Abstract：
Unlike somatotroph tumors, the data on correlates of tumor granulation patterns in functional TPIT lineage pituitary neuroendocrine tumors (corticotroph tumors) have been less uniformly documented in most clinical series. This study evaluated characteristics of 41 well-characterized functional corticotroph tumors consisting of 28 densely granulated corticotroph tumors (DGCTs) and 13 sparsely granulated corticotroph tumors (SGCTs) with respect to preoperative clinical and radiological findings, tumor proliferative activity (including mitotic count and Ki-67 labeling index), and postoperative early biochemical remission rates. The median (interquartile range (IQR)) tumor size was significantly larger in the SGCT group [16.00 (16.00) mm in SGCT vs 8.5 (9.75) mm in DGCT, p = 0.049]. T2-weighted signal intensity and T2 intensity (quantitative) did not yield statistical significance based on tumor granulation; however, the T2 intensity-to-white matter ratio was significantly higher in SGCTs (p = 0.049). The median (IQR) Ki-67 labeling index was 2.00% (IQR 1.00%) in the DGCT group and 4.00% (IQR 7.00%) in the SGCT group (p = 0.043). The mitotic count per 2 mm2 was higher in the SGCT group (p = 0.001). In the multivariate analysis, the sparse granulation pattern (SGCT) remained an independent predictor of a lower probability of early biochemical remission irrespective of the tumor size and proliferative activity (p = 0.012). The current study further supports the impact of tumor granulation pattern as a biologic variable and warrants the detailed histological subtyping of functional corticotroph tumors as indicated in the WHO classification of pituitary neuroendocrine tumors. More importantly, the assessment of the quantitative T2 intensity-to-white matter ratio may serve as a preoperative radiological harbinger of SGCTs.
摘要：
与生长激素肿瘤不同，在大多数临床系列中，关于功能性TPIT谱系垂体神经内分泌肿瘤（促肾上腺皮质激素肿瘤）中肿瘤肉芽模式相关性的数据记录较少。这项研究评估了41个特征明确的功能性促肾上腺皮质激素肿瘤的特征，这些肿瘤包括28个密集颗粒状促肾上腺皮质激素肿瘤（DGCTs）和13个稀疏颗粒状促肾上腺皮质激素肿瘤（SGCTs）。肿瘤增殖活性（包括有丝分裂计数和Ki-67标记指数），术后早期生化缓解率。SGCT组的中位（四分位距（IQR））肿瘤大小明显更大[SGCT为16.00（16.00）mm，DGCT为8.5（9.75）mm，p=0.049]。基于肿瘤肉芽，T2加权信号强度和T2强度（定量）未产生统计学意义；然而，SGCT中T2强度与白质的比值显著较高(p=0.049).DGCT组的中位数（IQR）Ki-67标记指数为2.00%（IQR1.00%），SGCT组为4.00%（IQR7.00%）（p=0.043）。SGCT组每2mm2的有丝分裂计数较高（p=0.001）。在多变量分析中，无论肿瘤大小和增殖活性如何,稀疏颗粒模式(SGCT)仍然是早期生化缓解概率较低的独立预测因子(p=0.012).当前的研究进一步支持肿瘤肉芽模式作为生物学变量的影响，并保证功能性促肾上腺皮质激素肿瘤的详细组织学分型，如垂体神经内分泌肿瘤的WHO分类所示。更重要的是,对定量T2强度与白质比值的评估可作为SGCT的术前放射学预兆.
