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Pilonieta M, Pérez P, Prevedello DM. The Clinical Relevance of the Thalamogeniculate Arteries in Endoscopic Endonasal Surgery for Giant Pituitary Adenomas in the Interpeduncular Fossa. J Neurol Surg A Cent Eur Neurosurg 2024; 85:100-104. [PMID: 35760289 DOI: 10.1055/s-0042-1748773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Bilateral thalamic stroke is usually due to compromised artery of Percheron, an anatomical variation of the vascular supply of the thalamus. The stroke in this area is very uncommon, and is mainly due to top of the basilar syndrome. Other causes are extremely rare. We describe the case of a patient with a pituitary adenoma who underwent surgery and later presented with a bilateral thalamic infarct, suggesting compromise of the artery of Percheron. This would be the third case published in the literature about this complication. We present a literature review about the vascular supply of the thalamus, the artery of Percheron, and its involvement in pituitary surgery.
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Affiliation(s)
- Martin Pilonieta
- CALDAS, Santa Sofia de Caldas Academic State Hospital, Manizales, Colombia
| | - Paula Pérez
- CALDAS, Santa Sofia de Caldas Academic State Hospital, Manizales, Colombia
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, United States
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Gaillard S, Adeniran S, Villa C, Jouinot A, Raffin-Sanson ML, Feuvret L, Verrelle P, Bonnet F, Dohan A, Bertherat J, Assié G, Baussart B. Outcome of giant pituitary tumors requiring surgery. Front Endocrinol (Lausanne) 2022; 13:975560. [PMID: 36105410 PMCID: PMC9465329 DOI: 10.3389/fendo.2022.975560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The management of giant pituitary tumors is complex, with few publications and recommendations. Consequently, patient's care mainly relies on clinical experience. We report here a first large series of patients with giant pituitary tumors managed by a multidisciplinary expert team, focusing on treatments and outcome. METHODS A retrospective cohort study was conducted. Giant pituitary tumors were defined by a main diameter > 40mm. Macroprolactinomas sensitive to dopamine agonists were excluded. All patients were operated by a single neurosurgical team. After surgery, multimodal management was proposed, including hormone replacement, radiotherapy and anti-tumor medical therapies. Outcome was modeled using Kaplan-Meyer representation. A logistic regression model was built to identify the risk factors associated with surgical complications. RESULTS 63 consecutive patients presented a giant adenoma, most often with visual defects. Patients were operated once, twice or three times in 59%, 40% and 1% of cases respectively, mainly through endoscopic endonasal approach. Giant adenomas included gonadotroph, corticotroph, somatotroph, lactotroph and mixed GH-PRL subtypes in 67%, 14%, 11%, 6% and 2% of patients respectively. Vision improved in 89% of patients with prior visual defects. Severe surgical complications occurred in 11% of patients, mainly for tumors > 50 mm requiring microscopic transcranial approach. Additional radiotherapy was needed for 29% of patients, 3 to 56 months after first surgery. For 6% of patients, Temozolomide treatment was required, 19 to 66 months after first surgery. CONCLUSIONS Giant pituitary tumors require multimodal management, with a central role of surgery. Most often, tumor control can be achieved by expert multidisciplinary teams.
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Affiliation(s)
- Stephan Gaillard
- Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France
| | - Sosthène Adeniran
- Department of Neurosurgery, Centre Hospitalier Universitaire Yalgado Ouédraogo University Hospital, Ouagadougou, Burkina Faso
| | - Chiara Villa
- Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France
- Department of Pathological Cytology and Anatomy, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France
- Department of Endocrinology, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, Liège, Belgium
| | - Anne Jouinot
- Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France
- Institut Curie, INSERM, MINES ParisTech, PSL-Research University, CBIO-Centre for Computational Biology, Paris, France
| | - Marie-Laure Raffin-Sanson
- Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France
- Université de Versailles Saint-Quentin-en-Yvelines UFR des Sciences de la Santé Simone Veil, Montigny-le-Bretonneux, France
| | - Loic Feuvret
- Radiation Oncology Department, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpétrière University Hospital, Paris, France
| | - Pierre Verrelle
- Radiation Oncology Department, Institut Curie, Paris, France
| | - Fidéline Bonnet
- Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Hormonal Biology Laboratory, Paris, France
| | - Anthony Dohan
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Jérôme Bertherat
- Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Center for Rare Adrenal Diseases, Paris, France
| | - Guillaume Assié
- Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Center for Rare Adrenal Diseases, Paris, France
| | - Bertrand Baussart
- Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France
- Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France
- *Correspondence: Bertrand Baussart, ;
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Carrillo-Najar C, Rembao-Bojórquez D, Tena-Suck ML, Zavala-Vega S, Gelista-Herrera N, Ramos-Peek MA, Gómez-Amador JL, Cazares-Raga F, Hernández-Hernández FDLC, Ortiz-Plata A. Comparative Proteomic Study Shows the Expression of Hint-1 in Pituitary Adenomas. Diagnostics (Basel) 2021; 11:diagnostics11020330. [PMID: 33671384 PMCID: PMC7922225 DOI: 10.3390/diagnostics11020330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 12/28/2022] Open
Abstract
Pituitary adenomas (PAs) can be unpredictable and aggressive tumors. No reliable markers of their biological behavior have been found. Here, a proteomic analysis was applied to identify proteins in the expression profile between invasive and non-invasive PAs to search for possible biomarkers. A histopathological and immunohistochemical (adenohypophyseal hormones, Ki-67, p53, CD34, VEGF, Flk1 antibodies) analysis was done; a proteomic map was evaluated in 64 out of 128 tumors. There were 107 (84%) invasive and 21 (16%) non-invasive PAs; 80.5% belonged to III and IV grades of the Hardy–Vezina classification. Invasive PAs (n = 56) showed 105 ± 43 spots; 86 ± 32 spots in non-invasive PAs (n = 8) were observed. The 13 most prominent spots were selected and 11 proteins related to neoplastic process in different types of tumors were identified. Hint1 (Histidine triad nucleotide-binding protein 1) high expression in invasive PA was found (11.8 ± 1.4, p = 0.005), especially at high index (>10; p = 0.0002). High Hint1 expression was found in invasive VEGF positive PA (13.8 ± 2.3, p = 0.005) and in Flk1 positive PA (14.04 ± 2.28, p = 0.006). Hint1 is related to human tumorigenesis by its interaction with signaling pathways and transcription factors. It could be related to invasive behavior in PAs. This is the first report on Hint expression in PAs. More analysis is needed to find out the possible role of Hint in these tumors.
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Affiliation(s)
- Carolina Carrillo-Najar
- Experimental Neuropathology Laboratory, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Insurgentes Sur 3877, Mexico City 14269, Mexico;
| | - Daniel Rembao-Bojórquez
- Neuropathology Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Insurgentes Sur 3877, Mexico City 14269, Mexico; (D.R.-B.); (M.L.T.-S.); (S.Z.-V.); (N.G.-H.)
| | - Martha L. Tena-Suck
- Neuropathology Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Insurgentes Sur 3877, Mexico City 14269, Mexico; (D.R.-B.); (M.L.T.-S.); (S.Z.-V.); (N.G.-H.)
| | - Sergio Zavala-Vega
- Neuropathology Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Insurgentes Sur 3877, Mexico City 14269, Mexico; (D.R.-B.); (M.L.T.-S.); (S.Z.-V.); (N.G.-H.)
| | - Noemí Gelista-Herrera
- Neuropathology Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Insurgentes Sur 3877, Mexico City 14269, Mexico; (D.R.-B.); (M.L.T.-S.); (S.Z.-V.); (N.G.-H.)
| | - Miguel A. Ramos-Peek
- Neurosurgery Division, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Insurgentes Sur 3877, Mexico City 14269, Mexico; (M.A.R.-P.); (J.L.G.-A.)
| | - Juan L. Gómez-Amador
- Neurosurgery Division, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Insurgentes Sur 3877, Mexico City 14269, Mexico; (M.A.R.-P.); (J.L.G.-A.)
| | - Febe Cazares-Raga
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies of National Polytechnic Institute, IPN Avenue 2508, Mexico City 07360, Mexico; (F.C.-R.); (F.d.l.C.H.-H.)
| | - Fidel de la Cruz Hernández-Hernández
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies of National Polytechnic Institute, IPN Avenue 2508, Mexico City 07360, Mexico; (F.C.-R.); (F.d.l.C.H.-H.)
| | - Alma Ortiz-Plata
- Experimental Neuropathology Laboratory, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Insurgentes Sur 3877, Mexico City 14269, Mexico;
- Correspondence: ; Tel.: +52-(55)5606-3822 (ext. 2008)
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Blackmon MM, Gilbert AR, Floyd J, Hafeez S, Seifi A. Lost to Follow-Up: Complications of an Invasive Giant Prolactinoma. Cureus 2020; 12:e9763. [PMID: 32944476 PMCID: PMC7489779 DOI: 10.7759/cureus.9763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Invasive giant prolactinomas are a rare type of prolactin-secreting tumors. Most lactotroph adenomas, including giant prolactinomas, consist of the sparsely granulated subtype and respond well to medical therapy with dopamine agonists. Proptosis due to intra-orbital tumor extension and ischemic infarction are two rare complications associated with these tumors. We report a case of a 51-year-old woman with a 30-year history of a macroprolactinoma who was lost to follow-up and returned with severe proptosis, a 10-cm invasive sellar mass on imaging, and markedly elevated serum prolactin levels, consistent with invasive giant prolactinoma. She was initially managed with dopamine agonists followed by palliative debulking of the tumor, which microscopically demonstrated a highly proliferative neoplasm predominantly consisting of sparsely granulated lactotroph adenoma with a minor component of the rare and aggressive acidophil stem cell adenoma subtype. Postoperatively, she developed a large left middle cerebral artery infarct and ultimately died. This case is notable in that it demonstrates the aggressive nature of invasive giant prolactinomas when not treated and highlights two rare findings in patients with this tumor: orbital invasion and ischemic infarct.
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Affiliation(s)
- Melodie M Blackmon
- Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Andrea R Gilbert
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - John Floyd
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Shaheryar Hafeez
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Ali Seifi
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
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