Comprehensive Evaluation of Rare Pituitary Lesions: A Single Tertiary Care Pituitary Center Experience and Review of the
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Comprehensive Evaluation of Rare Pituitary Lesions: A Single Tertiary Care Pituitary Center Experience and Review of the Literature Giulia Cossu 1 & Jean-Philippe Brouland 2,3 & Stefano La Rosa 2,3 & Chiara Camponovo 4 & Edoardo Viaroli 1 & Roy Thomas Daniel 1,3 & Mahmoud Messerer 1,3
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract The 2017 World Health Organization classification of central nervous system and endocrine tumors have introduced significant changes in the diagnostic criteria for pituitary lesions. The aim of our paper is to describe the epidemiological, clinico-pathological, and radiological features of a single consecutive institutional surgical series of rare pituitary lesions, using these new criteria. Of the 316 endoscopic endonasal trans-sphenoidal approaches performed for pituitary lesions between 2010 and 2018, 15 rare lesions were encountered. These included metastases, pituitary carcinomas, pituicytomas, granular cell tumor, primary pituitary lymphomas, germinoma, mixed gangliocytoma–adenoma, hypophysitis, and pituitary hyperplasia. Their clinical, radiological, and pathological features are herewith presented along with a literature review that enabled us to propose an algorithm to facilitate a diagnosis for rare pituitary lesions. Keywords Pituitary lesion . Rare disease . Surgery . Pathology . Radiology
Introduction Tumors of the sellar region represent around 10–15% of all intracranial neoplasms and include both pituitary and nonpituitary diseases [1]. In addition to pituitary adenomas, which represent about 90% of cases [2], a wide range of other rare non-neuroendocrine lesions can be observed. Pituitary tumors are currently classified using the criteria recently published in the World Health Organization (WHO) classification of central nervous system (CNS) [3] and endocrine tumors [1]. It is worth noting that the evolution of the terminology from the traditional term “pituitary adenoma” to “pituitary neuroendocrine neoplasm (PitNEN)” has recently been proposed to better define the variable clinical spectrum
of these tumors that can behave differently despite similar morphological features [4]. Since individual clinical and radiological characteristics of non-neuroendocrine sellar lesions are lacking, they are frequently not distinguishable from classic PitNENs based on clinical and imaging data alone and represent a challenge for both clinicians and radiologists. Consequently, the differential diagnosis mostly relies on both intraoperative findings of experienced surgeons and careful pathological analysis. The aim of our paper is to describe the epidemiological, clinico-pathological, and radiological features of our surgical series of rare non-adenomatous pituitary lesions, integrating our experience with the most recent data from the literature.
Materials and Methods * Mahmoud Messerer [email protected] 1
Department of Neurosurgery, Lausanne University Hospital, Rue du Bugnon 44, 1005 Lausanne, Switzerland
2
Department of Clinical Pathology,
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