Cystic appearance on magnetic resonance imaging in bihormonal growth hormone and prolactin tumors in acromegaly.

Autor: Varlamov EV; Department of Medicine, Oregon Health & Science University, Portland, OR, USA.; Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA.; Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA., Wood MD; Department of Pathology, Oregon Health & Science University, Portland, OR, USA.; Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA., Netto JP; Department of Radiology, Oregon Health & Science University, Portland, OR, USA., Thiessen J; Department of Radiology, Oregon Health & Science University, Portland, OR, USA., Kim J; Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA., Lim DST; Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA.; Department of Endocrinology, Singapore General Hospital, Singapore, Singapore., Yedinak CG; Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA.; Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA., Banskota S; Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA., Cetas JS; Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA.; Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA., Fleseriu M; Department of Medicine, Oregon Health & Science University, Portland, OR, USA. fleseriu@ohsu.edu.; Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA. fleseriu@ohsu.edu.; Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA. fleseriu@ohsu.edu.
Jazyk: angličtina
Zdroj: Pituitary [Pituitary] 2020 Dec; Vol. 23 (6), pp. 672-680.
DOI: 10.1007/s11102-020-01075-7
Abstrakt: 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.
Databáze: MEDLINE
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