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Review
. 2014;54(12):966-73.
doi: 10.2176/nmc.ra.2014-0178. Epub 2014 Nov 29.

Treatment of pituitary carcinomas and atypical pituitary adenomas: a review

Toshio Hirohata  1 , Yudo Ishii, Akira Matsuno
Affiliations
Review

Treatment of pituitary carcinomas and atypical pituitary adenomas: a review

Toshio Hirohata et al. Neurol Med Chir (Tokyo). 2014.

Abstract

Atypical pituitary adenomas (APAs) are aggressive tumors, harboring a Ki-67 (MIB-1) staining index of 3% or more, and positive immunohistochemical staining for p53 protein, according to the World Health Organization (WHO) classification in 2004. Pituitary carcinomas (PC) usually develop from progressive APAs and predominantly consist of hormone-generating tumors, defined by the presence of disseminations in the cerebrospinal system or systemic metastases. Most of the cases with these malignant pituitary adenomas underwent surgeries, irradiations and adjuvant medical treatments, nevertheless, the therapies are mainly palliative. Recently, the efficacy of temozolomide (TMZ), an orally administered alkylating agent, has been reported as an alternative medical treatment. However, some recent studies have demonstrated a significant recurrence rate after effective response to TMZ. Further clinical and pathological researches of malignant pituitary adenomas will be required to improve the outcome of patients with these tumors.

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Conflict of interest statement

Conflicts of Interest Disclosure

The authors have no conflicts of interest and no financial support to be disclosed.

Figures

Fig. 1.
Fig. 1.
A: MRI (T1-weighted axial image with gadolinium enhancement) of a pituitary carcinoma. An invasive PRL-secreting pituitary tumor is demonstrated to progress into the right cavernous sinus, the middle and posterior fossa, and the ambient cistern. B: MRI (T1-weighted sagittal image with gadolinium enhancement) of the disseminated deposits. The disseminations of the tumor in the third and the fourth ventricles (arrows) are demonstrated, which proved to be a pituitary carcinoma. MRI: magnetic resonance imaging, PRL: prolactin.
Fig. 2.
Fig. 2.
Pathological findings of the resected specimens of a PRL-secreting pituitary carcinoma. A: The hematoxylin-eosin staining (original magnification; ×200) shows highly dense tumor cells, affluent stromal microvessels, atypical nuclei, and mitoses. B: Immunohistochemistry (IHC) for PRL (original magnification; ×200) shows diffuse immunopositivity. C: IHC for Ki-67 (original magnification; ×200) shows 18% labeling index, representing a remarkably higher MIB-1 index than typical pituitary adenomas. D: IHC for p53 protein (original magnification; ×200) shows approximately 50% LI, designated as an atypical pituitary adenoma or a pituitary carcinoma. LI: labeling index, PRL: prolactin.
See this image and copyright information in PMC

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