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J Neurol Surg A Cent Eur Neurosurg 2022; 83(04): 391-395
DOI: 10.1055/s-0040-1722195
Case Report

Aggressive Pituitary Adenoma Not Fulfilling the New High-Risk Criteria with Progression after 18-Year Stable Clinical Course: Case Report

Tomohiro Kawaguchi
1   Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
,
Yoshikazu Ogawa
1   Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
,
Mika Watanabe
2   Department of Pathology, Tohoku University Hospital, Sendai, Japan
,
Teiji Tominaga
3   Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Abstract

Background The World Health Organization (WHO) classification of tumors of the endocrine organs was revised in 2017. The term atypical adenoma is no longer recommended, and tumors with rapid growth, radiologic invasion, and high Ki-67 labeling index are defined as high-risk adenomas. In this article, we present the case of an aggressive pituitary adenoma not fulfilling the new high-risk criteria with extraordinary rapid progression after very long stable disease, and discuss the remaining problem of the new criteria in terms of a complicated balance between pathologic findings and clinical features.

Case Description A 67-year-old man was admitted with sellar tumor. Serum prolactin concentration was high at 4,552.2 ng/mL. Transsphenoidal surgery achieved subtotal removal. Histologic diagnosis was lactotroph cell adenoma, and Ki-67 labeling index was 2.6%. Postoperatively, magnetic resonance imaging revealed no evidence of tumor regrowth, but terguride or cabergoline administration was continued for slight hyperprolactinemia. Second surgery was performed 18 years after initial surgery because the tumor showed extraordinary rapid regrowth and hyperprolactinemia of 969 ng/mL. Histologic diagnosis was lactotroph cell adenoma with Ki-67 labeling index of 28.9% and positive immunoreactivity for p53. This case could be diagnosed as a high-risk adenoma from the beginning of treatment based on the WHO 2017 criteria, but the clinical course was unusually long and the indication of aggressive adjuvant therapy after initial surgery remained unsolved.

Conclusion Pathologic confirmation for the present definition would be expected to assess the cutoff between typical adenomas and aggressive tumors.

Keywords

high-risk pituitary adenoma - atypical adenoma - lactotroph adenoma in men - malignant transformation - transsphenoidal surgery


Publication History

Received: 01 April 2020

Accepted: 28 August 2020

Article published online:
22 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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