU - Yuen, Kevin C.J.
AU - White, William L.
AU - Mooney, Michael A.
AU - Bernat, Anne Laure
AU - Mete, Ozgur
AU - Zadeh, Gelareh
AU - Gentili, Fred
AU - Little, Andrew S.
N1 - Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Purpose: The 2017 World Health Organization classification of pituitary tumors redefined pituitary null cell adenomas (NCAs) by restricting this diagnostic category to pituitary tumors that are negative for pituitary transcription factors and adenohypophyseal hormones. The clinical behavior of this redefined entity has not been widely studied, and this is a major shortcoming of the classification. This study evaluated the imaging and clinical features of NCAs from two pituitary centers and compared them with those of gonadotroph adenomas (GAs). Methods: Imaging, pathologic, and clinical characteristics of NCAs and GAs were retrospectively reviewed. Tumor immunohistochemistry was performed to confirm absence of adenohypophyseal hormones and pituitary transcription factor expression. Results: Thirty-one NCAs were compared with 38 GAs. NCAs were more likely to invade the cavernous sinus (15/31 [48%] vs. 5/38 [13%], P =.003) and had a higher proliferative index (i.e., MIB-1 > 3%, 11/31 [35%] vs. 5/38 [13%], P =.04). Gross total resection was less likely in the NCA group (19/31 [61%] vs. 33/38 [87], P =.02). Progression-free survival was worse in the NCA cohort (5-year progression-free survival, 0.70 vs. 1.00; P =.011, by log-rank test). Conclusions: Compared with GAs, NCAs are more invasive at the time of presentation and have a more aggressive clinical course. This study provides evidence that NCAs represent a distinct clinicopathologic entity with behavior that differs adversely from that of GAs. This may inform clinical decision-making, including frequency of postoperative tumor surveillance and timing of adjunctive treatments.
AB - Purpose: The 2017 World Health Organization classification of pituitary tumors redefined pituitary null cell adenomas (NCAs) by restricting this diagnostic category to pituitary tumors that are negative for pituitary transcription factors and adenohypophyseal hormones. The clinical behavior of this redefined entity has not been widely studied, and this is a major shortcoming of the classification. This study evaluated the imaging and clinical features of NCAs from two pituitary centers and compared them with those of gonadotroph adenomas (GAs). Methods: Imaging, pathologic, and clinical characteristics of NCAs and GAs were retrospectively reviewed. Tumor immunohistochemistry was performed to confirm absence of adenohypophyseal hormones and pituitary transcription factor expression. Results: Thirty-one NCAs were compared with 38 GAs. NCAs were more likely to invade the cavernous sinus (15/31 [48%] vs. 5/38 [13%], P =.003) and had a higher proliferative index (i.e., MIB-1 > 3%, 11/31 [35%] vs. 5/38 [13%], P =.04). Gross total resection was less likely in the NCA group (19/31 [61%] vs. 33/38 [87], P =.02). Progression-free survival was worse in the NCA cohort (5-year progression-free survival, 0.70 vs. 1.00; P =.011, by log-rank test). Conclusions: Compared with GAs, NCAs are more invasive at the time of presentation and have a more aggressive clinical course. This study provides evidence that NCAs represent a distinct clinicopathologic entity with behavior that differs adversely from that of GAs. This may inform clinical decision-making, including frequency of postoperative tumor surveillance and timing of adjunctive treatments.
KW - Gonadotroph adenoma
KW - Gonadotroph tumors
KW - Null cell adenoma
KW - Null cell pituitary tumor pituitary
UR - http://www.scopus.com/inward/record.url?scp=85070405574&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85070405574&partnerID=8YFLogxK
U2 - 10.1007/s11102-019-00981-9
DO - 10.1007/s11102-019-00981-9
M3 - Article
C2 - 31401793
AN - SCOPUS:85070405574
SN - 1386-341X
VL - 22
SP - 514
EP - 519
JO - Pituitary
JF - Pituitary
IS - 5
ER -