Objective: This study aimed to measure the incidence of tumor recurrence amongst patients that underwent endoscopic transsphenoidal surgery for pituitary adenomas, as well as the performance of the molecular and radiological factors that are commonly associated with recurrence.Methods: Patients of both adult and pediatric populations with pituitary adenomas who were treated for the rst time with endoscopic transsphenoidal surgery in a single tertiary care center, between June 2006 and December 2019 were included. Clinical features, laboratory results, imaging ndings and molecular test results were collected. Progression was measured in a follow-up MRI.Results: 88 patients were included. 19.5% presented gonadotroph adenomas and nonfunctional adenomas, followed by corticotrophs (17.2%) and somatotrophs (13.8%). 20.7% had cellular atypia, 26.2% p53 mutation and up to 79.5% had Ki-67 under 3%. On postoperative MRI (available for 90.9% of patients) 43.8% had tumor residue. Tumor progression occurred in 32 patients (36.4%). The Median progression-free survival time was 5.37 years (95%CI= 3.29 -N/A). Cellular atypia, Ki-67 elevation, cavernous sinus invasion and tumor residue were suggested as signi cant prognostic factors.Nonetheless, the multivariate time-to-event analysis identi ed tumor residue as the only factor signi cantly associated with progression: HR= 4.0, 95%CI= 1.56 -10.31.Conclusions: Residual tumor in postoperative imaging aids as a predictor for tumor progression and the invasion of the cavernous sinus, presence of cellular atypia and a proliferation index (Ki-67) above 3% in uence the speed at which the recurrence appears, therefore not being a predictive factor but rather a modi er of the recurrence.
Erdheim-Chester disease (ECD) is a rare non-Langerhans'cell histiocytosisdescribed in 1930 by Jakob Erdheim and William Chester, it can present as a multisystemic entity that forms xanthogranulomas which are foamy histiocytes surrounded by fibrotic tissue. Lesions are commonly located in long bones, central nervous system (CNS), cardiovascular system, lungs, kidneys and skin. The CNS is involved in approximately 50% of cases and can compromise both extra or intra-axial structures and therefore can mimic schwannomas or meningiomas, amongst other mass lesions [2, 9]. Clinical presentation will differ from patient to patient thus diagnosis depends greatly in imaging, immunohistochemistry and genetic findings within the pathology analysis [4]. The pathogenesis of this disease remains unknown. It is most commonly found in the middle-aged male population [1, 8]. Here, we present a case of a middle-aged woman with an extra-axial lesion that was initially considered to be neurosarcoidosis proving the diagnostic challenge this entity implies.
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