ECEESPE2025 ePoster Presentations Pituitary, Neuroendocrinology and Puberty (220 abstracts)
Aggressive pituitary tumours and carcinomas – clinicopathological data and treatment experiences from Hungary
Judit Tőke 1 , Annamária Kövesdi 1 , Csaba Sumánszki 1 , Csaba Csatlós 1 , Bálint Scheich 2 , Hajnalka Rajnai 2 , László Sipos 3 , Péter Orbay 3 , Gábor Nagy 3 , Nóra Nyilas 4 , Péter Várallyay 1 , Levente Jánváry 5 , Dániel Sinkó 6 , Péter Barsi 4 , Nikolette Szücs 1 , Marta Korbonits 7 & Miklós Tóth 1
1Semmelweis University, Department of Internal Medicine and Oncology, Budapest, Hungary; 2Semmelweis University, Department of Pathology and Experimental Cancer Research, Budapest, Hungary; 3Semmelweis University, Department of Neurosurgery and Neurointervention, Budapest, Hungary; 4Semmelweis University, Department of Neuroradiology, Medical Imaging Centre, Budapest, Hungary; 5National Institute of Oncology, Department of Radiation Oncology, Budapest, Hungary; 6Uzsoki Hospital, Department of Oncoradiology, Budapest, Hungary; 7Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, United Kingdom
JOINT1245
Introduction: Pituitary neuroendocrine tumours (PitNETs) are relatively common intracranial neoplasms that typically exhibit indolent behaviour. However, some tumours can be clinically aggressive, as indicated by early and frequent recurrences and resistance to standard treatments.
Aim: This study aims to characterise the clinicopathological data of patients with aggressive pituitary tumours (APTs) at a tertiary referral centre and to analyse the effectiveness of different treatment modalities.
Methods: This retrospective study included patients who met the following criteria: radiological evidence of invasive tumour growth (signs of infrasellar extension or parasellar growth classified with a Knosp grade of ≥ 3); a histopathological diagnosis of pituitary adenoma with increased proliferative activity defined by a Ki-67 index of ≥ 3%; (and, if available, a mitotic count ≥ 2 per high-power field); rapid tumour growth; and resistance to standard medical and surgical therapies. We analyzed demographic data and results from hormonal and radiological examinations, data presented as mean ± SD.
Results: From a total of 1,595 patients who underwent pituitary surgery between 2008 and 2023, we identified 20 patients (8 females and 12 males) with aggressive pituitary tumours based on the inclusion criteria defined above. The mean follow-up duration for these patients was 94.1 ± 71.8 months. The average age at diagnosis was 44.0 ± 13.78 years. Among these cases, five patients were later reclassified as having pituitary carcinoma due to the detection of metastasis. All patients had macroadenomas, with the largest tumour diameter measuring 33 ± 12 mm. Of these patients, fifteen had hormonally active tumours, presenting as follows: Cushing’s disease (n = 6), hyperprolactinaemia (n = 5), acromegaly (n = 3), and hyperthyroidism (n = 1). The total number of surgical interventions performed on these patients was 53. The median Ki-67 index was 7% (range: 3-40) and mitotic count was 4 per high-power field (range: 2-20), respectively. Fifteen patients (75%) received pituitary irradiation. The number of pituitary surgeries per patient per year was significantly lower after radiotherapy (0.39 ± 0.10 vs. 0.13 ± 0.05; P = 0.001). At least on short term, temozolomide treatment resulted in partial tumour remission in 3 out of 4 patients. Three metastatic and three non-metastatic patients died due to pituitary disease progression.
Conclusion: In our endocrine centre 1.3% of patients in the surgical pituitary tumour series have aggressive tumours. The study found that fewer surgical interventions were required after radiotherapy for these aggressive tumours. This finding reinforces current guidelines recommending earlier radiotherapy for pituitary adenomas when aggressive features are present.
Volume 110
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Endocrine Abstracts
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