Impact of granulation pattern on surgical and long-term outcomes in Cushing's disease: a comparative study of DGCT and SGCT.

BACKGROUND

Functioning corticotroph adenomas/PitNETs can be subclassified into Densely and Sparsely Granulated Corticotroph Tumors (DGCT and SGCT). Previous studies suggest that DGCTs are associated with favourable outcomes, while SGCTs may be more aggressive. However, data comparing these subtypes in large cohorts remain limited. MATERIALS &

METHODS

We performed a single-center retrospective analysis of 208 patients with CD who underwent TSS between 2004 and 2024. Of these, 175 had DGCT and 33 had SGCT. Data were collected on preoperative diagnostics and imaging, intraoperative findings and strategies, histopathology, and surgical early and long-term outcomes.

RESULTS

We found no significant differences in preoperative tumor characteristics or surgical approaches between DGCT and SGCT. However, SGCT patients presented with a shorter interval between symptom onset and surgery. DGCT patients exhibited higher early remission rates (96.9% vs. 87.1%) and lower long-term recurrence rates (9.3% vs. 12.9%). Histopathological analysis revealed higher MIB-1 indices and p53 expression in SGCT, indicating a more aggressive tumor phenotype.

CONCLUSION

Despite similar preoperative and intraoperative characteristics, SGCT was associated with a higher recurrence rate and more aggressive biological behavior. These findings emphasize the need for intensified follow-up and consideration of early adjuvant therapies for SGCT patients. Our study provides valuable insights into the management of DGCT and SGCT, suggesting that histological subtype plays a critical role in long-term prognosis and underscores the importance of tailored therapeutic strategies for these subtypes in CD.