J Pathol Transl Med.  2016 Nov;50(6):419-425. 10.4132/jptm.2016.06.30.

The Predictive Value of Pathologic Features in Pituitary Adenoma and Correlation with Pituitary Adenoma Recurrence

• Kim JS
• Lee YS
• Jung MJ
• Hong YK

• KMID: 2361989
• DOI: http://doi.org/10.4132/jptm.2016.06.30

Abstract

BACKGROUND
The 2004 World Health Organization classification introduced atypical pituitary adenoma (aPA), which was equivocally defined as invasion with increased mitotic activity that had a Ki-67 labeling index (LI) greater than 3%, and extensive p53 immunoreactivity. However, aPAs that exhibit all of these features are rare and the predictive value for recurrence in pituitary adenomas (PAs) remains uncertain. Thus, we sought to characterize pathological features of PAs that correlated with recurrence.
METHODS
One hundred and sixty-seven cases of surgically resected PA or aPA were retrieved from 2011 to 2013 in Seoul St. Mary's Hospital. Among them, 28 cases were confirmed to be recurrent, based on pathologic or radiologic examination. The pathologic characteristics including mitosis, invasion, Ki-67 LI and p53 immunoreactivity were analyzed in relation to recurrence.
RESULTS
Analysis of the pathologic features indicated that only Ki-67 LI over 3% was significantly associated with tumor recurrence (p = .02). The cases with at least one pathologic feature showed significantly higher recurrence rates (p < .01). Analysis indicated that cases with two pathologic features, Ki-67 LI over 3% and extensive p53 immunoreactivity 20% or more, were significantly associated with tumor recurrence (p < .01).
CONCLUSIONS
Based on these results, PA tumor recurrence can be predicted by using mitosis, invasion, Ki-67 LI (3%), or extensive p53 immunoreactivity (≥ 20%). Assessment of these features is recommended for PA diagnosis for more accurate prediction of recurrence.

Keyword

Pituitary neoplasms; Recurrence; Ki-67 antigen; Tumor suppressor protein p53

MeSH Terms

Classification
Diagnosis
Ki-67 Antigen
Mitosis
Pituitary Neoplasms*
Recurrence*
Seoul
Tumor Suppressor Protein p53
World Health Organization
Ki-67 Antigen
Tumor Suppressor Protein p53

Figure

• 

  Fig. 1. Microscopic findings of an atypical pituitary adenoma case with sphenoid sinus and dura invasion. (A) Tumor cells invading the sphenoid sinus. (B) Foci of tumor cell infiltration into the dura. (C) Tumor cells show extensive p53 immunoreactivity. (D) High Ki-67 labeling index (about 40%) is noted.

• 

  Fig. 2. Microscopic findings of a pituitary carcinoma case with metastasis to the distant cerebrum and skull. (A) The tumor cells metastasize to the cerebrum. (B) The skull bone tissue is infiltrated by the metastatic tumor cells. (C) Infiltrating tumor cells with mitotic activity. (D) High Ki-67 labeling index (about 15%) is observed.

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