Tag: Ki 67

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Giant Invasive Spinal Schwannoma: Its Clinical Features and Surgical Management

Neurosurgery 71:58–67, 2012 DOI: 10.1227/NEU.0b013e31824f4f96

Giant invasive spinal schwannoma (GISS) is defined as a lesion that extends over . 2 vertebral levels, erodes vertebral bodies, and extends posteriorly and laterally into the myofascial planes. Because of its rarity, few reports have been issued.

OBJECTIVE: To analyze the clinical features and outcomes of GISS and to discuss surgical strategies.

METHODS: We analyzed the medical records, pathological findings, and radiographic studies of patients with GISS.

RESULTS: Fourteen patients with GISS were surgically treated between 2002 and 2007. Five lesions were in the sacral region, 4 in the lumbosacral, 2 in the thoracolumbar, and 1 each in the cervical, cervicothoracic, and thoracic regions. Gross total resection was performed in 11 of the 14 patients. Satisfactory decompression was performed in all patients for neural compression. Postoperatively, all patients showed relief of pre- operative pain and paresthesia. The growth potential with the Ki-67 index was . 2% in 6 patients, and 4 of them experienced tumor regrowth or recurrence. All patients were followed up for at least 24 months. Final follow-up magnetic resonance images showed asymptomatic small tumor recurrence on the sacrum in 2 patients. Two patients required spinal stabilization. No instability was found on follow-up.

CONCLUSION: Total resection is the treatment of choice for patients with GISS and provides functional improvements, low permanent morbidity, and a low rate of recurrence. Total resection of the intraspinal portion and regular follow-up with con- sideration of the Ki-67 index is recommended when total resection is not achieved.

 

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Atypical pituitary adenomas: incidence, clinical characteristics, and implications

J Neurosurg 114:336–344, 2011.DOI: 10.3171/2010.8.JNS10290

The 2004 WHO classification of pituitary adenomas now includes an “atypical” variant, defined as follows: MIB-1 proliferative index greater than 3%, excessive p53 immunoreactivity, and increased mitotic activity. The authors review the incidence of this atypical histopathological subtype and its correlation with tumor subtype, invasion, and surgical features.

Methods. The records of 121 consecutive patients who underwent transsphenoidal surgery for pituitary adenomas during an 18-month period were retrospectively reviewed for evidence of atypical adenomas.

Results. Eighteen adenomas (15%) met the criteria for atypical lesions; 17 (94%) of the 18 were macroadenomas. On imaging, 15 (83%) demonstrated imaging evidence of surrounding invasion, compared with 45% of typical adenomas (p = 0.004). Atypical tumors occurred in 12 female (67%) and 6 male (33%) patients. Patient age ranged from 16 to 70 years (mean 48 years). Nine patients (50%) had hormonally active tumors, and 9 had nonfunctional lesions. Four (22%) of the 18 patients presented to us with recurrent tumors. Immunohistochemical analysis demonstrated the following tumor subtypes: GH-secreting adenoma with plurihormonal staining (5 patients [28%]); null-cell adenoma (5 patients [28%]); silent ACTH tumor (3 patients [17%]), ACTH-staining tumor with Cushing’s disease (2 patients [11%]), prolactinoma (2 patients [11%]), and silent FSH-staining tumor (1 patient [6%]). The MIB-1 labeling index ranged from 3% to 20% (mean 7%).

Conclusions. Atypical tumors were identified in 15% of resected pituitary adenomas, and they tended to be aggressive, invasive macroadenomas. More longitudinal follow-up is required to determine whether surgical outcomes, potential for recurrence, or metastasis of atypical adenomas vary significantly from their typical counterparts.

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