• Hirotaka Hasegawa, Jamie J Van Gompel, Soliman H Oushy, Bruce E Pollock, Michael J Link, Fredric B Meyer, Irina Bancos, Dana Erickson, Caroline J Davidge-Pitts, Jason T Little, Joon H Uhm, Amy A Swanson, Caterina Giannini, Anita Mahajan, and John L Atkinson.
• Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
• World Neurosurg. 2021 May 1; 149: e197-e216.

ObjectiveTo discuss optimal treatment strategy for spindle cell oncocytoma (SCO) of the pituitary gland.MethodsInstitutional 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.ResultsEighty-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).ConclusionsFrequent 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.Copyright © 2021 Elsevier Inc. All rights reserved.

18 keywords...

hide…