A régen jóindulatú tumorként számontartott hypophysisdaganatok ritkán agresszíven viselkednek, és metasztázist is adhatnak. Az Európai Endokrinológiai Társaság aktuális irányelve szerint a hypophysisadenomát agresszívnek tartjuk, ha a daganat radiológiailag invazív, és szokatlanul gyorsan növekszik, vagy kiújul az optimális standard kezelés ellenére. Jelenleg nem rendelkezünk olyan patológiai markerrel, amely egyértelműen jelezné a daganat agresszív, illetve malignus természetét. A hypophysiscarcinomát ezért jelenleg klinikai ismérvek alapján definiáljuk; a carcinoma diagnózisának kimondásához craniospinalis és/vagy távoli áttét igazolása szükséges. Az áttétek jellemzően évekkel a betegség első azonosítását követően jelennek meg. A szövettani vizsgálat utalhat a daganat agresszív voltára, ha a Ki67-index és a mitotikus ráta emelkedett, vagy a p53 immunhisztokémiailag pozitív. A betegek rövid és hosszú távú kezelését egyénre szabottan, multidiszciplináris hypophysisbizottságban kell meghatározni. A hypophysisadenomák kezelésében használatos standard gyógyszereket a még tolerálható maximális dózisban kell alkalmazni. A legtöbb beteg esetében ismételt műtét(ek)re és sugárkezelésre is sor kerül. Ha a daganat mégis progrediál, kemoterápia indítása javasolt, elsőként a temozolomid választandó. Ezt követően az immunellenőrzőpont-gátló készítmények, bevacizumab és peptidreceptor-radioterápia közül választhatunk. Orv Hetil. 2023; 164(30): 1167–1175.
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