Background

Pituitary adenomas (PAs) are among the most common brain tumors which characteristically become symptomatic due to the mass effect on surrounding structures and/or hormonal imbalances. This study describes 28 cases of PAs with an extrasellar invasive growth (EIG) at the early stage of tumor growth with normal sellar cavity size.

Methods

1200 cases of PAs either treated medically or via Endoscopic transsphenoidal surgery were reviewed during a 10-year period. Pre-operative imaging was analyzed to evaluate the tumor expansion pattern, tumor invasion sites and other relevant tumor properties. A comprehensive preoperative endocrinological along with postoperative histopathological studies were conducted to evaluate the subjects’ homeostasis and further identify the lesions characteristics.

Results

Of the 28 patients, patients 19, 2, 1 and 6 had a growth hormone (GH)-secreting PA, an adrenocorticotropic hormone (ACTH)-secreting PA, a nonfunctional PA (NFPA) and a mix-hormones secreting PA, respectively. There was a statistically significant difference between patients with and without EIG regarding types of PAs (P = 0.000). Post-hoc tests demonstrated that GH-secreting PAs (P = 0.0003) and mix-hormones secreting PAs (P = 0.0000) are significantly more invasive, while NFPAs (P = 0.0000) are less invasive. There was not a statistically significant difference between the invasion sites and different types of PAs (P = 0.122).

Conclusion

Among different histological subtypes of PAs, GH-secreting PAs revealed a remarkable tendency for EIG with normal sellar cavity size. The extra-sellar tumor extension with a normal sella did not correlate with atypical histology. Considering EIG patterns, surgeons should be vigilant to investigate and follow the tumor spreading to its enclosing boundary during surgery, the clival part of sphenoid bone should be more exposed, and both inferomedial and lateral borders of the sphenoid sinus should be carefully explored in order to remove the tumor.

中文翻译：

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鞍腔大小正常的垂体腺瘤鞍外浸润性生长模式

背景

垂体腺瘤 (PAs) 是最常见的脑肿瘤之一，由于对周围结构的占位效应和/或激素失衡，其特征性地出现症状。本研究描述了 28 例在肿瘤生长早期出现鞍外浸润性生长 (EIG) 且鞍腔大小正常的 PAs。

方法

在 10 年期间，对 1200 例接受药物治疗或通过内镜经蝶手术治疗的 PAs 进行了回顾。分析术前影像学以评估肿瘤扩张模式、肿瘤侵袭部位和其他相关肿瘤特性。进行了全面的术前内分泌学和术后组织病理学研究，以评估受试者的体内平衡并进一步确定病变特征。

结果

在 28 名患者中，19、2、1 和 6 名患者分别患有分泌生长激素 (GH) 的 PA、分泌促肾上腺皮质激素 (ACTH) 的 PA、非功能性 PA (NFPA) 和分泌混合激素的 PA。有和没有 EIG 的患者在 PA 类型方面存在统计学显着差异（P = 0.000）。事后测试表明，分泌 GH 的 PA (P = 0.0003) 和分泌混合激素的 PA (P = 0.0000) 的侵入性明显更强，而 NFPA (P = 0.0000) 的侵入性更小。侵袭部位和不同类型的PA之间没有统计学上的显着差异（P = 0.122）。

结论

在 PAs 的不同组织学亚型中，分泌 GH 的 PAs 显示出具有正常鞍腔大小的 EIG 的显着趋势。蝶鞍正常的鞍外肿瘤扩展与非典型组织学无关。考虑到 EIG 模式，外科医生在手术过程中应警惕检查和跟踪肿瘤向其包围边界的扩散，应更多地暴露蝶骨斜坡部分，应仔细探查蝶窦的下内侧和外侧边界，以便切除肿瘤。