• Aykut Gokbel, Ayse Uzuner, Atakan Emengen, Eren Yilmaz, OzturkSeda DumanSDDepartment of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey., Yonca Anik, Ihsan Anik, and Savas Ceylan.
• Department of Neurosurgery, VM Pendik Medical Park Hospital, Istanbul, Turkey.
• World Neurosurg. 2024 Dec 5.

ObjectiveCalcification in pituitary adenomas is a rare occurrence and its differential diagnosis typically includes other sellar masses. Common calcifications in pituitary adenomas are classified into 2 morphological forms: capsular (eggshell-like) and multiple small nodular calcifications located within the adenoma. Also, there is a pituitary stone term. This study aims to present the results of calcified pituitary adenoma case series who underwent endoscopic endonasal approach (EEA) and the clinical, histopathological characteristics and surgical outcomes of these cases.MethodsThis study conducted a retrospective cohort analysis of patients with calcified pituitary adenoma operated on by EEA between August 1997 and February 2024. The inclusion criteria were as follows: proven radiological calcification on preoperative neuroimaging, intraoperative findings of calcification, and definitive histopathological diagnosis of calcification. Among these patients, 11 cases were included.ResultsThe mean follow-up duration was 51.45 ± 37.24 (6-118) months. Based on the preoperative paranasal sinus computed tomography scans of patients, 9 patients (81.8%) had intratumoral calcification, 1 (9.1%) had capsular (eggshell-like) calcification, and 1 (9.1%) had both intratumoral and capsular calcification. Moreover, stone-like calcifications were observed in 4 patients (36.4%), soft-type calcifications in 3 (27.3%), hard-type calcifications in 3 (27.3%), and soft-type and hard-type calcifications in 1 (9%). Gross total resection was achieved in 9 patients (81.8%). Pathologic subtypes included nonfunctioning (n = 4), prolactin secreting (n = 3), growth hormone-secreting adenoma (n = 2), and pituitary apoplexy (n = 2). Ten patients had psammomatous-type calcifications and 1 had extensive ossification and osteoid metaplasia.ConclusionsPreoperative radiological evaluation, intraoperative classification of calcification, and postoperative histopathological assessments are crucial in the treatment of calcified adenomas. Bases on these findings, the EEA, with its advantages, is an approach that can be effectively used in the management of these calcified adenomas.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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