Treatment of pituitary carcinomas and atypical pituitary adenomas: a review

Neurol Med Chir (Tokyo). 2014;54(12):966-73. doi: 10.2176/nmc.ra.2014-0178. Epub 2014 Nov 29.


Atypical pituitary adenomas (APAs) are aggressive tumors, harboring a Ki-67 (MIB-1) staining index of 3% or more, and positive immunohistochemical staining for p53 protein, according to the World Health Organization (WHO) classification in 2004. Pituitary carcinomas (PC) usually develop from progressive APAs and predominantly consist of hormone-generating tumors, defined by the presence of disseminations in the cerebrospinal system or systemic metastases. Most of the cases with these malignant pituitary adenomas underwent surgeries, irradiations and adjuvant medical treatments, nevertheless, the therapies are mainly palliative. Recently, the efficacy of temozolomide (TMZ), an orally administered alkylating agent, has been reported as an alternative medical treatment. However, some recent studies have demonstrated a significant recurrence rate after effective response to TMZ. Further clinical and pathological researches of malignant pituitary adenomas will be required to improve the outcome of patients with these tumors.

Publication types

  • Review

MeSH terms

  • Adenoma / diagnosis
  • Adenoma / metabolism
  • Adenoma / pathology
  • Adenoma / therapy*
  • Administration, Oral
  • Antineoplastic Agents, Alkylating / therapeutic use*
  • Cell Transformation, Neoplastic / drug effects
  • Cell Transformation, Neoplastic / pathology
  • Combined Modality Therapy
  • Dacarbazine / analogs & derivatives*
  • Dacarbazine / therapeutic use
  • Disease Progression
  • Humans
  • Magnetic Resonance Imaging
  • Neoplasm Recurrence, Local / diagnosis
  • Neoplasm Recurrence, Local / metabolism
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / therapy
  • Pituitary Gland / pathology
  • Pituitary Hormones / metabolism
  • Pituitary Neoplasms / diagnosis
  • Pituitary Neoplasms / metabolism
  • Pituitary Neoplasms / pathology
  • Pituitary Neoplasms / therapy*
  • Temozolomide


  • Antineoplastic Agents, Alkylating
  • Pituitary Hormones
  • Dacarbazine
  • Temozolomide