TY - JOUR
T1 - A Comprehensive Study of Spindle Cell Oncocytoma of the Pituitary Gland
T2 - Series of 6 Cases and Meta-Analysis of 85 Cases
AU - Hasegawa, Hirotaka
AU - Van Gompel, Jamie J.
AU - Oushy, Soliman H.
AU - Pollock, Bruce E.
AU - Link, Michael J.
AU - Meyer, Fredric B.
AU - Bancos, Irina
AU - Erickson, Dana
AU - Davidge-Pitts, Caroline J.
AU - Little, Jason T.
AU - Uhm, Joon H.
AU - Swanson, Amy A.
AU - Giannini, Caterina
AU - Mahajan, Anita
AU - Atkinson, John L.
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/5
Y1 - 2021/5
N2 - 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.
AB - 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.
KW - Pituitary gland
KW - Posterior pituitary tumor
KW - Sellar tumor
KW - Spindle cell oncocytoma
KW - Transsphenoidal surgery
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U2 - 10.1016/j.wneu.2021.02.051
DO - 10.1016/j.wneu.2021.02.051
M3 - Article
C2 - 33610869
AN - SCOPUS:85102725585
SN - 1878-8750
VL - 149
SP - e197-e216
JO - World neurosurgery
JF - World neurosurgery
ER -