1
|
Demirci H, Kahraman D, Kuzucu P, Şenol Ö, Uğur KŞ, Ergün MA, Keskil S, Akdemir Özışık P. Growth hormone-releasing pituitary microadenoma overshaded by a macroadenoma: a case of double pituitary adenomas and review of the literature. Br J Neurosurg 2024; 38:1144-1150. [PMID: 35657108 DOI: 10.1080/02688697.2022.2076806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 03/21/2022] [Accepted: 05/09/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVES Double pituitary adenoma is a rare entity that can pose a significant challenge. The incidence of double or multiple pituitary adenomas is ∼1% in autopsy cases and 0.4-1.3% in surgical series. Its definition varies, including 'double adenomas' in the literature in contrast to 'multiple adenomas', which is more specific and suitable. While some authors require separating topographically unique tumours, others have used a looser definition of separate immunohistochemistry. CASE PRESENTATION We presented the case of a 26-year-old patient with recurrent carpal tunnel syndrome symptoms, with double pituitary adenomas secreting growth hormone (GH) and thyroid-stimulating hormone (TSH). To date, 89 patients have been reported in the literature with symptomatic carpal tunnel syndrome, but only five had GH-TSH secretion. CONCLUSIONS Double adenoma resection is of great importance for ensuring successful biochemical treatment. To ensure a successful operation, a careful preoperative 3T MRI examination is of great importance.
Collapse
Affiliation(s)
- Harun Demirci
- Department of Neurosurgery, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Devrim Kahraman
- Department of Pathology, Faculty of Medicine Hospital, TOBB University of Economics and Technology, Ankara, Turkey
| | - Pelin Kuzucu
- Department of Neurosurgery, Gülhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Özde Şenol
- Department of Neurosurgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Kadriye Şerife Uğur
- Department of ENT, Faculty of Medicine Hospital, TOBB University of Economics and Technology, Ankara, Turkey
| | - Mehmet Ali Ergün
- Department of Genetics, School of Medicine, Gazi University, Ankara, Turkey
| | | | - Pınar Akdemir Özışık
- Department of Neurosurgery, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| |
Collapse
|
2
|
Mansur G, Alsavaf MB, Pasquini L, Abouammo MD, Biswas C, Kumar P, Raval RR, Kobalka P, Carrau RL, Prevedello DM. "Intrasellar tumor-to-tumor metastasis: A single center experience with a systematic review". Pituitary 2024:10.1007/s11102-024-01441-9. [PMID: 39141205 DOI: 10.1007/s11102-024-01441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE This study investigates the rare occurrence of tumor-to-tumor metastasis in Pituitary Neuroendocrine Tumors (PitNETs), also known as pituitary adenomas, aiming to enhance understanding of its diagnostic and therapeutic challenges. We report two cases from our institution of tumor-to-tumor metastasis involving PitNETs, followed by a systematic literature review. METHODS We conducted a comprehensive literature review using PubMed and Google Scholar databases. This review provides insights into patient demographics, clinical presentations, primary tumor origin, management approaches and outcomes. RESULTS We identified 38 documented cases of tumor-to-tumor metastasis involving the pituitary gland in the literature. This revealed a diverse range of primary tumor origins, with lung, breast, and renal carcinomas being the most prevalent. Clinical presentations varied, with visual disturbances emerging as the most frequently reported symptom. Surgical interventions predominantly resulted in subtotal resection. Kaplan-Meier survival analysis demonstrated that endoscopic endonasal approaches (EEA) are associated with longer median survival times compared to other surgical methods. CONCLUSION Tumor-to-tumor metastasis to PitNETs must be considered in differential diagnoses of sellar masses. Prompt and accurate diagnosis, coupled with a multidisciplinary treatment strategy, is essential. Our study contributes to the scarce literature on such metastases, providing a foundation for further understanding of this complex pathological entity.
Collapse
Affiliation(s)
- Guilherme Mansur
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Doan Hall N 1049, 460 W 10th Ave., Columbus, OH, 43210, USA
| | - Mohammad Bilal Alsavaf
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Doan Hall N 1049, 460 W 10th Ave., Columbus, OH, 43210, USA
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Ludovica Pasquini
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Doan Hall N 1049, 460 W 10th Ave., Columbus, OH, 43210, USA
| | - Moataz D Abouammo
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Tanta University, Tanta, Egypt
| | - Chandrima Biswas
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Doan Hall N 1049, 460 W 10th Ave., Columbus, OH, 43210, USA
| | - Pavnesh Kumar
- Department of Radiation Oncology, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Raju R Raval
- Department of Radiation Oncology, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Peter Kobalka
- Department of Pathology, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Doan Hall N 1049, 460 W 10th Ave., Columbus, OH, 43210, USA.
| |
Collapse
|
3
|
Mancini AJ, Mathew R, Oentoro J, Devine AM, Maxwell C, Kravets I. Concurrent Papillary Craniopharyngioma and Growth Hormone-Secreting Pituitary Adenoma: A Rare and Aggressive Collision Tumor. AACE Clin Case Rep 2024; 10:144-148. [PMID: 39100629 PMCID: PMC11294742 DOI: 10.1016/j.aace.2024.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 08/06/2024] Open
Abstract
Background/Objective Collision tumors composed of craniopharyngiomas and pituitary adenomas are extremely rare. We report a collision tumor formed by a papillary craniopharyngioma and a growth hormone-secreting pituitary adenoma, which is the first report of such a tumor, to the best of our knowledge. Case Report A 49-year-old man presented with 2 months of headaches and blurry vision. An exam demonstrated frontal bossing, enlarged jaw and hands, macroglossia, and bitemporal hemianopsia, and magnetic resonance imaging (MRI) showed a 4.1 cm sellar/suprasellar mass with mass effect on the optic chiasm. The tumor was resected twice via a craniotomy, the second time due to interval growth, with the pathology after both surgeries showing a papillary craniopharyngioma. IGF-1 was 517 ng/mL (68-225) and growth hormone suppression test was positive. Repeat MRI showed residual tumor with ongoing mass effect on the optic chiasm and radiation therapy was initiated. MRI showed interval growth of the mass and IGF-1 rose to 700 ng/mL after which the patient underwent a transsphenoidal resection of the tumor; the pathology showed a residual papillary craniopharyngioma and a PIT1 lineage adenoma with most cells expressing growth hormone. After developing numerous complications, the patient passed away. Discussion Collision tumors of the sella are often associated with an aggressive clinical course, as they often go undiagnosed preoperatively, thus reducing the likelihood of total resection and leading to higher rates of craniopharyngioma recurrence. Conclusion A pituitary mass with an aggressive clinical course should prompt a high index of suspicion for a sellar collision tumor, though prognosis remains poor.
Collapse
Affiliation(s)
- Alyssa J. Mancini
- Division of Endocrinology and Metabolism, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Ribu Mathew
- Division of Endocrinology and Metabolism, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Jaymie Oentoro
- Department of Pathology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Alma M. Devine
- Division of Endocrinology and Metabolism, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Carolyn Maxwell
- Division of Endocrinology and Metabolism, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Igor Kravets
- Division of Endocrinology and Metabolism, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| |
Collapse
|
4
|
Wang G, Shen H, Chu Z, Shen J, Wang Y. Endoscopic transsphenoidal approach to a sphenoid sinus inverted papilloma combined with pituitary adenoma: a case report. Br J Neurosurg 2024; 38:202-204. [PMID: 32940105 DOI: 10.1080/02688697.2020.1820944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/05/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
Sphenoid sinus inverted papilloma (IP) is a very infrequent tumor, and the combination of sphenoidal IP with pituitary tumor is extremely rare. In this report, the authors describe the case of a 63-year-old male with oculomotor nerve palsy in the left eye due to sellar region tumor. After endoscopic transsphenoidal surgery, the postoperative pathological examination confirmed the co-occurrence of an sphenoidal IP and pituitary adenoma. To our knowledge, the present case is the second reported case of an IP with a pituitary adenoma.
Collapse
Affiliation(s)
- GengHuan Wang
- Neurosurgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - HePing Shen
- The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - ZhengMin Chu
- Neurosurgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - JianGuo Shen
- Neurosurgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - YiFei Wang
- Neurosurgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| |
Collapse
|
5
|
Chatain GP, Chee K, Driscoll M, Kleinschmidt-DeMasters B, Lillehei KO. Pituitary Adenoma Coexistent with Sellar Clear Cell Meningioma Unattached to the Dura: Case Report and Treatment Considerations. J Neurol Surg Rep 2024; 85:e1-e10. [PMID: 38213880 PMCID: PMC10776412 DOI: 10.1055/s-0043-1777792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/05/2023] [Indexed: 01/13/2024] Open
Abstract
Collision tumors involving the sella are rare. Intrasellar collision tumors are most commonly composed of a combination of pituitary adenomas and pituitary neuroendocrine tumors; however, collision tumors consisting of a pituitary adenoma and intrasellar meningioma are exceedingly rare. The authors present the case of a 47-year-old man who presented with progressive right eye vision loss. Magnetic resonance imaging showed a large, heterogeneously enhancing sellar mass with suprasellar extension. Using a transcranial approach with a right subfrontal craniotomy, near-total resection of the mass was achieved. Histologic analysis confirmed a diagnosis of a gonadotroph adenoma with concomitant clear cell meningioma (CCM). This patient was discharged with improvement in visual acuity and no signs of diabetes insipidus. Given the indistinguishable radiographic characteristics of pituitary adenoma and CCM, a preoperative diagnosis of a collision tumor was difficult. This case was uniquely challenging since the CCM component lacked the classic dural attachment that is associated with meningiomas on neuroimaging. CCMs are classified as central nervous system (CNS) World Health Organization (WHO) grade 2 tumors and tend to behave more aggressively, therefore warranting close surveillance for signs of tumor recurrence. This is the first case to report a collision tumor consisting of pituitary adenoma and CCM.
Collapse
Affiliation(s)
- Grégoire P. Chatain
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Keanu Chee
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Meghan Driscoll
- Department of Pathology, University of Colorado, School of Medicine, Aurora, Colorado, United States
| | - B.K. Kleinschmidt-DeMasters
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, United States
- Department of Pathology, University of Colorado, School of Medicine, Aurora, Colorado, United States
| | - Kevin O. Lillehei
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, United States
| |
Collapse
|
6
|
Kleinschmidt-DeMasters BK. Unusual features of neurosarcoidosis: A 18-year retrospective. Ann Diagn Pathol 2023; 67:152201. [PMID: 37607450 DOI: 10.1016/j.anndiagpath.2023.152201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Neurosarcoidosis (NS) is a challenging diagnosis for clinicians and pathologists. NS most often presents with leptomeningeal involvement where it mimics infectious or neoplastic meningitis, and in up to half of cases, systemic signs of sarcoidosis are lacking. Rare presentations include dural-based mass(es) (mimicking meningioma), hypothalamic/sellar-based lesions (mimicking pituitary adenoma), or as myelopathy (mimicking tumor or neurodegenerative condition). For pathologists, the morphological effects of prior therapy are not well documented. NS as an unsuspected cause of demise today is even less well known. METHODS Search of departmental databases and personal files, 2004-2022, for NS cases, with focus on the subset with features of interest to pathologists. RESULTS 22 cases were identified (8 M: 14F, 13-66 years), in 11 of which the CNS specimen represented first diagnosis of sarcoidosis. 20 were surgical and 2 were autopsy cases. Focus of the study revolved around 2 surgical cases with NS granulomas intimately admixed with tumor (1 meningoma, 1 gonadotroph pituitary adenoma/pituitary neuroendocrine tumor (PitNET). One surgical and one autopsy case each had decrease in lymphocytes and well-formed granulomas, with increased fibrosis and hemosiderin in post-treatment tissues. We speculate, but cannot prove, that this may be due to prior steroid therapy. Both autopsy cases were women (38, 43-years), both with cauda equina syndrome/ progressive weakness as first presentation, and extensive spinal cord/nerve root sarcoidosis at demise. First diagnosis of NS/sarcoidosis was at autopsy in the 38-year-old. CONCLUSIONS Unusual features for pathologists are that NS can co-exist within benign tumors, prior therapy alters histological features, and even in the modern era, may be first diagnosed at autopsy.
Collapse
Affiliation(s)
- B K Kleinschmidt-DeMasters
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA; Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| |
Collapse
|
7
|
Kikuta H, Jinguji S, Sato T, Bakhit M, Hiruta R, Sato Y, Sekine R, Tanabe H, Okada M, Saito K, Fujii M. A Collision Tumor of Pit-1/SF-1-positive Double Pituitary Adenoma and a Craniopharyngioma Coexisting with Graves' Disease. NMC Case Rep J 2023; 10:169-175. [PMID: 37398916 PMCID: PMC10310352 DOI: 10.2176/jns-nmc.2022-0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/13/2023] [Indexed: 07/04/2023] Open
Abstract
Double or multiple pituitary adenomas expressing different types of transcription factors and collision tumors of pituitary adenomas and craniopharyngiomas are rare. In this report, we present a case of pituitary adenoma of two different cell populations, Pit-1 and SF-1, and an adenoma and craniopharyngioma collision tumor with coexisting Graves' disease. The patient had a 16-mm pituitary tumor with pituitary stalk calcification and optic chiasm compression but no visual dysfunction. Based on hormonal profile results, the tumor in the sella was considered a nonfunctioning pituitary adenoma; nevertheless, the pituitary stalk was invaded by a different lesion, which was later confirmed to be a craniopharyngioma. Using an endoscopic endonasal approach, the pituitary adenoma was removed; however, a small remnant remained medial to the right cavernous sinus. Because the pituitary stalk lesion was isolated from the pituitary adenoma, it was preserved to maintain pituitary function. Three years after the initial surgery, the patient suffered from Graves' disease and was treated with antithyroid medications. However, the intrasellar residual and pituitary stalk lesions gradually increased in size. A second surgery was performed, and the residual intrasellar and stalk lesions were completely removed. As per the initial and second histopathologies, the pituitary adenoma comprised different cell groups positive for thyroid-(TSH) and follicle-stimulating hormones, and each cell group was positive for Pit-1 and SF-1. The pituitary stalk lesion was an adamantinomatous craniopharyngioma. We believe that TSH-producing adenoma was involved in the development of Graves' disease or that treatment for Graves' disease increased TSH-producing adenoma.
Collapse
Affiliation(s)
- Haruhiko Kikuta
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Shinya Jinguji
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Taku Sato
- Department of Neurosurgery, Azuma Neurosurgery Hospital, Fukushima, Fukushima, Japan
| | - Mudathir Bakhit
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Ryo Hiruta
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Yusuke Sato
- Department of Neurosurgery, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Rei Sekine
- Department of Pathology and Pathophysiology, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Hayato Tanabe
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Masayasu Okada
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Niigata, Japan
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Rosai Hospital, Iwaki, Fukushima, Japan
| | - Masazumi Fujii
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan
| |
Collapse
|
8
|
Rubino F, Eichberg DG, Saad AG, Komotar RJ, Ivan ME. Synchronous Posterior and Anterior Pituitary Tumors: A Case Report of a Hypothetic Paracrine Relationship. Asian J Neurosurg 2023; 18:377-382. [PMID: 37397038 PMCID: PMC10313437 DOI: 10.1055/s-0043-1768601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Tumors of the posterior pituitary are a distinct group of low-grade sellar neoplasms. Furthermore, the coexistence with an anterior pituitary tumor is extremely unlikely and could not be a mere coincidence and could be a paracrine relationship. Here, we present a case of 41-year-old woman with Cushing syndrome and two pituitary masses on magnetic resonance imaging. Histologic examination shows two distinct lesions. The first consisted of a pituitary adenoma with intense adrenocorticotropic hormone immunostaining and the second lesion consisted of a proliferation of pituicytes arranged in vague fascicles or pituicytoma. After a narrative review of the literature, we found that synchronous pituitary adenoma and a thyroid transcription factor 1 (TTF-1) pituitary tumor were only reported eight times in the past. These patients included two granular cell tumors and six pituicytomas and all of them coexisted with pituitary adenomas, seven functioning and one nonfunctioning. We analyze the hypothesis of a possible paracrine relationship for this concomitance, but this exceedingly rare situation is still a matter of debate. To the best of our knowledge, our case represents the ninth case of a TTF-1 pituitary tumor coexisting with a pituitary adenoma.
Collapse
Affiliation(s)
- Franco Rubino
- Department of Neurological Surgery, University of Miami, University of Miami Hospital, Miami, Florida, United States
| | - Daniel G. Eichberg
- Department of Neurological Surgery, University of Miami, University of Miami Hospital, Miami, Florida, United States
| | - Ali G. Saad
- Department of Pathology, University of Miami, University of Miami Hospital, Miami, Florida, United States
| | | | - Michael E. Ivan
- Sylvester Comprehensive Cancer Center, Miami, Florida, United States
| |
Collapse
|
9
|
Voznyak O, Hryniv N, Lytvynenko A, Zinkevych Y. Double Pituitary Adenomas in Patients With Cushing's Disease. Cureus 2023; 15:e38923. [PMID: 37188065 PMCID: PMC10176272 DOI: 10.7759/cureus.38923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 05/17/2023] Open
Abstract
Background and objective Double and multiple pituitary adenomas (PAs) are discovered in 2.6-3.3% of patients with Cushing's disease and in approximately 1% of autopsies. Undiagnosed and unremoved second PA may be the cause of unsuccessful surgical treatment of Cushing's disease. In this study, we aimed to describe our experience with the detection and treatment of patients with double PAs. Methods All patients in our series underwent transsphenoidal surgery (TSS) with endoscopic and neuronavigation assistance. Before 2017, we completely relied on MRI findings while planning surgery. From 2017 onwards, a broad revision of the sella turcica was conducted during surgeries regardless of the MRI data. Results Overall, 81 patients were included in the study: 51 before 2017 and 30 in 2017 after. In the pre-2017 group of patients, three out of 51 had double adenomas, and all of them were seen on MRI images. We encountered four more double PAs during the next period. Only two of them had been predicted by MRI. The remission rate was higher after 2017 and amounted to 90% (27 out of 30 patients). In contrast, before the implementation of total revision (pre-2017), our success rate was 82% (42 out of 51 cases). Both neoplasms in cases of double PAs yielded similar histological and immunohistochemical (IHC) features but were consistent with multiple PAs. Conclusions Although the improvement in our results in recent years cannot be clearly attributed to a targeted search for the second microadenoma, we still recommend performing a broad inspection of the sella turcica after the excision of the pituitary microadenoma regardless of preoperative MRI data.
Collapse
Affiliation(s)
| | - Nazarii Hryniv
- Centre of Neurosurgery, Clinical Hospital "Feofaniya", Kyiv, UKR
| | | | | |
Collapse
|
10
|
Tsukamoto T, Miki Y. Imaging of pituitary tumors: an update with the 5th WHO Classifications-part 2. Neoplasms other than PitNET and tumor-mimicking lesions. Jpn J Radiol 2023:10.1007/s11604-023-01407-0. [PMID: 36913010 PMCID: PMC10366287 DOI: 10.1007/s11604-023-01407-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/24/2023] [Indexed: 03/14/2023]
Abstract
Many types of tumors can develop in the pituitary gland. In the recently revised 5th editions of the World Health Organization (WHO) classifications (2021 WHO Classification of Central Nervous System Tumors and the 2022 WHO Classification of Endocrine and Neuroendocrine Tumors), various changes have been made to the tumors other than pituitary neuroendocrine tumor (PitNET)/pituitary adenoma, as well as PitNET. Adamantinomatous craniopharyngioma and papillary craniopharyngioma are now considered separate tumors in the 5th edition of the WHO classification. Tumors positive for thyroid transcription factor 1, a marker of posterior pituitary cells, are now grouped together in the pituicyte tumor family in the 5th edition of the WHO classification of Endocrine and Neuroendocrine Tumors. Poorly differentiated chordoma is newly listed in the 5th edition of the WHO Classification of Endocrine and Neuroendocrine Tumors. In this paper, we present the latest WHO classification of pituitary tumors (adamantinomatous craniopharyngioma, papillary craniopharyngioma, pituitary blastoma, pituicyte tumor family, tumors of pituitary origin other than those of the pituicyte tumor family, germinoma, meningioma, chordoma, metastatic tumors, lymphoma, and pituitary incidentaloma), review diseases requiring differentiation from tumors (pituitary abscess, hypophysitis, pituitary hyperplasia, Rathke's cleft cyst, arachnoid cyst, and aneurysm), and discuss diagnoses based on imaging findings.
Collapse
Affiliation(s)
- Taro Tsukamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan.
| |
Collapse
|
11
|
Huguet F, Gilly O, Dufour H, Figarella-Branger D, Guedj A. Gangliocytome hypophysaire et maladie de Cushing : à propos d’un cas. ANNALES D'ENDOCRINOLOGIE 2023. [DOI: 10.1016/j.ando.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
|
12
|
Li C, Feng D, Zhou D. Case report: Clinical and single-cell transcriptome sequencing analysis of a mixed gangliocytoma-adenoma presenting as acromegaly. Front Oncol 2022; 12:1088803. [PMID: 36568175 PMCID: PMC9772982 DOI: 10.3389/fonc.2022.1088803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Background Mixed gangliocytoma-adenoma (MGA) is a rare tumor of pituitary gland. It's difficult to distinguish it from pituitary adenoma by clinical manifestations, imaging features or serological testing. Thus, the histopathological examination is still the golden standard for diagnosis. Besides, studies on molecular level are still lacking. Case information In this case report, we described a 28-year-old male with MGA presenting as acromegaly, who suffered staging operation and post-operation gamma knife radiosurgery, but finally died of secondary hyperglycemic hyperosmolar collapse. A complete data including clinical, histopathological, ultrastructural and single-cell transcriptome level information were collected and analyzed. Conclusion This case report detailed the only clinical and molecular report of MGA following operation and radiotherapy. Complete clinical data enhanced the understanding of the diagnosis and treatment of this disease. Besides, the single-cell transcriptome sequencing analysis further disclosed the intra-tumoral heterogeneity and provided support for subsequent basic research.
Collapse
Affiliation(s)
- Chao Li
- Department of Neurosurgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Daqin Feng
- Department of Neurosurgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, China,*Correspondence: Dabiao Zhou, ; Daqin Feng,
| | - Dabiao Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,*Correspondence: Dabiao Zhou, ; Daqin Feng,
| |
Collapse
|
13
|
Schöning JV, Flitsch J, Lüdecke DK, Fahlbusch R, Buchfelder M, Buslei R, Knappe UJ, Bergmann M, Schulz-Schaeffer WJ, Herms J, Glatzel M, Saeger W. Multiple tumorous lesions of the pituitary gland. Hormones (Athens) 2022; 21:653-663. [PMID: 35947342 PMCID: PMC9712358 DOI: 10.1007/s42000-022-00392-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/19/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE/OBJECTIVE Multiple tumorous lesions in one pituitary gland are rare and mostly described in case reports. Their incidences and combinations are defined in larger collectives. Therefore, we analyzed our large collection for double tumors and combinations of tumors, cysts, and inflammation. METHODS The German Registry of Pituitary Tumors, including cases from 1990 to 2018, served as the database. Our collection comprises a total of 16,283 cases up until the end of 2018. Of these cases, 12,673 originated from surgical and 3,610 from autopsy material. All specimens were fixed in formalin and embedded in paraffin. The sections were stained with hematoxylin-eosin and PAS. Monoclonal (prolactin, TSH, FSH, LH, and α subunit) or polyclonal (GH and ACTH) antibodies were used to detect pituitary hormones in the lesions. Since 2017, antibodies against the transcription factors Pit-1, T-Pit, and SF-1 have been used in difficult cases. The criteria of the 2017 WHO classification have been basic principles for classification since 2018 (Osamura et al. 2017). For differentiation of other sellar tumors, such as meningiomas, chordomas, or metastases, the use of additional antibodies was necessary. For these cases, it was possible to use a broad antibody spectrum. Autopsy pituitaries were generally studied by H&E and PAS sections. If any lesions were demonstrated in these specimens, additional immunostaining was performed. RESULTS Multiple tumorous lesions with more than one pituitary neuroendocrine tumor (PitNET) respectively adenoma make up 1.4% (232 cases) in our collection. Within the selected cases, synchronous multiple pituitary neuroendocrine tumors (PitNETs) account for 17.3%, PANCH cases (pituitary adenoma with neuronal choristoma) for 14.7%, PitNETs and posterior lobe tumors for 2.2%, PitNETs and metastases for 5.2%, PitNETs and mesenchymal tumors for 2.6%, PitNETs and cysts for 52.2%, and PitNETs and primary inflammation for 6.0%. The mean patient age was 53.8 years, with a standard deviation of 18.5 years. A total of 55.3% of the patients were female and 44.7% were male. From 1990 to 2018, there was a continuous increase in the number of multiple tumorous lesions. CONCLUSION From our studies, we conclude that considering possible tumorous double lesions during surgeries and in preoperative X-ray analyses is recommended.
Collapse
Affiliation(s)
- Jannik von Schöning
- Institute of Neuropathology, University of Hamburg, UKE, Martinistraße 52, 20246 Hamburg, Germany
| | - Jörg Flitsch
- Clinic of Neurosurgery, University of Hamburg, UKE, 20246 Hamburg, Germany
| | - Dieter K. Lüdecke
- Clinic of Neurosurgery, University of Hamburg, UKE, 20246 Hamburg, Germany
| | - Rudolf Fahlbusch
- International Neuroscience Institute (INI), Rudolf-Pichelmayr-Str. 4, 30625 Hannover, Germany
| | - Michael Buchfelder
- Clinic of Neurosurgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Rolf Buslei
- Institute of Pathology, SozialStiftung Bamberg, 96049 Bamberg, Germany
| | - Ulrich J. Knappe
- Department of Neurosurgery, Johannes-Wesling-Klinikum Minden, 32429 Minden, Germany
| | - Markus Bergmann
- Institute of Neuropathology, Klinikum Bremen-Mitte, 28205 Bremen, Germany
| | | | - Jochen Herms
- Zentrum für Neuropathologie und Prionforschung, LMU-University of Munich, 81377 Munich, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University of Hamburg, UKE, Martinistraße 52, 20246 Hamburg, Germany
| | - Wolfgang Saeger
- Institute of Neuropathology, University of Hamburg, UKE, Martinistraße 52, 20246 Hamburg, Germany
| |
Collapse
|
14
|
Sadiqo R, Abdulsada AM, Ismail M, Hoz SS. Ectopic schwannoma of the sellar region in a 1-year-old child: A case report and review of literature. Surg Neurol Int 2022; 13:438. [DOI: 10.25259/sni_658_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/07/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Schwannomas are cranial and spinal nerves’ sheath tumors accounting for up to 8% of all intracranial neoplasms. Although typical intracranial schwannomas originate from Schwann cells surrounding cranial nerves, ectopic schwannomas are not associated with a known cranial nerve or have an unknown origin. The location of schwannomas may impose clinical challenges. Sellar region schwannomas are rare whether it is ectopic or not. Herein, we report a pediatric case of a 1-year-old female with ectopic, intra-supra sellar with a literature review. We report the first case of juvenile ectopic schwannoma in the sellar region.
Methods:
A PubMed Medline database search was performed by the following combined formula of medical subject headings (MESH) terms and keywords: ((sella turcica [MeSH Terms]) OR (sella*[Title/Abstract]) OR (ectopic [Title/Abstract]) AND ((neurilemmoma [MeSH Terms]) OR (schwannoma [Title/Abstract]) OR (neuroma [Title/Abstract]) OR (neurinoma [Title/Abstract])).
Results:
Total results of 206 articles were obtained. In exclusion of intraparenchymal and intraventricular schwannomas, only 34 articles remained. Thirty-nine cases were included in 34 articles. According to the reported cases, intrasellar schwannomas are more common in elderly individuals in an average of 49.5 years (range: 19– 79 years). They have a good prognosis and affect males to females equally (20:19).
Conclusion:
Ectopic schwannoma sited in the sellar region is rare. It is the first case to be reported in the pediatric age group with a literature review. This lesion should be highlighted and included in the differential diagnosis of sellar mass.
Collapse
Affiliation(s)
- Rauf Sadiqo
- Department of Neurosurgery, Educational-Surgical Clinic by the Medical University of Azerbaijan, Azerbaijan, Iraq,
| | | | - Mustafa Ismail
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
| |
Collapse
|
15
|
DNA Methylation Profiling in Rare Sellar Tumors. Biomedicines 2022; 10:biomedicines10092225. [PMID: 36140326 PMCID: PMC9496079 DOI: 10.3390/biomedicines10092225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 11/28/2022] Open
Abstract
The histologic diagnosis of sellar masses can be challenging, particularly in rare neoplasms and tumors without definitive biomarkers. Moreover, there is significant inter-observer variability in the histopathological diagnosis of many tumors of the CNS, and some rare tumors risk being misclassified. DNA methylation has recently emerged as a useful diagnostic tool. To illustrate the clinical utility of machine-learning-based DNA methylation classifiers, we report a rare case of primary sellar esthesioneuroblastoma histologically mimicking a non-functioning pituitary adenoma. The patient had multiple recurrences, and the resected specimens had unusual histopathology. A portion of the resected sellar lesion was profiled using clinically validated whole-genome DNA methylation and classification. DNA was extracted from the tissue, hybridized on DNA methylation chips, and analyzed using a clinically validated classifier. DNA methylation profiling of the lesion showed that the tumor classified best with the esthesioneuroblastoma reference cohort. This case highlights the difficulty in diagnosing atypical sellar lesions by standard histopathological methods. However, when phenotypic analyses were nonconclusive, DNA methylation profiling resulted in a change in diagnosis. We discuss the growing role of DNA methylation profiling in the classification and diagnosis of CNS tumors, finding that utilization of DNA methylation studies in cases of atypical presentation or diagnostic uncertainty may improve diagnostic accuracy with therapeutic and prognostic implications.
Collapse
|
16
|
Alkundi A, Momoh R, Nash M. Concurrent growth hormone-producing pituitary adenoma and Rathke’s cleft cyst. BMJ Case Rep 2022; 15:15/8/e250332. [PMID: 35985746 PMCID: PMC9396197 DOI: 10.1136/bcr-2022-250332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A case report describing a finding of concurrent growth hormone-producing pituitary adenoma and a radiologic evidence of Rathke’s cleft cyst(RCC) in a middle-aged female is presented. We reviewed the literature and discussed management perspectives for this uncommon finding.
Collapse
Affiliation(s)
- Alamin Alkundi
- Diabetes and Endocrinology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
- Medical Education, Cardiff University, Cardiff, UK
| | - Rabiu Momoh
- Intensive Care Medicine, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Marcus Nash
- General Medicine, William Harvey Hospital, Ashford, UK
| |
Collapse
|
17
|
Gong L, Chen H, Zhang W, Liu X, Wang Y, Mu X, Zhang F, Li Q, Heng L, Zhang W. Primary collision tumors of the sellar region: Experience from a single center. J Clin Neurosci 2022; 100:204-211. [PMID: 35489256 DOI: 10.1016/j.jocn.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/06/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
Collision tumors are extremely rare in the sellar region, and their features have not been fully characterized. Here, we report our single-center experience in the diagnosis and management of these tumors, focusing primarily on their clinicopathological features. We first performed a retrospective study of pathological reports from patients who had undergone surgery for pituitary adenoma (PA) or craniopharyngioma (CP) at our hospital. Next, to identify collision tumors, patients with a second pathological diagnosis-such as Rathke's cleft cyst (RCC), gangliocytoma (GC), meningioma, or atypical teratoid/rhabdoid tumor (AT/RT)-were considered. Finally, the clinicopathological characteristics of these tumors were reviewed and analyzed. The results demonstrated that eleven of 2359 PA or CP cases (0.47 %) were found to exhibit sellar collision tumors; the patient cohort had a median age of 52 years (23-71) and was predominantly female (63.6 %, 7/11). In details, of the 2092 cases of PA, 10 were diagnosed with concurrent lesions (seven of RCC and one each of CP, meningioma, and GC). Of the 267 CP cases, a single patient presented with associated AT/RT. To our knowledge, this is the first reported adult case of this subtype. Notably, the preoperative CT and/or MRI of each patient revealed solely PA or CP. The endoscopic endonasal approach was the preferred surgery. In conclusion, the sellar collision tumors occur with low incidence, and the primary subtype is PA and RCC. Their definitive diagnosis depends primarily on pathological findings.
Collapse
Affiliation(s)
- Li Gong
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Huangtao Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Wendong Zhang
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Xiaoyan Liu
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Yuanyuan Wang
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Xiaorong Mu
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Fuqin Zhang
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Qing Li
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China; State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
| | - Lijun Heng
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, PR China.
| | - Wei Zhang
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China.
| |
Collapse
|
18
|
Martin EC, Bitner BF, Perez-Rosendahl M, Kuan EC, Linskey ME. Mixed gangliocytoma-pituitary adenoma in MEN1 syndrome: A case report and literature review. Neuropathology 2022; 42:155-159. [PMID: 35137463 DOI: 10.1111/neup.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
Pituitary adenoma is one of the three most common neoplasms described in multiple endocrine neoplasia type 1 (MEN1), and patients with pituitary adenoma occupies 30-50% of those with MEN1-related tumor. Mixed gangliocytoma-pituitary adenoma (MGPA) is a rare clinical entity in which gangliomatous cells are intermixed with adenomatous cells. This tumor has been estimated to account for 0.52-1.26% of all pituitary tumors. We report a rare case of MGPA in a patient with MEN1. A retrospective chart review was conducted on a patient with MEN1 diagnosed with MGPA in 2019 at a single tertiary academic medical center. A review of the literature was performed on MGPA and pituitary adenoma in MEN1. MGPA is rare, with only 174 cases previously reported in the literature and only three prior case reported in a patient with MEN1. There are multiple hypotheses regarding their pathogenesis, and it is unclear whether the MEN1 gene (menin) plays a role in the pathogenesis of MGPA. This tumor in MEN1 is a rare clinical entity of unknown etiology. Further studies are required with difficulty due to its low incidence.
Collapse
Affiliation(s)
- Elaine C Martin
- Department of Otolaryngology - Head & Neck Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Benjamin F Bitner
- Department of Otolaryngology - Head & Neck Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Mari Perez-Rosendahl
- Department of Pathology and Laboratory Medicine, University of California Irvine Medical Center, Orange, California, USA
| | - Edward C Kuan
- Department of Otolaryngology - Head & Neck Surgery, University of California Irvine Medical Center, Orange, California, USA.,Department of Neurological Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Mark E Linskey
- Department of Neurological Surgery, University of California Irvine Medical Center, Orange, California, USA
| |
Collapse
|
19
|
Tena Suck ML, Balcázar-Padrón JC, Navarro-Garcia Llano JP, Ortíz-Plata A, Gómez-Amador JL. Macro Pituitary Adenoma and Frontal Calcified Cavernous Malformation: A Coincidence or a True Partnership? Cureus 2022; 14:e21152. [PMID: 35165602 PMCID: PMC8833093 DOI: 10.7759/cureus.21152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/15/2022] Open
Abstract
Collision tumors are rare neoplasms composed of two different types of histological tissues in the same organ. The most frequent association with cerebral cavernous malformations (CCMs) are meningiomas, gliomas, and gangliogliomas, while the most frequent sellar collision is between pituitary adenoma (PA) and craniopharyngiomas, and still very few cases have been reported. We present the case of a 43-year-old woman who started two months ago with a fall from her height followed by severe headache and bilateral hemianopsia. An isointense, enhancing sellar tumor, and a right frontal lesion compatible with CCM were observed on MRI. Surgery was performed through anterior interhemispheric and endoscopic transnasal approaches for the cavernoma and the sellar tumor, respectively, removing both lesions and sending them to pathology. The sellar tumor corresponded to a PA showing positive immunohistochemistry for prolactin and follicle-stimulating hormone (FSH). In the post-op period, the patient developed a seizure and diabetes insipidus, for which she received appropriate treatment. Our findings were conclusive with a collision tumor, since both lesions presented two different histological tissues. Different densities were observed in both lesions using imaging studies, which were later confirmed with histopathology and immunohistochemistry.
Collapse
|
20
|
Kameda-Smith MM, Zhang E, Lannon M, Algird A, Reddy K, Lu JQ. Pituitary metastasis: From pathology to clinical and radiological considerations. J Clin Neurosci 2021; 93:231-240. [PMID: 34656254 DOI: 10.1016/j.jocn.2021.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE A review of the literature with respect to pituitary metastases (PM) with clinical and radiological considerations are summarized to facilitate clinical decision making in the management of PM METHODS: A review of literature associated with PM and tumour to tumour metastases in the English literature was reviewed and summarized RESULTS: Pituitary metastases account for 1.0-3.6% of all surgically treated pituitary lesions. Often identified in parallel with extensive disseminated disease, once diagnosed, the prognosis is generally poor, although survival is highly heterogeneous and dependent on the primary tumor histology. Within this anatomical region is also the observation of tumor-to-tumor metastases and collision tumours. Both the tumor macro- and microenvironment play central roles to the progression of disease with distinctive radiological features that may suggest a metastatic sellar lesion as opposed to a primary pituitary lesion. Surgical resection is the first line of therapy followed by adjuvant chemoradiotherapy and endocrinological evaluation for hormonal supplementation CONCLUSION: PMs are relatively rare but important oncological entities representing disseminated disease in the majority of cases. Careful consideration of the relevant clinical history and radiological features can aid the clinician differentiate between a metastatic lesion to the pituitary region and a primary pituitary tumor. While surgical resection is first line therapy, stereotactic radiosurgery in carefully selected patients is emerging as a viable alternative.
Collapse
Affiliation(s)
| | - E Zhang
- McMaster University, Canada; Diagnostic Imaging, Canada
| | - M Lannon
- McMaster University, Canada; Departments of Surgery, Canada
| | - A Algird
- McMaster University, Canada; Departments of Surgery, Canada
| | - K Reddy
- McMaster University, Canada; Departments of Surgery, Canada
| | - J-Q Lu
- McMaster University, Canada; Neuropathology, Canada
| |
Collapse
|
21
|
Shih RY, Schroeder JW, Koeller KK. Primary Tumors of the Pituitary Gland: Radiologic-Pathologic Correlation. Radiographics 2021; 41:2029-2046. [PMID: 34597177 DOI: 10.1148/rg.2021200203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Primary tumors of the pituitary gland are the second most common histologic category of primary central nervous system tumors across all age groups and are the most common in adolescents to young adults, despite originating from a diminutive endocrine gland that is often described as "about the size of a pea." The vast majority of these represent primary tumors of the adenohypophysis, specifically pituitary adenomas, which can be either functional or silent with regard to hormone hypersecretion. According to the fourth edition of the World Health Organization classification of endocrine tumors, published in 2017, cellular lineage and immunohistochemical stains for pituitary hormones and/or transcription factors help with making the correct pathologic diagnosis. From a radiologic standpoint, microadenomas pose challenges for accurate detection and avoiding false-negative or false-positive results, while macroadenomas pose challenges from local mass effect on surrounding structures. Pituitary carcinoma and pituitary blastoma also arise from the adenohypophysis and are characterized by metastatic disease and infantile presentation, respectively. While primary tumors of the adenohypophysis are common, a second category comprising primary tumors of the Rathke pouch (ie, craniopharyngioma) are uncommon, and a third category comprising primary tumors of the neurohypophysis (eg, pituicytoma) are rare. The authors review all three categories of pituitary tumors, with emphasis on radiologic-pathologic correlation, including the typical neuroimaging, histologic, and molecular features that may point toward a specific diagnosis. Work of the U.S. Government published under an exclusive license with the RSNA.
Collapse
Affiliation(s)
- Robert Y Shih
- From the Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (R.Y.S.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (J.W.S.); and Department of Radiology, Mayo Clinic, Rochester, Minn (K.K.K.)
| | - Jason W Schroeder
- From the Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (R.Y.S.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (J.W.S.); and Department of Radiology, Mayo Clinic, Rochester, Minn (K.K.K.)
| | - Kelly K Koeller
- From the Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (R.Y.S.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (J.W.S.); and Department of Radiology, Mayo Clinic, Rochester, Minn (K.K.K.)
| |
Collapse
|
22
|
Hasegawa H, Jentoft ME, Young WF, Lakomkin N, Van Gompel JJ, Link MJ, Atkinson JL, Meyer FB. Collision of Craniopharyngioma and Pituitary Adenoma: Comprehensive Review of an Extremely Rare Sellar Condition. World Neurosurg 2021; 149:e51-e62. [PMID: 33647491 DOI: 10.1016/j.wneu.2021.02.091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The collision of pituitary adenoma and craniopharyngioma is extremely rare and thus there remains a paucity of data. METHODS We described a patient from our institution. We also performed a systematic review and subsequent quantitative synthesis of the literature (n = 21) and our institutional case to yield an integrated cohort, and a descriptive analysis was carried out. RESULTS Twenty-two patients (15 males and 7 females) were included in the integrated cohort. The median age was 47.0 years (range, 8-75 years). The tumor subtypes were 5 somatotropic, 5 lactotropic, 4 nonfunctioning, 3 gonadotropic, 2 corticotropic, 1 plurihormonal, and 1 silent subtype 3 for pituitary adenomas, and 19 adamantinomatous, 2 papillary, and 1 unknown subtype for craniopharyngiomas. Three different radiographic patterns were observed: solid mass with cystic component (n = 5), coexistence of two distinct solid components (n = 3), and a mixed-intensity solid mass (n = 5). The first 2 were consistent with histologically separate collision, whereas the third was consistent with histologically admixed collision. Among 19 patients in whom the postoperative course was recorded, a secondary intervention was required in 14 (73.7%) because of tumor progression or residual. The recurrence rate after gross total resection was 33.3%. Postoperative hormone replacement was required in 33.3%. The 10-year cumulative overall survival was 73.1%. CONCLUSIONS Most craniopharyngiomas were adamantinomatous. There are 2 types of collisions: separated and admixed. Tumor control, overall survival, and endocrinologic remission are more challenging to achieve than for solitary tumors, but gross total resection of both tumors is important for satisfactory tumor control.
Collapse
Affiliation(s)
- Hirotaka Hasegawa
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan
| | - Mark E Jentoft
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA
| | - William F Young
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nikita Lakomkin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John L Atkinson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Fredric B Meyer
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| |
Collapse
|
23
|
Neal MT, Richards AE, Curley KL, Donev K, Lyons MK, Kalani MA. Spinal intramedullary hemangioblastoma and schwannoma collision tumor: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2059. [PMID: 36034507 PMCID: PMC9394162 DOI: 10.3171/case2059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUNDIntramedullary spinal cord tumors represent a minority of intradural tumors. Among intramedullary spinal cord tumors, hemangioblastomas are uncommon, and schwannomas are extremely rare. Collision tumors are histologically distinct tumors that are intermingled and growing together.OBSERVATIONSIn this report, the authors describe a patient with a cervical intramedullary collision tumor involving a hemangioblastoma and schwannoma. To the authors’ knowledge, no prior spinal intramedullary collision tumor involving multiple neoplasms has been described. The patient’s presentation and management are described.LESSONSClinicians should consider the possibility of collision tumors when evaluating intramedullary spinal cord tumors, especially when patient presentation and radiographic findings are atypical. When tumors with similar radiographic characteristics form collision tumors, distinction using preoperative imaging can be extremely challenging. In addition, surgical management of intramedullary collision tumors, like that for all intramedullary spinal cord tumors, should involve meticulous perioperative care and a methodical surgical technique. Maximal safe resection will depend upon histopathological diagnosis, anatomical location of the tumor, presence of distinct dissection planes, and stability of neuromonitoring. Finally, ongoing research on the genetics of intramedullary spinal cord tumors may identify underlying genetic links for intramedullary hemangioblastomas and schwannomas.
Collapse
Affiliation(s)
- Matthew T. Neal
- Department of Neurosurgery, Mayo Clinic Arizona, Phoenix, Arizona; and
| | | | - Kara L. Curley
- Department of Neurosurgery, Mayo Clinic Arizona, Phoenix, Arizona; and
| | - Kliment Donev
- Department of Pathology, Mayo Clinic Minnesota, Rochester, Minnesota
| | - Mark K. Lyons
- Department of Neurosurgery, Mayo Clinic Arizona, Phoenix, Arizona; and
| | - Maziyar A. Kalani
- Department of Neurosurgery, Mayo Clinic Arizona, Phoenix, Arizona; and
| |
Collapse
|
24
|
Merrill SA, Sharma A, Carlin RE, McCullough AE, Porter AB, Bendok BR, Kouloumberis PE. A Rare Intracranial Collision Tumor of Meningioma and Metastatic Uterine Adenocarcinoma: Case Report and Literature Review. World Neurosurg 2020; 145:340-347. [PMID: 32987172 DOI: 10.1016/j.wneu.2020.09.108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND A collision tumor is a rare entity consisting of 2 histologically distinct tumor types (benign or malignant) in the same anatomic location. This can occur from a tumor-to-tumor metastasis or as a result of 2 adjacent intracranial tumors colliding and growing together. To our knowledge, this is the first reported case of collision tumor with confirmed meningioma and uterine adenocarcinoma. Multiple mechanisms have been proposed for the facilitative growth of collision tumors, including local epigenetic signaling. Clinically, it is important to consider collision tumors in the differential diagnosis of a rapidly growing intracranial lesion in the setting of systemic cancer to provide optimal surgical and postoperative management. CASE DESCRIPTION A 78-year-old, right-handed woman with a known 10-year history of stable meningioma presented for evaluation of a right sphenoid wing lesion. She had recently completed treatment of uterine papillary serous carcinoma with no evidence of disease on follow-up imaging. On presentation, there was significant progression of the meningioma resulting in brain compression and right third nerve palsy. The patient underwent urgent resection of the lesion. Pathology demonstrated a collision tumor with a combination of metastatic uterine papillary serous carcinoma and meningioma. CONCLUSIONS It is important to consider a collision tumor when a patient with a benign intracranial lesion presents with rapid progression, even in the context of a systemic cancer that rarely metastasizes to the brain. Appropriate histopathologic assessment is crucial in these cases and can have a significant impact on treatment plan and prognosis.
Collapse
Affiliation(s)
- Sarah A Merrill
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | | | | | | | - Alyx B Porter
- Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA
| | | | | |
Collapse
|
25
|
Brown TV, Cheesman KC, Post KD. RECURRENT PITUITARY APOPLEXY IN AN ADENOMA WITH SWITCHING PHENOTYPES. AACE Clin Case Rep 2020; 6:e221-e224. [PMID: 32984525 DOI: 10.4158/accr-2019-0273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 04/17/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To describe an unusual presentation of a patient with recurrent pituitary apoplexy of an adenoma that switched phenotypes from a nonfunctioning, or silent gonadotroph adenoma (SGA), to a silent corticotroph adenoma (SCA). We discuss the potential etiologies of both recurrent pituitary apoplexy and phenotype switching of pituitary tumors. Methods The presented case includes clinical and biochemical findings, surgical outcomes, and pathologic reports related to the treatment of our patient who presented with recurrent pituitary apoplexy. Results A 56-year-old man presented for evaluation of decreased libido and was found to have a low testosterone level. A pituitary magnetic resonance image demonstrated an 8-mm pituitary adenoma. He underwent transsphenoidal surgery (TSS) to remove the tumor and pathology demonstrated an SGA immunopositive for luteinizing hormone and follicle-stimulating hormone with evidence of apoplexy. Eight years later, the patient underwent another TSS after developing acute-onset headache, vomiting, and a cranial nerve palsy. Pathology at this time showed a necrotic tumor consistent with apoplexy with negative immunostains for all pituitary tumors. Three years after this, the tumor recurred and after another TSS the tumor stained positive for adrenocorticotropic hormone but was negative for luteinizing hormone and follicle-stimulating hormone with hemorrhage consistent with apoplexy. A few years afterward, he again developed acute-onset headache and cranial nerve palsies and had another TSS. On pathology, the tumor demonstrated extensive necrosis consistent with apoplexy and again stained positive for adrenocorticotropic hormone. The patient was then referred for radiation therapy and was subsequently lost to follow up. Conclusion Recurrent pituitary apoplexy in the same patient has only been described 3 times in the literature. There have been no case reports of a pituitary adenoma that switched phenotypes from an SGA to SCA. We suggest that pituitary apoplexy may recur multiple times due to a tumor with particularly fragile vessel walls and increased vascularization. We review the literature that suggests clinical and molecular similarities between SGAs and SCAs. Further studies are needed to determine the etiologies of recurrent apoplexy and pituitary adenomas with switching phenotypes.
Collapse
Affiliation(s)
- Teresa V Brown
- Division of Endocrinology, Diabetes, and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Khadeen C Cheesman
- Division of Endocrinology, Diabetes, and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kalmon D Post
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York
| |
Collapse
|
26
|
Pituitary Metastatic Composite Tumors: A Case Report with Next-Generation Sequencing and Review of the Literature. Case Rep Oncol Med 2020; 2020:5073236. [PMID: 32774962 PMCID: PMC7391092 DOI: 10.1155/2020/5073236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 07/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background While pituitary tumors are well understood, little research has been done on metastasis from primary tumors into pituitary adenomas, also known as composite tumors. Because only 34 cases of composite tumors have been reported to date, we hope to better characterize these tumors by reviewing cases reported in the literature and reviewed our own documented case, which includes next-generation sequencing. Case Presentation. A 74-year-old man presented to the emergency department with left vision loss for 3 months. He had a history of colon cancer treated with colectomy and clear cell renal carcinoma treated with left nephrectomy. A preoperative MRI demonstrated growth of a peripherally enhancing, centrally necrotic mass with sellar expansion measuring 5.7 × 3.1 × 3.0 cm. Given these findings, an endoscopic endonasal transsphenoidal resection was performed. Histological assessment revealed a composite tumor: one neoplasm was a nonfunctioning pituitary adenoma, and another neoplasm was a clear cell carcinoma. Next-generation sequencing demonstrated that the tumors shared mutations in VHL and Notch2. The patient died 2 months later from systemic metastatic cancer. Conclusion From our literature review, most metastatic lesions in these composite tumors originated from neoplasms of the lung and kidney. Approximately 63% patients presented with ophthalmoplegia as the initial symptom while 23% displayed hormonal abnormalities. Postoperative mortality had a median of 3.5 months. In our patient, the presence of VHL and Notch2 mutations in both tumors highlights the possibility of using next-generation sequencing to help identify therapeutic targets even in complex composite neoplasms.
Collapse
|
27
|
Gezer E, Cantürk Z, Selek A, Çetinarslan B, Tarkun İ, Sözen M, Kiraz U, Gürbüz YS, Ceylan S, Çabuk B. Cushing's disease due to a pituitary adenoma as a component of collision tumor: A case report and review of the literature. J Med Case Rep 2020; 14:59. [PMID: 32423480 PMCID: PMC7236304 DOI: 10.1186/s13256-020-02382-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/25/2020] [Indexed: 01/15/2023] Open
Abstract
Background The coexistence of two morphologically different tumors attached to each other creates a very rare type of tumor called a collision tumor. Collision tumors containing pituitary adenoma–sellar meningioma have only been described in four cases to date; we discuss a fifth case harboring a collision tumor comprising a pituitary corticotroph adenoma and a sellar meningioma in the same anatomic position. Case presentation A 34-year-old Caucasian woman presented with menstrual irregularity, severe weakness of the proximal muscles, and 10–15 kg weight gain within a year. Basal plasma cortisol and adrenocorticotrophic hormone levels were 17.7 mg/dL and 58 pg/mL, respectively. Her diurnal cortisol rhythm was impaired (plasma cortisol at 23:00, 18.2 mg/dL) and after a 48-hour, 2-mg dexamethasone suppression test, plasma cortisol level was 13.6 mg/dL. The results were consistent with a diagnosis of Cushing’s syndrome. We then performed a nocturnal 8-mg dexamethasone suppression test and the suppression of cortisol was not greater than 50% (21.4 to 19.3). A pituitary magnetic resonance imaging revealed a tuberculum sellae meningioma arising from within the sellar region. An operation was chosen in order to examine whether the tumor was an adrenocorticotrophic hormone/corticotropin-releasing hormone-secreting lesion or if there were any microadenomas that could be observed during the operation. Via an extended endoscopic endonasal approach the meningioma was resected successfully. Unexpectedly, our patient complained of nausea and vomiting postoperatively. Plasma cortisol was 2.6 mg/dL and orally administered hydrocortisone treatment was initiated immediately. Histopathological examination revealed that the tumor generally consisted of a pituitary corticotroph adenoma infiltrated by meningioma. Our patient maintained hydrocortisone treatment for 11 months. At the latest visit, she had lost 12 kg, and her hypertension, menstrual irregularity, and weakness of the proximal muscles had disappeared. Her mental and physical wellbeing were restored. Conclusions To the best of our knowledge, this is the first report of Cushing’s disease due to a pituitary corticotroph adenoma adjacent to a meningioma. Even if a high-dose dexamethasone suppression test fails to suppress basal cortisol level, the importance of considering a suprasellar/sellar meningioma a possible component of a collision tumor presenting as adrenocorticotrophic hormone-dependent Cushing’s syndrome is highlighted here.
Collapse
Affiliation(s)
- Emre Gezer
- Department of Endocrinology and Metabolism, Kocaeli University, Faculty of Medicine, 41380, Kocaeli, Turkey.
| | - Zeynep Cantürk
- Department of Endocrinology and Metabolism, Kocaeli University, Faculty of Medicine, 41380, Kocaeli, Turkey
| | - Alev Selek
- Department of Endocrinology and Metabolism, Kocaeli University, Faculty of Medicine, 41380, Kocaeli, Turkey
| | - Berrin Çetinarslan
- Department of Endocrinology and Metabolism, Kocaeli University, Faculty of Medicine, 41380, Kocaeli, Turkey
| | - İlhan Tarkun
- Department of Endocrinology and Metabolism, Anadolu Medical Center, Kocaeli, Turkey
| | - Mehmet Sözen
- Department of Endocrinology and Metabolism, Kocaeli University, Faculty of Medicine, 41380, Kocaeli, Turkey
| | - Umay Kiraz
- Department of Pathology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Yeşim Saliha Gürbüz
- Department of Pathology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Savaş Ceylan
- Department of Neurosurgery, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Burak Çabuk
- Department of Neurosurgery, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| |
Collapse
|
28
|
de Almeida Verdolin A, Lamback EB, Ventura N, Guasti A, da Mata Pereira PJ, Gadelha MR, Chimelli L. Collision sellar lesions: coexistence of pituitary adenoma and Rathke cleft cyst-a single-center experience. Endocrine 2020; 68:174-181. [PMID: 31802354 DOI: 10.1007/s12020-019-02149-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/22/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Collision sellar lesions represent the coexistence of distinct histopathological lesions found in the sella turcica. They are uncommon entities and have mainly been reported as pituitary adenoma (PA) associated to Rathke cleft cyst (RCC). Pre- and perioperative diagnosis is difficult, since most of the cases appear clinically, radiologically, and macroscopically as solitary cystic sellar lesion. METHODS A retrospective study of histological reports from patients operated for PA from 2013 to 2018 in a single neurosurgery reference center was performed. Patients who also exhibited RCC in the histological sections were included. Clinical and biochemical data were collected from medical files. MRI scans and histopathological slides were also reviewed. RESULTS Among 554 PA, five patients (0.9%) presented the association of PA and RCC. At diagnosis, patients had median age of 60 years (33-78) with, at least, one pituitary dysfunction, and visual field loss and/or headache. There was a female predominance (n = 3). All patients had nonfunctioning PA. MRI studies showed a predominantly cystic lesion and were unable to distinguish both lesions. The definitive diagnosis was made by histopathology. CONCLUSION The association of PA and RCC is extremely rare. On MRI, they appear as a solid-cystic or cystic sellar tumors. RCC can rupture causing granulomatous reaction with cholesterol crystal formation, which can be mistaken for craniopharyngiomas during surgery. Therefore, collision sellar lesion must be included in the differential diagnosis of cystic sellar lesions. The definitive diagnosis is made by histological study.
Collapse
Affiliation(s)
| | - Elisa Baranski Lamback
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nina Ventura
- Radiology Division, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - André Guasti
- Neurosurgery Division, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | | | - Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrinology Division, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rua do Resende 156/Centro, Rio de Janeiro, 20231-092, Brazil
| | - Leila Chimelli
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rua do Resende 156/Centro, Rio de Janeiro, 20231-092, Brazil.
| |
Collapse
|
29
|
Levitus CF, Charitou MM. AN INCIDENTAL COLLISION TUMOR OF THE SELLA TURCICA. AACE Clin Case Rep 2020; 5:e247-e249. [PMID: 31967045 DOI: 10.4158/accr-2019-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/07/2019] [Indexed: 11/15/2022] Open
Abstract
Objective To present a case describing an incidentally discovered pituitary mass that was found to be a collision tumor containing 2 distinct histologic cell types: (1) a growth hormone (GH)-secreting pituitary adenoma, and (2) a gangliocytoma. Methods Sellar gangliocytomas are very rare benign neuroblastic tumors that originate from the posterior pituitary. The majority are associated with pituitary adenomas. The co-existence of these 2 morphologically distinct tumors is known as a collision tumor, a rare disease entity of which the pathogenesis is not well understood. We present a case of a woman with an incidentally discovered pituitary mass that was found to be a collision tumor. Results A 44-year-old woman presented with an incidentally discovered pituitary mass and was found to have elevated insulin-like growth factor 1 (IGF-1) levels. The patient underwent endoscopic transsphenoidal excision of the pituitary mass. Histopathology of the tumor revealed a mixed pituitary adenoma that stained for GH and prolactin, and a gangliocytoma. Postoperatively, the patient developed temporary central adrenal insufficiency and permanent diabetes insipidus. Postoperative lab studies revealed a normal IGF-1 level, and a magnetic resonance imaging scan showed no residual or recurrent tumor. Conclusion While sellar gangliocytoma is a rare lesion, when it is present, a co-existing pituitary adenoma should also be suspected. Further investigation should be done to determine the pathophysiology of these collision tumors, which could be beneficial in guiding diagnosis and treatment.
Collapse
|
30
|
Evolving Strategies for Resection of Sellar/Parasellar Synchronous Tumors via Endoscopic Endonasal Approach: A Technical Case Report and Systematic Review of the Literature. World Neurosurg 2020; 133:381-391.e2. [DOI: 10.1016/j.wneu.2019.08.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/15/2022]
|
31
|
Sagan KP, Andrysiak-Mamos E, Sagan L, Nowacki P, Małkowski B, Syrenicz A. Cushing's Syndrome in a Patient With Rathke's Cleft Cyst and ACTH Cell Hyperplasia Detected by 11C-Methionine PET Imaging-A Case Presentation. Front Endocrinol (Lausanne) 2020; 11:460. [PMID: 32774326 PMCID: PMC7388627 DOI: 10.3389/fendo.2020.00460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Adrenocorticotropic Hormone (ACTH)-dependent Cushing's Syndrome (CS) is most often caused by a pituitary adenoma. Although rarely, it can also result from pituitary corticotroph cell hyperplasia (CH). Reports on concomitant pituitary lesions including ACTH-producing adenomas and Rathke's cleft cysts (RCCs) have been published. Positron emission tomography (PET), using 11C-labelled-methionine (MET) as a tracer and co-registered with magnetic resonance imaging (MRI) has been shown to be useful in the diagnosis of pituitary collision lesions, however, its role is still under investigation. In this work we present the case of a patient in whom CS was caused by non-adenomatous CH within the wall of an RCC. Case Summary: In 2015 a patient with signs and symptoms of CS was referred to our Department. Biochemical studies repeatedly showed elevated midnight serum cortisol and ACTH levels. Magnetic resonance imaging of the sellar region revealed an RCC and MET-PET/MR showed heterogeneous labelled-methionine metabolism in the vicinity of the cyst's wall. Transsphenoidal surgery resulted in rapid, complete and lasting relief of symptoms. Histopathological examination demonstrated an RCC and CH. Conclusions: Concomitance of pituitary focal lesions is a rare phenomenon. Methionine-labelled PET/MR may be useful in the diagnosis of collision sellar lesions, including CH. Corticotroph cell hyperplasia can present as mild and fluctuating hypercortisolaemia.
Collapse
Affiliation(s)
- Karol Piotr Sagan
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
- *Correspondence: Karol Piotr Sagan
| | - Elzbieta Andrysiak-Mamos
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Leszek Sagan
- Department of Neurosurgery, Pomeranian Medical University, Szczecin, Poland
| | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Bogdan Małkowski
- Department of Diagnostic Imagining, Collegium Medicum Nicolaus Copernicus University, Toruń, Poland
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| |
Collapse
|
32
|
Marco Del Pont F, Villalonga JF, Ries-Centeno T, Arakaki N, Katz D, Cervio A. Pituicytoma Associated with Acromegaly and Cushing Disease. World Neurosurg 2019; 136:78-82. [PMID: 31874293 DOI: 10.1016/j.wneu.2019.12.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pituicytoma is a rare neoplasm arising in the sellar region (World Health Organization grade I). Clinically, pituicytomas mimic nonfunctioning pituitary macroadenomas and are occasionally incidentally discovered at autopsy. Pituitary adenomas can occur with other sellar pathologies, and the term "collision sellar lesions" has been coined for this rare entity. There have only been a few reports of the coexistence of pituicytoma and pituitary adenoma. We present 2 cases of pituicytoma coexisting with acromegaly and Cushing disease. CASE DESCRIPTION Case 1: A 29-year-old woman had acromegaly. The macroadenoma was partially removed in her first surgery; thus an endonasal reoperation was required for debulking and posterior radiosurgery. Pituicytoma coexisting with somatotropinoma was diagnosed on pathologic examination. Case 2: A 33-year-old woman had adrenocorticotropic hormone-dependent Cushing disease. She underwent endonasal resection. Undetectable postoperative cortisol levels provided evidence that the underlying adrenocorticotropic hormone source was successfully removed. On the basis of morphologic features and the immunohistochemical profile, pituicytoma was diagnosed on pathologic examination. Pituitary adenoma was not confirmed histologically in this patient. CONCLUSIONS Only 117 cases of pituicytoma have been reported since it was first described in 1955. Before our report, only 5 cases of patients with pituicytoma coexisting with pituitary adenoma had been described. The coexistence of these 2 entities may not just be a mere coincidence but may be due to a yet unknown pathophysiologic link or common progenitor lineage of both lesions. Association between pituicytoma and pituitary adenoma is increasingly being reported.
Collapse
Affiliation(s)
| | - Juan F Villalonga
- LINT, Faculty of Medicine, National University of Tucumán, Tucumán, Argentina
| | | | - Naomi Arakaki
- Department of Anatomy and Pathology, FLENI, Buenos Aires, Argentina
| | - Debora Katz
- Department of Endocrinology, FLENI, Buenos Aires, Argentina
| | - Andrés Cervio
- Department of Neurosurgery, FLENI, Buenos Aires, Argentina
| |
Collapse
|
33
|
Simultaneous Resection of Pituitary Macroadenoma and Sphenoid Sinus Inverted Papilloma: The Challenge of Operating Sinonasal and Skull Base Pathologies Through a Single-Stage Endoscopic Endonasal Approach. World Neurosurg 2019; 133:260-265. [PMID: 31605847 DOI: 10.1016/j.wneu.2019.09.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Coexistence of sinonasal and skull base tumors is uncommon but possible, and the endonasal route seems to be the best option to manage both lesions simultaneously. We report the first case in the English literature of concomitant sphenoid sinus inverted papilloma and pituitary macroadenoma treated through an endoscopic endonasal approach. CASE DESCRIPTION A 68-year-old man presented with a history of progressive visual loss and nasal obstruction. Clinical examination disclosed bitemporal hemianopsia. Computed tomography scan and magnetic resonance imaging obtained on admission showed a large sellar/suprasellar enhancing lesion with a marked mass effect on the optic chiasm. Imaging also showed a second mass extending from the sphenoid sinus to the left nasal cavity with obstruction of the maxillary sinus ostium and development of maxillary sinus mucocele. Both tumors were entirely resected by an endoscopic endonasal approach. Additionally, middle meatal antrostomy and marsupialization with drainage of the maxillary mucocele was performed. Biopsy confirmed the coexistence of a pituitary macroadenoma and sphenoid sinus inverted papilloma. CONCLUSIONS This case and the literature suggest that patients with concomitant nasal and skull base pathologies can be simultaneously managed. The otolaryngologist plays an essential role in removing the sinonasal lesion to ensure a safe surgical corridor before entering the intracranial cavity and for planning for the skull base reconstruction.
Collapse
|
34
|
Kontogeorgos G, Thodou E. Double adenomas of the pituitary: an imaging, pathological, and clinical diagnostic challenge. Hormones (Athens) 2019; 18:251-254. [PMID: 31388898 DOI: 10.1007/s42000-019-00126-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/24/2019] [Indexed: 12/14/2022]
Abstract
Double and multiple adenomas of the pituitary are composed of two or more distinct tumors located in the same gland. They represent uncommon lesions measuring less than 1 cm, reported as having a low incidence in autopsies and occurring even more infrequently in surgical series. The histological diagnosis of double adenomas in surgical material is often extremely difficult, and confirmation requires immunohistochemistry and, occasionally, electron microscopy. Fragmented tissue material submitted for histology after transsphenoidal resection complicates the diagnosis. Difficulties in demonstrating double or multiple adenomas by imaging techniques contribute to diagnostic failure. Magnetic resonance imaging (MRI) techniques may disclose two separate adenomas located in the same pituitary gland. Intraoperative MRI and imaging ultrasonography, together with positron emission computed tomography, more accurately identify sites of residual tumors. These techniques might also detect postoperatively a residual tumor belonging to the second component of double adenoma. Double adenomas may also create extreme clinical diagnostic challenges. It is almost impossible to suspect functioning double adenomas with combined hormone secretion, each one secreting a different hormone, and distinguish them from an isolated plurihormonal adenoma, simultaneously secreting more than one hormone. Double adenomas may underlie surgical failure when one adenoma is removed while the other is left behind. Despite the low frequency of double adenomas, identification and resection of both of them is of major importance for the achievement of biochemical cure.
Collapse
Affiliation(s)
| | - Eleni Thodou
- Department of Pathology, University of Thessaly, Larissa, Greece
| |
Collapse
|
35
|
Sivakoti S, Nandeesh BN, Bhatt AS, Chandramouli BA. Pituitary Adenoma with Granulomatous Hypophysitis: A Rare Coexistence. Indian J Endocrinol Metab 2019; 23:498-500. [PMID: 31741914 PMCID: PMC6844172 DOI: 10.4103/ijem.ijem_259_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Sumitra Sivakoti
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - B. N. Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anusha S. Bhatt
- Department of Pathology, Kasturba Medical College, Mangalore, Karnataka, India
| | - B. A. Chandramouli
- Department of Neurosurgery, Aster RV Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
36
|
Ishino H, Takekoshi S, Teshima T, Uchida K, Sakonju I, Hara Y. Hyperadrenocorticism Caused by a Pituitary Ganglioglioma in a Dog. Vet Pathol 2019; 56:609-613. [PMID: 30774022 DOI: 10.1177/0300985819829530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An 11-year-old castrated male Chihuahua dog was presented with complaints of polyuria, polydipsia, abdominal enlargement, and alopecia. Hyperadrenocorticism was diagnosed on the basis of clinical signs, blood tests, adrenocorticotropin-stimulation test results, and an elevated serum adrenocorticotropin concentration. Contrast-enhanced magnetic resonance imaging showed that the pituitary gland was enlarged, compatible with a pituitary macroadenoma. Pituitary-dependent hyperadrenocorticism was suspected, and transsphenoidal hypophysectomy was thus performed for complete resection of the tumor. After surgery, the serum adrenocorticotropin concentration normalized and the hyperadrenocorticism resolved. Histological and immunocytochemical analyses revealed a benign tumor composed of mature neuronal cells and glial cells, suggestive of a ganglioglioma with immunolabeling for adrenocorticotropin. Careful analysis of the resected tumor revealed no pituitary adenoma tissue. The clinical and histopathologic findings indicated that the ganglioglioma was directly responsible for the hyperadrenocorticism. This is the first case of hyperadrenocorticism caused by a ganglioglioma in a dog.
Collapse
Affiliation(s)
- Hirokazu Ishino
- 1 Laboratory of Small Animal Surgery 1, School of Veterinary Medicine, Kitasato University, Towada, Aomori, Japan
| | - Susumu Takekoshi
- 2 Division of Host Defense Mechanism, Department of Cell Biology, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Takahiro Teshima
- 3 Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Kazuyuki Uchida
- 4 Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Iwao Sakonju
- 1 Laboratory of Small Animal Surgery 1, School of Veterinary Medicine, Kitasato University, Towada, Aomori, Japan
| | - Yasushi Hara
- 5 Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| |
Collapse
|
37
|
Yang B, Yang C, Sun Y, Du J, Liu P, Jia G, Jia W, Zhang Y, Wang J, Xu Y, Wang S. Mixed gangliocytoma-pituitary adenoma in the sellar region: a large-scale single-center experience. Acta Neurochir (Wien) 2018; 160:1989-1999. [PMID: 30109498 DOI: 10.1007/s00701-018-3632-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mixed gangliocytoma-pituitary adenoma is an extremely rare tumor occurring in the sellar region, histologically composed of both gangliocytic and pituitary adenomatous architectures. The histogenesis of these tumors remains unknown, and the diagnosis, treatment, and prognosis are yet to be fully understood. METHODS We retrospectively reviewed the clinical, radiological, and histopathological profiles from a series of 20 patients with sellar mixed gangliocytoma-pituitary adenomas. All patients underwent surgical tumorectomy via an endoscopic or microscopic transsphenoidal approach. Perioperative magnetic resonance imaging (MRI) and computed tomography (CT) data were reviewed. Immunohistochemical stains and electron microscopy examination were performed. Follow-up outcomes were presented. RESULTS This case series consisted of 13 females and seven males (age range, 20-59 years; mean age, 42.3 ± 11.2 years). Preoperative endocrine examination showed elevated growth hormone (GH) in nine patients and hyperprolactinemia in eight patients. The tumors were positive for GH in 15 cases, prolactin in 13 cases, adrenocorticotropic hormone in three cases, and thyroid-stimulating hormone in one case. Gross total resection was achieved in 15 patients, and subtotal resection in five patients. During an average follow-up period of 42.5 ± 29.0 months, no recurrence was noted. CONCLUSIONS The clinical and neuroimaging features of sellar mixed gangliocytoma-pituitary adenomas are non-specific, and invasion into the cavernous sinus is common. Surgical resection via a transsphenoidal approach is the preferred treatment, and the surgical outcomes are favorable. Moreover, our histopathological findings are more likely to support the theory that mixed gangliocytoma-pituitary adenoma originates from the neuronal transdifferentiation of adenomatous cells.
Collapse
Affiliation(s)
- Bao Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Chenlong Yang
- Department of Orthopedics, Peking University Third Hospital, North Garden Street No. 49, Haidian District, Beijing, 100191, China
| | - Yilin Sun
- Department of Ultrastructural Pathology, Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Jiang Du
- Department of Neuro-pathology, Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Pinan Liu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Guijun Jia
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Wang Jia
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Yazhuo Zhang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Jisheng Wang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Shuo Wang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China.
| |
Collapse
|
38
|
The Coexistence of Growth Hormone-Producing Pituitary Adenoma and Rathke Cleft Cyst: How Can We Diagnosis Preoperation? J Craniofac Surg 2018; 29:1887-1889. [PMID: 30080768 DOI: 10.1097/scs.0000000000004811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Pituitary adenoma (PA) rarely coexists with Rathke's cleft cyst (RCC). Previously, only 13 cases of patients with growth hormone (GH)-producing PA and concomitant RCC have been reported. Here, the authors report a 54-year-old female patient with a GH-secreting PA coexisting with an RCC. Acromegaly was diagnosed according to the physical examination and endocrine data. Preoperatively, the coronal magnetic resonance imaging (MRI) contained 2 different signal intensities, these unusually MRI findings for the intrasellar mass were rarely. According to our clinical experience for diagnosis of PA and RCC, besides GH-producing PA in this case, but the possibility of concomitant RCC should be considered. One-and-a-half nostril endoscopic transsphenoidal approach was performed. Intraoperatively, the adenoma was successfully removed and a large amount of grayish fluid from the cyst was released. The endocrine testing was normal soon after the operation and the patient remained well for a follow-up period of 3 months. The postoperative MRI (obtained 3 months after surgery) showed no intrasellar and suprasellar mass. The authors retrospectively analyzed the all 14 cases of concomitant GH-secreting PAs and RCCs and summarized MRI characteristics. When preoperative MRI contained 2 different signal intensities, one mass lesion showed low or isointense signal on the T1-weighted and T2-weighted images, whereas the other lesion showed low signal on the T1-weighted images and hyperintense on the T2-weighted images, the collision MRI features may be helpful for the preoperative diagnosis of concomitant PAs and RCCs.
Collapse
|
39
|
Hong Y, Fang Y, Wu Q, Zhang J, Wang Y. Ganglioglioma of the adenohypophysis mimicking pituitary adenoma: A case report and review of the literature. Medicine (Baltimore) 2018; 97:e11583. [PMID: 30045287 PMCID: PMC6078729 DOI: 10.1097/md.0000000000011583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ganglioglioma is a generally benign tumor, mostly occurring in patients <30 years old. Temporal lobe is most frequently involved. Up to now, only 3 cases were reported of ganglioglioma in the pituitary gland, all being confined to the neurohypophysis. Here, we are the first to report an adenohypophysis ganglioglioma. CASE PRESENTATION A 43-year-old woman presented with chronic headache was referred to our hospital. Magnetic resonance imaging (MRI) indicated pituitary adenoma. Endoscopic transnasal transsphenoidal surgery was performed. The tumor was rich in blood supply, with tough texture, therefore only subtotal resection was conducted. Pathology analysis revealed an adenohypophysial tumor composed of dysplastic ganglion cells and neoplastic glial cells collided with nonspecific hyperplasia of pituitary cells. Immunohistochemistry revealed positive staining of synaptophysin, glial-fibrillary acidic protein, and CD34. The results were consistent with the diagnosis of ganglioglioma. After the surgery the patient recovered well except developing cerebrospinal fluid rhinorrhea, which was controlled by lumbar drainage. MRI 6 months later did not show any sign of progression. CONCLUSION According to the findings of our case, concerns should be raised considering ganglioglioma as a differential diagnosis of mass located in the sellar region. Furthermore, an ideal management strategy for pituitary ganglioglioma is not known; therefore, more cases and long-term follow-up are needed to enrich our knowledge of the diagnosis, treatment, and prognosis of this rare intracranial lesion.
Collapse
Affiliation(s)
- Yuan Hong
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine
| | - Yuanjian Fang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine
| | - Qun Wu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine
| | - Jianmin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine
- Brain Research Institute
- Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Yongjie Wang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine
| |
Collapse
|
40
|
|
41
|
Chang TW, Lee CY, Jung SM, Lai HY, Chen CT, Yeap MC, Chuang CC, Hsu PW, Chang CN, Tu PH, Lee ST. Correlations between clinical hormone change and pathological features of pituicytoma. Br J Neurosurg 2018; 32:501-508. [PMID: 29749277 DOI: 10.1080/02688697.2018.1472212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Ting-Wei Chang
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Ching-Yi Lee
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Shih-Ming Jung
- Departments of Pathology, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Hung-Yi Lai
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Chun-Ting Chen
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Mun-Chun Yeap
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Chi-Cheng Chuang
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Peng-Wei Hsu
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Chen-Nen Chang
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Po-Hsun Tu
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Shih-Tseng Lee
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| |
Collapse
|
42
|
Affiliation(s)
- Jian-Qiang Lu
- Department of Pathology and Molecular Medicine/Neuropathology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Almunder R Algird
- Department of Surgery/Neurosurgery, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
43
|
Ogando-Rivas E, Alalade AF, Boatey J, Schwartz TH. Double pituitary adenomas are most commonly associated with GH- and ACTH-secreting tumors: systematic review of the literature. Pituitary 2017; 20:702-708. [PMID: 28766078 DOI: 10.1007/s11102-017-0826-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Double adenomas in the pituitary gland are a rare occurrence. The ability to cure a hormone-producing adenoma with surgery is dependent on the ability to identify and completely remove the correct adenoma. The relative frequency of each subtype of hormone-secreting adenomas confirmed with magnetic resonance image (MRI), surgery and immunohistochemistry is not defined. METHODS Following PRISMA guidelines, we performed a systematic review of PubMed Central, Google Scholar, Scopus Database, Cochrane database and Science Research, using the key-words: "double pituitary adenomas", "multiple pituitary adenomas" and only papers where multiple or truly separate double pituitary adenomas were identified pre-surgically by MRI and/or confirmed by pathology/immunohistochemistry staining were included. RESULTS We reviewed papers from 1975 to 2016 and found 17 cases with two pituitary adenomas and 1 with three pituitary adenomas. The ages ranged from 22 to 67 years old, and there were twelve females and five males. Immunohistochemical staining showed that the most common double pituitary adenomas were growth hormone (GH)- followed by adrenocorticotropic (ACTH)-secreting. CONCLUSION Double pituitary adenomas are rare but most commonly found with GH- or ACTH-producing tumors. It is critical to remove all identified possible adenomas to achieve biochemical cure and clinicians should have heightened sensitivity in patients with acromegaly or Cushing's Disease.
Collapse
Affiliation(s)
- Elizabeth Ogando-Rivas
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical College, Box 99, 525 East 68th St., New York, NY, 10065, USA
| | - Andrew F Alalade
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical College, Box 99, 525 East 68th St., New York, NY, 10065, USA
| | - Jerome Boatey
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical College, Box 99, 525 East 68th St., New York, NY, 10065, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical College, Box 99, 525 East 68th St., New York, NY, 10065, USA.
- Department of Otolaryngology, New York Presbyterian Hospital, Weill Cornell Medical College, Box 99, 525 East 68th St., New York, NY, 10065, USA.
- Department of Neuroscience, New York Presbyterian Hospital, Weill Cornell Medical College, Box 99, 525 East 68th St., New York, NY, 10065, USA.
| |
Collapse
|
44
|
Zhao Y, Zhang H, Lian W, Xing B, Feng M, Liu X, Wang R. Collision tumors composed of meningioma and growth hormone-secreting pituitary adenoma in the sellar region: Case reports and a literature review. Medicine (Baltimore) 2017; 96:e9139. [PMID: 29390316 PMCID: PMC5815728 DOI: 10.1097/md.0000000000009139] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Collision tumor is a rare disease that represents the coexistence of two histologically distinct neoplasms in the same area without histological admixture or an intermediate cell population zone. To our best knowledge, 13 cases besides our 2 cases have been reported till now, and our report represents the first publication regarding a collision tumor composed of growth hormone (GH)-secreting pituitary adenoma and sellar meningioma. PATIENT CONCERNS We collected two cases of collision tumors composed of meningioma and GH-secreting adenoma in the sellar region from 2014 to 2015 at Peking Union Medical College Hospital (PUMCH). DIAGNOSIS Two cases were diagnosed with solid sellar tumors, and two tumor types were suspected with magnetic resonance imaging (MRI). Blood hormone tests revealed increased insulin-like growth factor 1 (IGF-1) and GH levels. INTERVENTIONS Both cases underwent transsphenoidal microsurgical resection of pituitary adenoma. OUTCOMES The tumor was completely resected, and the pathological examination after the operation revealed meningioma and GH-secreting pituitary adenoma. LESSONS Collision tumors consisting of pituitary adenomas with other sellar neoplasms are rare. Histological examination is necessary because preoperative studies cannot guarantee an accurate diagnosis. If a collision tumor is suspected prior to operation, a craniotomy may need to be considered before other operation methods to avoid reoperation.
Collapse
Affiliation(s)
- Yi Zhao
- Department of Neurosurgery, Peking Union Medical College Hospital
| | - Hui Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital
- Tsinghua University School of Medicine, Beijing 100084, China
| | - Wei Lian
- Department of Neurosurgery, Peking Union Medical College Hospital
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital
| | - Xiaohai Liu
- Department of Neurosurgery, Peking Union Medical College Hospital
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital
| |
Collapse
|
45
|
Abstract
AbstractObjective: The concomitant presence of pituitary adenoma (PA) with Rathke’s cleft cyst (RCC) is rare, and most of the literature published is case reports. RCC’s clinicopathological features have not been well described. Methods: We retrospectively reviewed the data of 15 patients with PA associated with RCC. We also provide a systematic review of the literature. Results: The patients included males and seven females. The transsphenoidal approach was adopted for all patients except one, who underwent right frontal craniotomy. Complete resection was achieved in nine cases, with grossly complete resection in five and partial removal in one. Of the PA subtypes available, five patients had nonfunctional pituitary adenomas, three had multiple-hormone secreting PAs, three had prolactin-producing adenomas, and one had a growth hormone-secreting adenoma. All of the patients’ symptoms and abnormal endocrine test results resolved or were relieved after surgery. The mean follow-up time was 27.6±16.6 months. All of the patients recovered well and had no signs of recurrence during their follow-up, except for one patient. Conclusions: A cyst-like signal indicated on images or cystic materials encountered during operation in a patient with PA suggest the possibility of PA associated with RCC. Transsphenoidal surgery is the preferred approach and can resolve or relieve patients’ symptoms to a great extent. Histologically, nonfunctional PA and prolactinoma are the most common types of PA coexisting with RCC; the mechanisms of PA associated with RCC need to be investigated further.
Collapse
|
46
|
Ban VS, Chaudhary BR, Allinson K, Santarius T, Kirollos RW. Concomitant Primary CNS Lymphoma and FSH-Pituitary Adenoma Arising Within the Sella. Entirely Coincidental? Neurosurgery 2017; 80:E170-E175. [PMID: 28362886 PMCID: PMC5808144 DOI: 10.1093/neuros/nyw003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 11/22/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND IMPORTANCE: Collision tumors are the simultaneous occurrence of more than one type of neoplasm within an anatomic space. In the pituitary sella, collision tumors are exceedingly rare, and not much is known about their etiology and prognosis. CLINICAL PRESENTATION: A 74-year-old man presented with a concomitant primary pituitary lymphoma (diffuse large B-cell non-Hodgkin's lymphoma; DLBCL) and follicle-stimulating hormone (FSH)-adenoma diagnosed histologically after clinical features of apoplexy prompted urgent surgical decompression and resection. Strong immunoreactivity for FSH by the lymphoma was evident. Full-body workup demonstrated no other source for the lymphoma. He subsequently underwent 4 cycles of chemotherapy and has been in remission for over 32 months. His ophthalmoplegia at presentation persisted with no further deficits. CONCLUSIONS: Four cases of collision tumors of primary pituitary lymphoma and adenoma have previously been reported. This case represents the first combination of an FSH-adenoma and a DLBCL in the literature. Prompt involvement of the hematology-oncology team contributed to the good outcome seen in this case. The putative role played by pituitary hormones in tumorigenesis is reviewed in this case report. The association is either a chance occurrence or due to the induction of lymphoma cell proliferation by the binding of FSH produced by the adenoma to the FSH receptors on the lymphoma cells.
Collapse
Affiliation(s)
- Vin Shen Ban
- Division of Neurosurgery, Addenbroo-ke's Hospital, Cambridge, UK
| | | | - Kieren Allinson
- Depart-ment of Histopathology, Addenbrooke's Hospital, Cambridge, UK
| | - Thomas Santarius
- Division of Neurosurgery, Addenbroo-ke's Hospital, Cambridge, UK
| | | |
Collapse
|
47
|
Heng LJ, Jia D, Gong L, Zhang W, Ma J, Qu Y. Endoscopic Endonasal Resection of a Mixed Lesion of Gangliocytoma and Nonfunctioning Pituitary Adenoma. World Neurosurg 2017; 106:1050.e1-1050.e6. [DOI: 10.1016/j.wneu.2017.05.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
|
48
|
Shepard MJ, Elzoghby MA, Ghanim D, Lopes MBS, Jane JA. Transsphenoidal Surgery for Mixed Pituitary Gangliocytoma-Adenomas. World Neurosurg 2017; 108:310-316. [PMID: 28887280 DOI: 10.1016/j.wneu.2017.08.174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most sellar gangliocytomas are discovered with a concurrent pituitary adenoma, also known as a mixed gangliocytoma-adenoma (MGA). MGAs are rare, with fewer than 100 cases reported in the literature to date and only 1 previously documented surgical series. Because MGAs are radiologically indistinguishable from pituitary adenomas, they are often diagnosed after surgery. Combined with the paucity of clinical outcome data for these tumors, this makes their diagnosis and management challenging. Here we describe the clinical presentation and outcomes of 10 individuals who were diagnosed with a MGA at a single institution. METHODS This retrospective case series study included patients diagnosed with a combined sellar MGA between 1993 and 2016. RESULTS This series comprised 10 patients, mean age of 44 years (range, 28-63 years) diagnosed with an MGA. The mean tumor size was 1.6 cm (range, 0.4-2.4 cm). Five patients presented with acromegaly, and 1 patient had recurrent Cushing disease. Transsphenoidal surgery was performed in all cases, and gross total resection was achieved in 7 patients (70%). Histologically, 9 of the 10 MGAs were identified as mixed somatotroph adenoma-gangliocytomas. The median duration of follow-up was 74 months (range, 2-180 months). Following adjuvant treatment (n = 3), all patients with acromegaly (n = 4) achieved biochemical remission, and no patient experienced recurrence of the pituitary tumor with a median radiographic follow-up of 48 months. CONCLUSIONS MGAs are often associated with a hypersecretory adenoma. Transsphenoidal surgery is well tolerated by most patients, and when performed in combination with adjuvant therapy, a low rate of recurrence and reversal of preoperative endocrinopathy can be expected.
Collapse
Affiliation(s)
- Matthew J Shepard
- Department of Neurologic Surgery, University of Virginia Health Center, Charlottesville, Virginia, USA
| | | | - Daffer Ghanim
- School of Medicine, James Cook University, Townsville, Queensland, Australia
| | - M Beatriz S Lopes
- Department of Neurologic Surgery, University of Virginia Health Center, Charlottesville, Virginia, USA; Department of Pathology, University of Virginia Health Center, Charlottesville, Virginia, USA
| | - John A Jane
- Department of Neurologic Surgery, University of Virginia Health Center, Charlottesville, Virginia, USA.
| |
Collapse
|
49
|
Intra-Suprasellar Schwannoma Presumably Originating from the Internal Carotid Artery Wall. Clin Neuroradiol 2017; 28:127-135. [DOI: 10.1007/s00062-017-0601-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/17/2017] [Indexed: 12/01/2022]
|
50
|
|