Objective: To discuss optimal treatment strategy for spindle cell oncocytoma (SCO) of the pituitary gland. Methods: Institutional cases were retrospectively reviewed. A systematic literature search and subsequent quantitative synthesis were performed for further analysis. The detailed features were summarized and the tumor control rate (TCR) was calculated. Results: Eighty-five patients (6 institutional and 79 literature) were included. The annual incidence was approximately 0.01–0.03/100,000. The mean age was 56 years. Vision loss was present in 60%. Seventy-three percent showed hormonal abnormalities. On magnetic resonance imaging, tumor was avidly enhancing, and the normal gland was commonly displaced anterosuperiorly. Evidence of hypervascularity was seen in 77%. Gross total resection (GTR) was achieved in only 24% because of its hypervascular, fibrous, and adhesive nature. The mean postoperative follow-up was 3.3 years for institutional cases and 2.3 years for the integrated cohort. The TCR was significantly better after GTR (5-year TCR, 75%; P = 0.012) and marginally better after non-GTR + upfront radiotherapy (5-year TCR, 76%; P = 0.103) than after non-GTR alone (5-year TCR, 24%). The TCRs for those with low Ki-67 index (≤5%) were marginally better than those with higher Ki-67 index (5-year rate, 57% vs. 23%; P = 0.110). Conclusions: Frequent endocrine-related symptoms, hypervascular signs, and anterosuperior displacement of the gland support preoperative diagnosis of SCO. GTR seems to have better long-term tumor control, whereas the fibrous, hypervascular, and adhesive nature of SCO makes it difficult to achieve GTR. In patients with non-GTR, radiotherapy may help decrease tumor progression.

A Comprehensive Study of Spindle Cell Oncocytoma of the Pituitary Gland: Series of 6 Cases and Meta-Analysis of 85 Cases / Hasegawa H.; Van Gompel J.J.; Oushy S.H.; Pollock B.E.; Link M.J.; Meyer F.B.; Bancos I.; Erickson D.; Davidge-Pitts C.J.; Little J.T.; Uhm J.H.; Swanson A.A.; Giannini C.; Mahajan A.; Atkinson J.L.. - In: WORLD NEUROSURGERY. - ISSN 1878-8750. - ELETTRONICO. - 149:(2021), pp. e197-e216. [10.1016/j.wneu.2021.02.051]

A Comprehensive Study of Spindle Cell Oncocytoma of the Pituitary Gland: Series of 6 Cases and Meta-Analysis of 85 Cases

Giannini C.;
2021

Abstract

Objective: To discuss optimal treatment strategy for spindle cell oncocytoma (SCO) of the pituitary gland. Methods: Institutional cases were retrospectively reviewed. A systematic literature search and subsequent quantitative synthesis were performed for further analysis. The detailed features were summarized and the tumor control rate (TCR) was calculated. Results: Eighty-five patients (6 institutional and 79 literature) were included. The annual incidence was approximately 0.01–0.03/100,000. The mean age was 56 years. Vision loss was present in 60%. Seventy-three percent showed hormonal abnormalities. On magnetic resonance imaging, tumor was avidly enhancing, and the normal gland was commonly displaced anterosuperiorly. Evidence of hypervascularity was seen in 77%. Gross total resection (GTR) was achieved in only 24% because of its hypervascular, fibrous, and adhesive nature. The mean postoperative follow-up was 3.3 years for institutional cases and 2.3 years for the integrated cohort. The TCR was significantly better after GTR (5-year TCR, 75%; P = 0.012) and marginally better after non-GTR + upfront radiotherapy (5-year TCR, 76%; P = 0.103) than after non-GTR alone (5-year TCR, 24%). The TCRs for those with low Ki-67 index (≤5%) were marginally better than those with higher Ki-67 index (5-year rate, 57% vs. 23%; P = 0.110). Conclusions: Frequent endocrine-related symptoms, hypervascular signs, and anterosuperior displacement of the gland support preoperative diagnosis of SCO. GTR seems to have better long-term tumor control, whereas the fibrous, hypervascular, and adhesive nature of SCO makes it difficult to achieve GTR. In patients with non-GTR, radiotherapy may help decrease tumor progression.
2021
A Comprehensive Study of Spindle Cell Oncocytoma of the Pituitary Gland: Series of 6 Cases and Meta-Analysis of 85 Cases / Hasegawa H.; Van Gompel J.J.; Oushy S.H.; Pollock B.E.; Link M.J.; Meyer F.B.; Bancos I.; Erickson D.; Davidge-Pitts C.J.; Little J.T.; Uhm J.H.; Swanson A.A.; Giannini C.; Mahajan A.; Atkinson J.L.. - In: WORLD NEUROSURGERY. - ISSN 1878-8750. - ELETTRONICO. - 149:(2021), pp. e197-e216. [10.1016/j.wneu.2021.02.051]
Hasegawa H.; Van Gompel J.J.; Oushy S.H.; Pollock B.E.; Link M.J.; Meyer F.B.; Bancos I.; Erickson D.; Davidge-Pitts C.J.; Little J.T.; Uhm J.H.; Swanson A.A.; Giannini C.; Mahajan A.; Atkinson J.L.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/862473
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