Pathological characteristics of reoperated regrowing clinically nonfunctioning pituitary tumor cases in comparison with initial surgical cases

Abstract

Objective: Postoperative nonfunctioning pituitary tumor (NFPT) regrowth is a significant concern, but its predictive factors are not well established. This study aimed to elucidate the pathological characteristics of NFPTs indicated for reoperation for tumor regrowth.

Methods: Pathological, radiological, and clinical data were collected from patients who underwent repeat operation for NFPT at Moriyama Memorial Hospital (MMH) between April 2018 and September 2023. For comparison, we also gathered data from patients who underwent initial surgery for NFPT during the same period at MMH.

Results: Overall, 61 and 244 NFPT patients who respectively underwent reoperation and initial operation were evaluated. The mean period between the previous operation and reoperation was 113 months. Immunonegativity for any adenohypophyseal hormone was significantly more frequent in the reoperation group than in the initial operation group. In addition, the rate of hormone-negative but transcription factor-positive (H-/TF+) tumors among silent gonadotroph tumors was significantly higher in the reoperation group than in the initial operation group. Furthermore, seven silent corticotroph tumors (SCTs) in the reoperation group were ACTH-negative but TPIT-positive. Because most of the previous surgeries were performed in other hospitals a long time ago, we could procure the previous pathological results with immunohistochemistry (IHC) only from 21 patients. IHC for TF had not been performed in all the previous specimens. IHC for adenohypophyseal hormone was almost the same as the current results, and many H-/TF+ tumors were previously diagnosed as NCT. In addition, the reoperated patients were classified into 3 groups on the basis of the condition of the previous operation: gross total resection (GTR), 12 patients; subtotal resection (STR), 17 patients; and partial resection (PR), 32 patients. The mean Ki-67 LI in the GTR, STR, and PR subgroups were 1.82, 1.37, and 0.84, respectively, with the value being significantly higher in the GTR subgroup than in the PR subgroup (P < 0.05).

Conclusions: The ratio of H-/TF+ tumors is significantly higher in symptomatically regrown tumors than in the initial cases, which used to be diagnosed as NCT. PR cases tend to grow symptomatically in a shorter period, even with lower Ki-67 LI than GTR cases.

Keywords: gross total resection; nonfunctioning pituitary tumor; null cell tumor; regrowth; silent corticotroph tumor; silent gonadotroph tumors; transcription factor.

Figure 1

Histological classification of NFPT divided into 2 groups: (A) reoperation (n = 61) and (B) initial operation (n = 244). Histological classification is according to the results of immunohistochemistry. NFPT, nonfunctioning pituitary tumor; Gn, gonadotropin; ACTH, adrenocorticotrophic hormone; GH, growth hormone; TSH, thyrotropin stimulating hormone; PRL, prolactin; HNT, hormone-negative tumor; SF1, steroidogenic factor 1; TPIT, T-box transcription factor; PIT1, pituitary transcription factor 1; SGT, silent gonadotroph tumor; SCT, silent corticotroph tumor.

Figure 2

Representative case of regrowing nonfunctioning pituitary tumors after prior TSS. GTR case (A–C) and PR case (D–F). Preoperative (A) and postoperative (B) enhanced T1-weighted MR images showing GTR after initial surgery. However, enhanced T1-weighted MR image before reoperation (C) showing tumor regrowth and compression of the optic nerve again 137 months after the primary surgery. Preoperative (D) and postoperative (E) enhanced T1-weighted MR images showing PR after initial TSS. Preoperative enhanced T1-weighted MR image before reoperation (F) showing tumor regrowth and compression of the optic nerve again 80 months after the primary surgery. TSS, transsphenoidal surgery; GTR, gross total resection; PR, partial resection; MR, magnetic resonance.