目的:非功能性垂体神经内分泌肿瘤(PitNETs)根据亚型在生长模式上表现出广泛的变异性。与其他非功能性腺瘤(NFPA)相比,沉默的促肾上腺皮质激素腺瘤(SCAs)表现出积极的生长,尤其是海绵窦.在这项研究中,与NFPA相比,我们试图描述SCA的其他生长模式。
方法:我们对2018年8月1日至2024年5月11日在单个机构通过鼻内镜入路(EEA)手术切除的所有无功能PitNETs患者进行了回顾性分析。术前计算机断层扫描(CT)和磁共振成像(MRI)进行了审查,以确定向鞍上空间的延伸,蝶窦,海绵窦,还有Clivus.
结果:纳入91例患者,包括20个SCA和71个NFPA。SCAs表现出明显更高的进入蝶窦的增长率(55.0%vs.23.94%,p=0.013),clivus(65.0%vs.16.9%,p<0.0001),和海绵窦(定义为Knosp3级或4级;55.0%vs.23.35%,p=0.016)。其他NFPA更有可能生长到鞍上空间(92.96%与75.0%,p=0.038)。组间肿瘤体积相似(11.93cm3与9.06cm3,p=0.2)。
结论:沉默的促肾上腺皮质激素PitNETs显示出骨结构侵入的倾向,通过鞍底生长到蝶窦的速率更高,向后生长到悬崖,横向进入海绵状窦。其他无功能的PitNET倾向于遵循阻力最小的路径,向上生长进入鞍上空间。生长模式的这些差异可能是治疗沉默的促肾上腺皮质激素PitNETs的一些临床挑战。
OBJECTIVE: Nonfunctional pituitary neuroendocrine tumors (PitNETs) exhibit wide variability in growth pattern based on subtype. Silent corticotroph adenomas (SCAs) demonstrate aggressive growth compared to other nonfunctional adenomas (NFPAs), especially into the cavernous sinus. In this study, we sought to characterize other growth patterns of SCAs in comparison to NFPAs.
METHODS: We performed a retrospective analysis of all patients with nonfunctional PitNETs treated with surgical resection via endoscopic endonasal approach (EEA) at a single institution from August 1, 2018, to May 11, 2024. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) were reviewed to determine extension into the suprasellar space, sphenoid sinus, cavernous sinus, and clivus.
RESULTS: Ninety-one patients were included, including 20 SCAs and 71 NFPAs. SCAs demonstrated significantly greater rates of growth into the sphenoid sinus (55.0% vs. 23.94%, p=0.013), clivus (65.0% vs. 16.9%, p<0.0001), and cavernous sinus (defined as Knosp grade 3 or 4; 55.0% vs. 23.35%, p=0.016). Other NFPAs were more likely to grow into the suprasellar space (92.96% vs. 75.0%, p=0.038). Tumor volume was similar between groups (11.93 cm3 vs. 9.06 cm3, p=0.2).
CONCLUSIONS: Silent corticotroph PitNETs demonstrate predilection for invasion of bony structures, with higher rates of growing through the sellar floor into the sphenoid sinus, growing posteroinferiorly into the clivus, and laterally into the cavernous sinuses. Other nonfunctional PitNETs tended to follow the path of least resistance, growing superiorly into the suprasellar space. These differences in growth patterns may account for some of the clinical challenges of treating silent corticotroph PitNETs.