Cystic appearance on magnetic resonance imaging in bihormonal growth hormone and prolactin tumors in acromegaly
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Cystic appearance on magnetic resonance imaging in bihormonal growth hormone and prolactin tumors in acromegaly Elena V. Varlamov1,2,6 · Matthew D. Wood3,5 · Joao Prola Netto4 · Jaclyn Thiessen4 · Jung Kim6 · Dawn Shao Ting Lim6,7 · Christine G. Yedinak2,6 · Swechya Banskota6 · Justin S. Cetas2,6 · Maria Fleseriu1,2,6
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To investigate demographic, imaging and laboratory characteristics, and treatment outcomes of acromegaly patients who have bihormonal (BA) growth hormone (GH) and prolactin (PRL) immunoreactive adenomas compared to patients who have densely granulated GH adenomas (DGA) and sparsely granulated GH adenomas (SGA). Methods Retrospective review of single-center surgically treated acromegaly patients; pathology was analyzed by a single neuropathologist using 2017 WHO criteria. Preoperative magnetic resonance imaging was assessed to evaluate tumor size, cystic component, invasion and T2 signal intensity. Results Seventy-seven patients; 19 BA (9 mammosomatotroph and 10 mixed GH and PRL adenomas) were compared with 30 DGA, and 28 SGA. Patients with BA were older than SGA (49.6 vs 38.5 years, p = 0.035), had a higher IGF-1 index (3.3 vs 2.3, p = 0.040) and tumors were less frequently invasive (15.8% vs 57.1%, p = 0.005). BA more frequently had a cystic component on MRI than both SGA and DGA (52.6% vs 14.3%, and 22%, p = 0.005 and 0.033, respectively). When all histological types were combined, biochemical remission postoperatively was more common in non-cystic than cystic tumors (50% vs 22.5%, p = 0.042). Somatostatin receptor ligand response rate was 66.7%, 90.9% and 37.5% in BA, DGA and SGA patients, respectively (p = 0.053). Conclusion Imaging characteristics are an increasingly important adenoma behavior determinant. An adenoma cystic component may suggest that a GH adenoma is a BA. Cystic tumors exhibited lower rates of surgical remission in this series; therefore, optimized individual patient treatment is needed, as patients could be candidates for primary medical treatment. Keywords Acromegaly · Growth hormone secreting pituitary adenoma · Mixed prolactin-growth secreting tumors · Mammosomatotroph · Bihormonal · Somatostatin receptor ligands
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11102-020-01075-7) contains supplementary material, which is available to authorized users. * Maria Fleseriu [email protected] 1
Department of Medicine, Oregon Health & Science University, Portland, OR, USA
2
Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
3
Department of Pathology, Oregon Health & Science University, Portland, OR, USA
4
Department of Radiology, Oregon Health & Science University, Portland, OR, USA
Acromegaly is a disease characterized by growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess, which is caused in more than 95% of patients by a pituitary 5
Knight Cancer Inst
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