The relationship between hormonal and immunophenotypic characteristics and sellar floor destruction in pituitary adenomas

Aim: Pituitary adenomas are neuroendocrine tumors that are benign, usually have a benign course, can be locally aggressive from time to time, and carry a very rare risk of malignant transformation. Sometimes these benign tumors can manifest themselves with the local compression effect. This compression effect includes irritation and destruction of the upper wall of the sphenoid sinus, ie the floor of the sella, inside the sphenoid bone. Ki-67 antibody; It is a nuclear protein that indicates cells proliferating within tumoral cells. Tumor cells with a high immunohistochemically ki-67 index tend to be more aggressive. The aim of this study is to determine the relationship of histopathologically detected erosion of the sella floor with the hormonal profile and immunohistochemically studied ki-67 index in functional and non-functional pituitary adenomas with surgical indication and operated endoscopically in our clinic. Materials and Methods: Patients who are older than 18 years old and applied to our clinic with any complaint and was diagnosed with pituitary adenoma after radiological and clinical examination, in the Department of Neurosurgery of Ankara University Faculty of Medicine, Ibn-i Sina Hospital, between January 2018 and 2023 included the study. Demographic data, radiological data, biochemical data and pathology records of 60 patients who underwent endonasal trans-sphenoidal pituitary adenomectomy surgery were included in the study by retrospectively reviewing after approval of the ethics committee. Although the number of patients who met these criteria was 60, 15 patients were not included in the study because 13 patients did not have a pathological diagnosis of pituitary adenoma and 2 patients had received hormonal therapy before, and because the sella floor materials of 5 patients were not sufficient in terms of sampling and examination, the study included 40 patients in total. The relationship between Ki-67 indices and hormonal profiles of 40 patients and the presence of Sella Floor destruction was investigated with the data obtained. Results: A total of 40 patients were included in the study. Of the included patients, 17 (42.5%) were female and 23 (57.5%) were male. The minimum age value is 20 and the maximum age value is 74. Average age is 50.25, median age is 53.00. The minimum value of ki-67 is 1, the maximum value of ki-67 is 25. The mean value of ki-67 was found to be 4. In hormonal profile distribution, 7 (17.5%) patients were found to be Somatotrope, 8 (20%) patients to Mammotrop, 15 (37.5%) patients to Gonadotrope, 1 (2.5%) to Thyrotrope, 3 (7.5%) patients to negative due to hormonal staining. In the histopathological examination, Sella Floor Destruction was detected in 18 (45%) patients. In the classification according to Ki-67 value, 16 (40%) patients were evaluated as high ki-67 values with a value of 3 or more. According to this; The incidence of bone erosion was higher in those with a high ki-67 index than in those with a low ki-67 index, and those with a somatotropic hormone profile had a higher ki-67 index than those with a gonadotropic hormone profile. Conclusion: In our study, it was observed that the base of the sella was more prone to destruction during tumoral development in cases with Ki-67 values of 3 and above. We think that the effects of chronic inflammation and mechanical compression due to oncogenesis are important in this. On the other hand; The rate of ki-67 index being higher in those with somatotropic hormone profile was found to be higher than those with hormone profile gonadotropic. We believe that studies with larger series are needed to better understand the relationship between hormonal profile and Sella Floor destruction. Keywords: pituitary adenoma, sphenoid sinus, floor of the sella, ki-67