Clinical review: Diagnosis and management of pituitary carcinomas.
Journal Title: Journal of Clinical Endocrinology and Metabolism - Year 2005, Vol 90, Issue 5
Abstract
Pituitary carcinomas are rare, making up some 0.2% of all pituitary tumors,but represent a particular challenge to clinical practice. The diagnosis of a pituitary carcinoma requiresevidence of metastatic disease, either outside the central nervous system (CNS) or as separate noncontiguousfoci within the CNS. They may present as typical pituitary adenomas, which reveal their malignant characteronly as time progresses, or as peculiarly aggressive tumors ab initio. Recent changes in histopathologicalclassification have clarified many of the features of such tumors, including immunohistochemical stainingfor Ki-67 and p53, but to date none has been found to be pathognomonic. The majority of carcinomas aresecretory, usually arising from corticotroph tumors or prolactinomas, but all histological types andsecretory patterns are represented. Treatment is by surgery, transsphenoidal wherever possible, and conventionaland stereotactic radiotherapy, but ultimately, a plethora of therapies may be required, including variousattempts at medical therapy. Chemotherapy in some instances probably prolongs survival, but, in general,their progress from the diagnosis of carcinomatous changes is progressive and inexorable. However, wedo not believe there will be any real prospect of long-term survival until the development and use oftherapies targeted at specific molecular abnormalities.
Authors and Affiliations
Gregory A Kaltsas, Panagiotis Nomikos, George Kontogeorgos, Michael Buchfelder, Ashley B Grossman
Keywords
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