Endocrinologically Silent Pituitary Tumors

Cappabianca, Paolo; Esposito, Felice; Cavallo, Luigi Maria; Colao, Annamaria

doi:10.1016/b978-1-4160-6839-6.10021-8

Cited by 3 publications

(1 citation statement)

References 90 publications

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“…28 Plastic surgeons regularly use autologous fat grafts, and free fat grafts are regularly applied in controlling cerebral spinous fluid leaks by neurosurgeons. 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

Pre‐gerotal fat patch—A novel alternative to haemostatic agents during partial nephrectomy

Timm,

Thomson,

Bolton

et al. 2023

BJUI Compass

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ObjectiveThis study aimed to determine if using a pre‐gerotal fat patch at open partial nephrectomy (PN) as a haemostatic bolster is a viable alternative to using synthetic haemostatic agents.Materials and methodsHuman Research Ethics Committee approval was obtained for audit of a prospectively kept database from July 2012 to July 2021, which followed outcomes of patients who received a low‐tension pre‐gerotal fat patch renorrhaphy at open PN. Patient demographics, intraoperative measures, histological outcomes and post‐operative complications were analysed. Using a retroperitoneal approach, the peritoneum was mobilised and a vascularised pedicle of pre‐gerotal fat was rotated in the direction of the kidney. Routine definition of the hilum, clamping of the hilar vessels and dissection of mass followed. After watertight closure and haemostasis, the harvested pre‐gerotal fat patch was placed over the defect and secured using low‐tension renorrhaphy. Two‐layer closure of the abdominal wall with placement of a drain was routine.ResultsA total of 55 patients underwent open PN. Mean age was 60.4 (35–77) years. There were 38 men and 17 women, and 32 right and 23 left PNs. Mean mass size was 31.9 mm (10–95 mm) and collecting system was breached in 36.5% of cases. One patient (1.9%) suffered a Clavien–Dindo IIIb complication requiring return to theatre and transfusion due to a bleed from an intercostal artery. There were no renal bed bleeds, urine leaks or urine fistulas detected. Mean intraoperative blood loss was 355 mL (50–1500 mL) and mean post‐operative creatinine increased by 10.7 μmol/L (51–172 μmol/L). Mean follow up was 40.2 (4–109) months.ConclusionUtilisation of an anatomical pre‐gerotal fat patch to provide pressure at the renorrhaphy site during open PN is an effective technique to assist with surgical haemostasis. This simple technique avoids the costs of haemostatic agents, whilst adding minimal operating time to procedures.

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“…28 Plastic surgeons regularly use autologous fat grafts, and free fat grafts are regularly applied in controlling cerebral spinous fluid leaks by neurosurgeons. 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

Pre‐gerotal fat patch—A novel alternative to haemostatic agents during partial nephrectomy

Timm,

Thomson,

Bolton

et al. 2023

BJUI Compass

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Atypical pituitary adenomas: clinical characteristics and role of ki-67 and p53 in prognostic and therapeutic evaluation. A series of 50 patients

Solari

Pagliuca

et al. 2016

Neurosurg Rev

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The aim of the study was to assess incidence rate, hormonal activity, and local invasiveness and evaluate outcomes of so-diagnosed atypical pituitary adenomas that underwent endoscopic endonasal surgery at the Division of Neurosurgery of Università degli Studi di Napoli Federico II. According to the 2004 WHO classification, atypical pituitary adenomas are defined by an invasive growth, Ki-67/MIB-1 proliferative index greater than 3 %, high p53 immunoreactivity, and increased mitotic activity. A retrospective analysis of a series of 434 pituitary adenomas that underwent endoscopic endonasal surgery at our department between March 2007 and February 2013 was performed. Fifty adenomas (11.5 %) met the criteria of diagnosis of atypical lesions; 10 (21.6 %) of the 50 patients were recurrent tumors with a previous transsphenoidal surgery. Forty-one (82 %) were macroadenomas, and 21/50 (42 %) showed a clear invasion of the cavernous sinus. Histotype of atypical adenomas figured out to be nonfunctioning in 23 cases (46 %), PRL secreting in 10 cases (20 %), ACTH secreting and GH secreting each apart in 8 patients (16 %), and in a single case a GH/PRL secreting adenoma (2 %). The Ki-67 labeling index ranged from 3.5 to 22.5 % (mean 5.6 %). Tumor recurrence was observed in six cases (12 %) after a mean time of 18 months (range 9-24 months). Mean follow-up was 36.5 months (range 2-80 months). Atypical pituitary adenomas account for ca. 10 % of all pituitary adenomas; these lesions have peculiar features. It should be considered that a strong immunopositivity of p53 and higher Ki-67 LI could predict an increased risk of tumor recurrence, but more studies and larger series are expected to confirm and enlarge the diagnostic and therapeutic management process of these lesions.

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Commentary

Mashiko

2019

Journal of Neurosciences in Rural Practice

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Endocrinologically Silent Pituitary Tumors

Cited by 3 publications

References 90 publications

Pre‐gerotal fat patch—A novel alternative to haemostatic agents during partial nephrectomy

Pre‐gerotal fat patch—A novel alternative to haemostatic agents during partial nephrectomy

Atypical pituitary adenomas: clinical characteristics and role of ki-67 and p53 in prognostic and therapeutic evaluation. A series of 50 patients

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