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Are aggressive pituitary tumors and carcinomas two sides of the same coin? Pathologists reply to clinician’s questions

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Abstract

Pituitary adenohypophyseal tumors are considered as benign and termed “adenomas”. However, many tumors are invasive and a proportion of these exhibit an “aggressive behavior” with premature death due to progressive growth. Only very rare (0.2%) tumors with metastases are considered malignant and termed “carcinomas”. Taking into account this variability in behavior and the oncological definition, pathologists have proposed changing the term adenoma to tumor. Here we explain why use the term tumor instead of adenoma and identify tumor characteristics, associated with a high risk for poor prognosis. In a cohort of 125 tumors with aggressive behavior (APT) and 40 carcinomas with metastases (PC), clinical and pathological features were very similar. The comparison of this cohort (APT+PC) with a reference surgical cohort of 374 unselected patients clearly shows that the two cohorts differ greatly, especially the percentage of tumors with Ki67 ≥ 10% (35%vs3%; p < 0.001). A five-tiered prognostic classification, associating invasion and proliferation, identified grade 2b tumors (invasive and proliferative), with a high risk of recurrence/progression. Because half of the APT+ PC tumors have a Ki67 index ≥10%, and 80% of them show 2 or 3 positive markers of proliferation, we suggest that tumors that are clinically aggressive, invasive and highly proliferative with a Ki67 ≥ 10%, represent tumors with malignant potential. The percentage of grade 2b tumors, suspected of malignancy, which will become aggressive tumors or carcinomas is unknown. It is probably very low, but higher than 0.2% in surgical series. Early identification and active treatment of these aggressive tumors is needed to decrease morbidity and prolong survival.

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Authors and Affiliations

  1. University of Lyon 1, University of Lyon, F-69000, Lyon, France

    Jacqueline Trouillas, Alexandre Vasiljevic, Anne Wierinckx & Gérald Raverot

  2. Faculty of Medicine Lyon-Est, F-69372, Lyon, France

    Jacqueline Trouillas, Alexandre Vasiljevic & Gérald Raverot

  3. Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100, L’Aquila, Italy

    Marie-Lise Jaffrain-Rea

  4. Neuroendocrinology, Neuromed Institute, IRCCS, 86077, Pozzilli, Italy

    Marie-Lise Jaffrain-Rea

  5. Cancer Research Center of Lyon (CRCL), INSERM U1052, CNRS UMR5286, University of Lyon, 69008, Lyon, France

    Alexandre Vasiljevic, Anne Wierinckx & Gérald Raverot

  6. Pathology Department, Groupement Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France

    Alexandre Vasiljevic

  7. Department of Clinical Epidemiology and Endocrinology, Leids Universitair Medisch Centrum Ringgold Standard Institution, Leiden, Zuid-Holland, Netherlands

    Olaf Dekkers

  8. School of Medicine, University of Belgrade, Belgrade, Serbia

    Vera Popovic

  9. ProfileXpert, SFR-Est, CNRS UMR-S3453, INSERM US7, Cedex, 69373, Lyon, France

    Anne Wierinckx

  10. Department of Endocrinology, St Vincent’s Hospital, Sydney, New South Wales, Australia

    Ann McCormack

  11. Hormone and Cancer Group, Garvan Institute of Medical Research, Sydney, New South Wales, Australia

    Ann McCormack

  12. Endoc Center for Endocrine Tumors, Erik-Blumenfeld-Platz 27a, 22587, Hamburg, Germany

    Stephan Petersenn

  13. Endocrinology, Skane university Hospital, Malmo, Sweden

    Pia Burman

  14. Endocrinology, University of Lund, Malmo, Sweden

    Pia Burman

  15. Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, 59 Pinel Boulevard, 69677, Bron, France

    Gérald Raverot

  16. Fédération d’Endocrinologie Pôle Est, Groupement Hospitalier Est, 59 Boulevard Pinel, 69677, Bron, France

    Gérald Raverot

  17. Pathology Department, Foch Hospital, 40 rue Worth, 92151, Suresnes, France

    Chiara Villa

  18. INSERM U1016, CNRS UMR 8104, Cochin Institute, Paris Descartes University, rue du faubourg Saint-Jacques, 75014, Paris, France

    Chiara Villa

  19. Endocrinology Department CHU de Liège, University of Liège, Sart Tilman B35, 4000, Liège, Belgium

    Chiara Villa

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  1. Jacqueline Trouillas
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  2. Marie-Lise Jaffrain-Rea
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  3. Alexandre Vasiljevic
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  5. Vera Popovic
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Correspondence to Jacqueline Trouillas.

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Trouillas, J., Jaffrain-Rea, ML., Vasiljevic, A. et al. Are aggressive pituitary tumors and carcinomas two sides of the same coin? Pathologists reply to clinician’s questions. Rev Endocr Metab Disord 21, 243–251 (2020). https://doi.org/10.1007/s11154-020-09562-9

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