Cystic versus non-cystic silent corticotrophic adenomas: clinical and histological analysis of 62 cases after microscopic transsphenoidal surgery—a retrospective, single-center study

• Published in: Scientific reports 2023-02, Vol.13 (1), p.2468-2468, Article 2468
• Main Authors: Sumislawski, Piotr, Huckhagel, Torge, Krajewski, Kara Leigh, Aberle, Jens, Saeger, Wolfgang, Flitsch, Jörg, Rotermund, Roman
• Format: Article
• Language: English
• Subjects: 692/163/2743; 692/4028/546; Adenoma - pathology; Adenoma - surgery; Adrenocorticotropic Hormone; Clinical aspects; Cortisol; Diabetes; Diabetes insipidus; Estrogens; Female; Follicle-stimulating hormone; Hemorrhage; Histology; Humanities and Social Sciences; Humans; Hydrocortisone; Hyperprolactinemia; Hyponatremia; Hypopituitarism - etiology; Inappropriate ADH Syndrome; Insulin-like growth factor I; Insulin-like growth factors; Invasiveness; Investigations; Ki-67 Antigen; Lesions; Male; Mitosis; multidisciplinary; Neoplasm Recurrence, Local; Patients; Pituitary (anterior); Pituitary Neoplasms - pathology; Pituitary Neoplasms - surgery; Prolactin; Remission; Retrospective Studies; Risk factors; Science; Science (multidisciplinary); Sinuses; Statistical analysis; Surgery; Testosterone; Treatment Outcome; Tumor Suppressor Protein p53; Tumors; Visual field
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-023-29628-3

Silent corticotrophic adenomas (SCAs) represent a rare group of non-functioning adenomas with a potentially aggressive clinical course. Cystic component is a very common finding among SCAs, but its clinical relevance has not yet been investigated. The aim of this study was to analyze clinical features of cystic and non-cystic SCAs, perioperative complications after microscopic transsphenoidal surgery, clinical outcome after first and repeat surgery along with risk factors for recurrence. We conducted a retrospective analysis of 62 silent corticotrophic adenomas treated at our university medical center via microscopic transsphenoidal surgery between January 2008 and July 2019. Parameters investigated included histology, invasiveness, intratumoral haemorrhage or cystic component on MRI, perioperative alteration of visual field, tumor size, pre- and postoperative ACTH, FSH, GH, LH, TSH, prolactin, cortisol, free T4, free T3, IGF-1, estrogen and testosterone levels, perioperative complications, neoadjuvant and adjuvant therapy along with clinical outcomes. A total of 62 patients were analyzed. The mean follow up was 28.3 months. Tumors with a cystic component occur statistically significant more often among male than non-cystic (80.6% vs. 44.4%, p  = 0.02) and display lower rates of cavernous sinus invasion and sphenoid sinus invasion were significantly lower for cystic lesions comparing to non-cystic tumors (42.3% vs. 69.4%, p  = 0.04 and 3.8% vs. 47.2%, p   0.99) with histological markers such as Ki67 (21.1% vs. 13.8%, p  = 0.70) and p53 expression (6.3% vs. 0%, p  = 0.39) as well as mitotic rate (5.3% vs. 10.3%, p  > 0.99) were comparable between both groups. The presence of cystic component did not affect the tumor recurrence (10% vs. 16%, p  = 0.68). Mean dura