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A Comprehensive Study of Spindle Cell Oncocytoma of the Pituitary Gland: Series of 6 Cases and Meta-Analysis of 85 Cases
- Source :
- World Neurosurgery. 149:e197-e216
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- 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.
- Subjects :
- Male
Pituitary gland
medicine.medical_specialty
Posterior pituitary tumor
medicine.medical_treatment
03 medical and health sciences
0302 clinical medicine
medicine
Adenoma, Oxyphilic
Humans
Pituitary Neoplasms
Pituitary Neoplasm
Aged
Retrospective Studies
Transsphenoidal surgery
medicine.diagnostic_test
business.industry
T-cell receptor
Magnetic resonance imaging
Hypervascularity
Middle Aged
Radiation therapy
medicine.anatomical_structure
Tumor progression
030220 oncology & carcinogenesis
Meta-analysis
Sellar tumor
Female
Surgery
Neurology (clinical)
Radiology
Spindle cell oncocytoma
business
030217 neurology & neurosurgery
Human
Subjects
Details
- ISSN :
- 18788750
- Volume :
- 149
- Database :
- OpenAIRE
- Journal :
- World Neurosurgery
- Accession number :
- edsair.doi.dedup.....ab8bc8d6ac6fedb6efd79dc968c5e600