Development and validation of a prediction model for consistency of pituitary adenoma: the PiTCon score.

PURPOSE: Pituitary adenomas (PAs) usually have a soft consistency, facilitating gross total resection. However, 5-13% of PAs with fibrous consistency are challenging to remove entirely and are accompanied by greater morbimortality. This study aims to identify the clinical and radiological characteristics that correlate with PA fibrous consistency preoperatively. A simple scoring system has been proposed to predict incidence of fibrous PAs. MATERIALS AND METHODS: Consecutive interventions (226) were analyzed, all performed through an endoscopic endonasal transsphenoidal approach. Univariable and multivariable logistic regression analysis was performed. Hosmer-Lemeshow test and receiver operating characteristic (ROC) curves were assessed to evaluate the model. A point scoring system (PiTCon) was derived based on the multivariable regression model. Our study aimed to identify the clinical and radiological characteristics that correlate with fibrous tumor consistency preoperatively. RESULTS: The best diagnostic accuracy for predicting PA consistency consisted of five predictive factors: age, compressive symptoms, panhypopituitarism, craniocaudal extension of the PA in mm, and prior surgery. The multivariable model achieved good discrimination with an area under the curve (AUC) of the ROC curve being 0.82 and the 95% CI 0.76 to 0.88. Internal validation yielded an optimism-adjusted C-statistic of 0.80 (95% CI 0.74 to 0.86). A point scoring system (PiTCon score) was designed using the best predictive model. CONCLUSIONS: PA consistency can be estimated preoperatively regarding clinical and radiological characteristics. We propose a point-based scoring system (PiTCon score) that can better guide neurosurgeons in clinical decision-making and surgical risk assessment and help establish and describe patient prognosis.

Metástasis cerebelosa de carcinoma folicular de tiroides / A cerebellar metastasis from follicular thyroid carcinoma

Presentamos el primer caso clínico de metástasis cerebelosa de carcinoma folicular de tiroides. Se trata de una mujer de 78 años de edad, que fue sometida a tiroidectomía total, hace 23 años cuyo estudio histológico fue de adenoma de tiroides atípico en el lóbulo tiroideo izquierdo. Los niveles séricos de tiroglobulina (Tg) aumentaron en las revisiones posteriores. Los niveles de anticuerpos anti-tiroglobulina fueron siempre negativos. Recibió tratamiento con radioyodo en varias ocasiones. En el estudio de seguimiento una nueva TC reveló una lesión a nivel de hemisferio cerebeloso izquierdo. La paciente fue sometida a resección quirúrgica de esta lesión. Los hallazgos inmunohistoquímicos mostraron un origen tiroideo de la metástasis, con células tumorales con positividad difusa e intensa para citoqueratina-7 (CK7), factor de transcripción tiroideo-1 (TTF-1) y positiva focal para Tg, y débil para CK19, y negatividad para PGAF, galectina-3 y CK20. El análisis de las mutaciones V600E y V600K del gen BRAF fue negativa (AU)

We present here, for the first time, a case of cerebellar metastasis from a follicular thyroid carcinoma. A 78 year-old woman had undergone total thyroidectomy 23 years previously for an atypical thyroid adenoma in the left thyroid lobe. Serum thyroglobulin (tg) levels subsequently increased but thyroglobulin antibody levels were always negative. She received radioiodine therapy on several occasions. In the follow-up localizing study a whole body CT scan revealed an image at the left cerebellar hemisphere level. The patient underwent surgery for the cerebellar lesion and immunohistochemistry revealed it to be a metastasis of thyroid origin; the tumour cells had diffuse and intense positivity for cytokeratin-7 (CK7), thyroid transcription factor-1 (TTF-1) and tg, focal and weak positivity for CK19 and negativity for PGAF, galectin-3 and CK20. The analysis of V600K V600E BRAF gene mutations was negative (AU)

Respuesta terapéutica al tratamiento médico en el prolactinoma gigante quístico / Therapeutic response to medical treatment in cystic giant prolactinoma

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