Predictive Factors of Biological Behaviour in Pituitary Adenoma

Background: Predicting biological behavior of pituitary adenomas is a complex but highly desirable issue for both scientific and practical porpoises. Recently, a clinico-pathological grading based on histopathological and neuroradiological features has been proposed, stratifying the risk of progression/recurrence in 5 classes. Aim of our study is to perform an independent external validation of this score and identify other potential predictor of aggressive behaviour. Results: Five hundred sixty-six patients with pituitary adenomas were included in this study (253 FSH/LH, 147 GH, 85 PRL, 72 ACTH and 9 TSH tumors). In 437 cases, pituitary adenomas were non-invasive, with low (grade 1a: 378 cases) or high (grade 1b: 59 cases) proliferative activity. In 129 cases, tumors were invasive, with low (grade 2a: 87 cases) or high (grade 2b: 42 cases) proliferative activity. During the follow-up (mean: 5.8 years), 60 patients developed disease recurrence or progression, with a total of 130 patients with pituitary disease at last follow-up. Univariate analysis demonstrated a significantly higher risk of disease persistence and recurrence/progression in patients with PRL, ACTH and FSH/LH tumors as compared to those with somatotroph tumors, and in those with high proliferative activity (grade 1b and 2b) or >1 cm diameter. Multivariate analysis confirmed that tumor type and grade are independent predictors of disease free-survival and progression free-survival. Tumor grading resulted the first parameter emerging in the decision tree analyses with CHAID growing process to stratify patients according to the risk of recurrence/progression. Conclusions: Our data confirmed the validity of Trouillas’ score, being tumor type and grade independent predictors of disease evolution. Therefore, we recommend to always consider both features, together with tumor histological subtype, in the clinical setting to early identify patients at higher risk of an aggressive behaviour

When is a multidisciplinary approach required in management of intracranial complications of sinonasal inflammatory disorders?

Intracranial complications of sinonasal inflammatory disorders are relatively unusual but can cause significant morbidity and mortality. They often occur in patients with comorbid disorders and immunocompromised but also people without risk factors can be affected. Intracranial complications of acute rhinosinusitis are rare, probably due to oral antibiotics availability, but are less predictable as they often occur in immunocompetent patients without comorbidity. Their management requires a multidisciplinary approach to plan and customize the therapeutic treatment. Intracranial complications of chronic rhinosinusitis are more predictable as they occur often in immunocompromised patient with particularly risk factors. For this reason, a multidisciplinary approach it’s important for treatment and mostly for prevention. The aim of this paper is to present an overview of different multidisciplinary management of intracranial complications of sinonasal inflammatory disorders according to their etiology and severity

Processing and characterization of layered UHTCMCs reinforced with continuous or discontinuous carbon fibers

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Endoscopic transsphenoidal approach as a promising surgical option in the treatment of craniopharyngioma

10.1530/endoabs.32.P85

3D Virtual Modeling for Morphological Characterization of Pituitary Tumors: Preliminary Results on Its Predictive Role in Tumor Resection Rate

Among potential factors affecting the surgical resection in pituitary tumors, the role of tumor three-dimensional (3D) features is still unexplored. The aim of this study is to introduce the use of 3D virtual modeling for geometrical and morphological characterization of pituitary tumors and to evaluate its role as a predictor of total tumor removal. A total of 75 patients operated for a pituitary tumor have been retrospectively reviewed. Starting from patient imaging, a 3D tumor model was reconstructed, and 3D characterization based on tumor volume (Vol), area, sphericity (Spher), and convexity (Conv) was provided. The extent of tumor removal was then evaluated at post-operative imaging. Mean values were obtained for Vol (9117 +/- 8423 mm(3)), area (2352 +/- 1571 mm(2)), Spher (0.86 +/- 0.08), and Conv (0.88 +/- 0.08). Total tumor removal was achieved in 57 (75%) cases. The standard prognostic Knosp grade, Vol, and Conv were found to be independent factors, significantly predicting the extent of tumor removal. Total tumor resection correlated with lower Knosp grades (p = 0.032) and smaller Vol (p = 0.015). Conversely, tumors with a more irregular shape (low Conv) have an increased chance of incomplete tumor removal (p = 0.022). 3D geometrical and morphological features represent significant independent prognostic factors for pituitary tumor resection, and they should be considered in pre-operative planning to allow a more accurate decision-making process

Epigenomic and somatic mutations of pituitary tumors with clinical and pathological correlations in 111 patients

Objective To profile clinically non-aggressive and aggressive pituitary adenomas (PAs)/pituitary neuroendocrine tumours (PitNETs) and pituitary carcinomas for somatic mutations and epigenetic alterations of genes involved in cell proliferation/differentiation, microRNAs (miRNA)/long noncoding RNA (LncRNA)-post-transcriptional regulators and therapy targets. Design Retrospective observational study. Patients and Measurements A total of 64 non-aggressive and 41 aggressive PAs/PitNETs and 6 pituitary carcinomas treated by endoscopic surgery with >= 1-year follow-up were included. Somatic mutations of 17 genes and DNA methylation of 22 genes were assessed. Ten normal pituitaries were used as control. Results We found at least one mutation in 17 tumours, including 6/64 non-aggressive, 10/41 aggressive PAs/PitNETs, and 1/6 pituitary carcinoma. AIP (N = 6) was the most frequently mutated gene, followed by NOTCH (4), and TP53 (3). Hypermethylation of PARP15, LINC00599, ZAP70 was more common in aggressive than non-aggressive PAs/PITNETs (p < .05). Lower levels of methylation of AIP, GNAS and PDCD1 were detected in aggressive PAs/PITNETs than non-aggressive ones (p < .05). For X-linked genes, males presented higher level of methylation of FLNA, UXT and MAGE family (MAGEA11, MAGEA1, MAGEC2) genes in aggressive vs. non-aggressive PAs/PITNETs (p < .05). In pituitary carcinomas, methylation of autosomal genes PARP15, LINC00599, MIR193 and ZAP70 was higher than in PAs/PITNETs, while X-linked genes methylation level was lower. Conclusions Somatic mutations and methylation levels of genes involved in cell proliferation/differentiation, miRNA/LncRNA-post-transcriptional regulators and targets of antineoplastic therapies are different in non-aggressive and in aggressive PAs/PitNETs. Methylation profile also varies according to gender. Combined genetic-epigenetic analysis, in association with clinico-radiological-pathological data, may be of help in predicting PA/PitNET behaviour

Cesare Taruffi and acromegaly: the story of a discovery never made

The “Luigi Cattaneo” Wax Museum houses the skull and wax bust of Luigi Marchetti, a man with acromegaly who died in 1808 at the age of 47 years. His case aroused the interest of many famous anatomists and nineteenth century clinicians including Rudolf Virchow. Cesare Taruffi’s study of this case and the exemplary and symbolic comparison between the exact wax replica and the human skull show how traumatic and complex this anatomical-pathological paradigm must have been for nineteenth century medical science. It also marks the historical continuity between endocrinological research in the old Bologna Anatomy School from Mondino Dei Liuzzi to Marcello Malpighi and Giovan Battista Morgagni and present-day expertise in pituitary neurosurgery at Bologna University and the city’s “Carlo Alberto Pizzardi” Bellaria Hospital

Endoscopic endonasal approach for loco-regional recurrent clivus chordomas

Introduction. Role of surgery for loco-regional recurrences of clivus chordomas (CCs) is still debated. It has been proposed in selected cases with a curative or with palliative intent, eventually followed by radiation or chemo/radiation treatments. Only limited data on the endoscopic endonasal approach (EEA) are available. Research question. To assess the role of EEA for loco-regional recurrent CCs. Materials and Methods. All consecutive loco-regional recurrent CCs operated by EEA at our Institution from 1998 to 2021 were identified. The extension of tumor resection, symptoms control, overall survival (OS), and progression free survival (PFS) were assessed. Results. Series includes 54 patients (53.7% females, mean age 55± 14 years). Surgery was planned with a resective aim in 35 (64.8%) patients, while it was palliative in 19 (35.2%). Gross tumor removal was achieved in 24 cases (44.4%). Main complications consisted of 2 (3.7%) CSF leaks. Further local relapses were observed in 30 (55.5%) patients after 25± 24 months; 29 (53.7%) patients deceased after 34 ± 31 months. OS and PFS were lower in these cases than primary surgeries (p<0.001 and p<0.001), but cases undergone surgery with a resective aim had a significant better OS and PFS than for those treated for palliation (p<0.001). Determinants of recurrences were tumoral size (p=0.48) and previous radiotherapy (p=009). Discussion and Conclusions. EEA has proven to be effective for loco-regional recurrent CCs alleviating patients symptoms and preserving their quality of life with limited morbidities. However, because overall prognosis is poor, EEA should be reserved to selected recurrent cases

Anatomy of the optic canal and its clinical role

The optic canal is a short funnel-like structure extending from the optic foramen to the orbital apex, where the optic nerve (ON) and the ophthalmic artery (OA) pass through. The relationship between these two structures has been already well reported, in particular in the majority of cases the artery runs within the optic sheath below the ON, which is surrounded be arachnoidal membrane in this part. [1]. However, few anatomical variants have been reported, such as the origin of the OA from the intracavernous tract of the internal carotid artery [1]. In this case, it is possible for the OA not to pass thorough the optic canal, but in the superior orbital fissure [1]. For its course and for the normal location of the OA it could be difficult to analyze the anatomy of the content of the optic canal from the classic transcranial dissection [2,3]. Therefore, we performed the opening of the ventral surface of the optic canal in 6 cadavers (12 pairs of optic canals), adopting an endonasal route, performed with the auxilium of the endoscopic visualization technology. Our dissections clearly show the relationship between OA and ON in the optic canal. This knowledge is of particular importance for tumors invading the optic canal, such as tubercular sellae meningiomas, which can be safely approached through this endoscopic endonasal route, avoiding the risk of injury of OA within the optic canal [2.3