51
|
Pojskić M, Zbytek B, Beckford NS, Boop FA, Arnautović KI. First Report of Coexistence of Two Ectopic Pituitary Tumors: Rathke Cleft Cyst and Silent Adrenocorticotropic Hormone Adenoma. World Neurosurg 2017; 104:1048.e1-1048.e7. [PMID: 28532906 DOI: 10.1016/j.wneu.2017.05.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rathke cleft cysts (RCCs) and pituitary adenomas (PAs) are thought to have a common embryonic ancestry; however, PAs with a concomitant RCC inside the sella turcica are rarely observed. Ectopic pituitary tumors are also rare. CASE DESCRIPTION We present the case of a 65-year-old woman with an ectopic RCC in the sphenoid sinus and outside the sella turcica concomitant with an adrenocorticotropic hormone (ACTH)-staining, clinically silent PA. The patient had headache but no endocrine or visual disturbances. Preoperative magnetic resonance imaging revealed infrasellar cystic lesion in the sphenoid sinus with erosion of the clivus and intact sellar floor. The patient underwent gross total microsurgical resection through the transnasal route with an uneventful postoperative course. CONCLUSIONS To our knowledge, this is the first reported ectopic RCC located outside the sella turcica with a concomitant ACTH-staining PA. This also appears to be the first ACTH-staining adenoma concomitant with RCC reported in the literature, regardless of location, not presenting with Cushing disease. This case shows that we can now include pituitary adenoma with or without a concomitant RCC in the differential diagnosis of processes in the sphenoid sinus. As both PAs and RCCs are benign sellar lesions, surgical management of a concomitant occurrence of these tumors mainly depends on the size of the lesions and their clinical manifestations. For patients with PA and concomitant RCC, surgical resection should be considered, as there is an approximatrely 20% recurrence rate of the cyst after resection and the possibility of future clival erosion, if left untreated.
Collapse
Affiliation(s)
- Mirza Pojskić
- Department of Neurosurgery, University of Marburg, Marburg, Germany
| | - Blazej Zbytek
- Department of Pathology and Laboratory Medicine; Center for Adult Cancer Research; University of Tennessee Health Science Center, Memphis, Tennessee
| | - Neal S Beckford
- Department of Otolaryngology-Head-Neck Surgery, University of Tennessee-Memphis, Memphis, Tennessee
| | - Frederick A Boop
- Semmes Murphey Neurologic and Spine Institute and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kenan I Arnautović
- Semmes Murphey Neurologic and Spine Institute and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
| |
Collapse
|
52
|
Arana Molina C, González Rivera N, Gómez-Moreno G, Farfan Lopez F, Martín Hernández T. Sellar collision tumor involving a primary fibrosarcoma: Clinical, morphological and immunohistochemical study of a case and review of the literature. ACTA ACUST UNITED AC 2017; 64:176-178. [PMID: 28440757 DOI: 10.1016/j.endinu.2016.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Carlos Arana Molina
- Endocrinology and Nutrition Unit, Virgen Macarena University Hospital, Seville, Spain.
| | | | - Gerardo Gómez-Moreno
- Department of Special Care in Dentistry Group, Pharmacological Research in Medicine, Faculty of Dentistry, University of Granada, Granada, Spain
| | | | | |
Collapse
|
53
|
Caporalini C, Buccoliero AM, Pansini L, Moscardi S, Novelli L, Baroni G, Bordi L, Ammannati F, Taddei GL. Pituitary adenoma with adipose tissue: A new metaplastic variant. Neuropathology 2017; 37:329-334. [DOI: 10.1111/neup.12361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Chiara Caporalini
- Pathology Unit; Anna Meyer Children's University Hospital; Florence Italy
| | | | - Luigi Pansini
- Neurosurgery Unit; Careggi University Hospital; Florence Italy
| | - Selene Moscardi
- Pathology Unit; Anna Meyer Children's University Hospital; Florence Italy
| | - Luca Novelli
- Pathology Unit; Careggi University Hospital; Florence Italy
| | - Gianna Baroni
- Pathology Unit; Careggi University Hospital; Florence Italy
| | - Lorenzo Bordi
- Neurosurgery Unit; Careggi University Hospital; Florence Italy
| | | | | |
Collapse
|
54
|
Sharma A, K.Richfield E, Lubitz SE. Acromegaly Occurring In A Patient With A Pituitary Adenoma, Lymphocytic Hypophysitis, And A Rathke Cleft Cyst. AACE Clin Case Rep 2017. [DOI: 10.4158/ep161369.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
55
|
Zhang J, Xu S, Liu Q, Li X, Jia D, Li G. Intrasellar and Suprasellar Schwannoma Misdiagnosed as Pituitary Macroadenoma: A Case Report and Review of the Literature. World Neurosurg 2016; 96:612.e1-612.e7. [DOI: 10.1016/j.wneu.2016.08.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/27/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
|
56
|
Yowtak J, Sharma S, Forseen SE, Alleyne CH. Anterior Gray Matter Pituicytic Heterotopia with Monomorphic Anterior Pituitary Cells: A Variant of Nonsecretory Pituitary Adenoma Neuronal Choristoma? Report of a Rare Case and Review of the Literature. World Neurosurg 2016; 97:759.e1-759.e8. [PMID: 27744079 DOI: 10.1016/j.wneu.2016.09.125] [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: 07/22/2016] [Revised: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mixed tumors of adenomatous and neuronal cells in the sellar region are an uncommon finding. The origins of these heterogeneous tumors are unknown, and management remains unsettled. We report a very rare case of anterior gray matter pituicytic heterotopia with monomorphic anterior pituitary cells that likely represents a variant of nonsecreting pituitary adenoma neuronal choristoma (PANCH) with no ganglion cells. We also review the current literature for the various clinical presentations of PANCH. CASE DESCRIPTION A 49-year-old female complaining of headache, blurred vision, and hair loss was found to have a nonsecretory sellar mass with compression of the optic chiasm on magnetic resonance imaging (MRI). The mass was excised via a transsphenoidal procedure. Histological analysis of tissue sections revealed heterotopic gray matter with reactive gliosis without ganglion cells or Herring bodies. Only 1 smear exhibited characteristics of a pituitary adenoma. CONCLUSIONS The overall findings were most consistent with a variant of PANCH. At a postoperative follow-up of 4.5 years, there was resolution of visual symptoms, and the residual sellar mass was stable on MRI. Neuronal choristoma is hypothesized to originate from embryonal pituitary or hypothalamus, or by differentiation from pituitary adenoma cells. Surgery is the cornerstone of management, and the clinical course appears to be similar to that of nonfunctioning pituitary adenoma in reported cases.
Collapse
Affiliation(s)
- June Yowtak
- Department of Neurosurgery, Augusta University, Augusta, Georgia, USA.
| | - Suash Sharma
- Department of Pathology, Augusta University, Augusta, Georgia, USA
| | - Scott E Forseen
- Department of Radiology, Augusta University, Augusta, Georgia, USA
| | - Cargill H Alleyne
- Department of Neurosurgery, Augusta University, Augusta, Georgia, USA
| |
Collapse
|
57
|
Cossu G, Daniel RT, Messerer M. Gangliocytomas of the sellar region: A challenging diagnosis. Clin Neurol Neurosurg 2016; 149:122-35. [DOI: 10.1016/j.clineuro.2016.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 07/19/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
|
58
|
Abstract
The sellar region is a tiny anatomic compartment in which many lesions and developmental diseases can be found. If pituitary adenomas represent most of the sellar mass, it is important to recognize other pathologic conditions before any surgical procedure, because the optimal treatment may differ considerably from one lesion to another. A careful clinical evaluation followed by neuroimaging studies and an endocrinologic and ophtalmologic workup will lead, in most cases, to a diagnosis with near certainty. This article provides an overview of sellar diseases with emphasis on their most useful characteristics for clinical practice.
Collapse
Affiliation(s)
- Damien Bresson
- Neurosurgery Department, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, Paris 75010, France
| | - Philippe Herman
- ENT Department, Lariboisière Hospital, Université Paris VII - Diderot, 2 rue Ambroise Paré, Paris 75010, France
| | - Marc Polivka
- Department of Pathology, Lariboisiere Hospital, 2 rue Ambroise Paré, Paris 75010, France
| | - Sébastien Froelich
- Neurosurgery Department, Assistance Publique-Hôpitaux de Paris, Université Paris VII - Diderot, 2 rue Ambroise Paré, Paris 75010, France.
| |
Collapse
|
59
|
Spontaneous pituitary adenoma occurring after resection of a Rathke's cleft cyst. J Clin Neurosci 2016; 33:247-251. [PMID: 27600168 DOI: 10.1016/j.jocn.2016.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/14/2016] [Indexed: 11/21/2022]
Abstract
Rathke's cleft cysts (RCC) are benign cystic lesions that originate from remnants of the epithelial lining of Rathke's pouch. RCC are known rarely to occur together with a concomitant pituitary adenoma. Here, we report a patient with a pituitary adenoma arising in the same location as a previously-resected RCC, 3 years post-operatively, and review the literature of "collision" sellar lesions. Consecutive transsphenoidal operations from a single-center between 2008 and 2016 were reviewed to identify patients with pituitary adenoma arising after surgical resection of RCC, and a systematic search of the literature was also performed to identify such patient reports, as well as reports of concomitant pituitary adenoma and RCC. Of 837 transsphenoidal operations from our own experience, one patient with pituitary adenoma occurring after RCC resection was identified and is reported here. A systematic review of the literature resulted in identification of 34 patients with concomitant RCC and pituitary adenoma and no incidents of pituitary adenoma occurring after resection of RCC. Concomitant occurrence of RCC and pituitary adenoma was more commonly diagnosed in women (61%), at a median age of diagnosis of 44 years. The RCC histological analysis in these patients consistently described ciliated columnar or cuboidal epithelium. Although rare, the presence of a new, pathologically-distinct lesions in the sella after prior surgical treatment, is possible. During post-operative monitoring, physicians should consider that what appears as a "recurrent" lesion may actually be growth of a new and entirely different lesion.
Collapse
|
60
|
Novello M, Gessi M, Doglietto F, Anile C, Lauriola L, Coli A. Characteristics of ganglion cells in pituitary gangliocytomas. Neuropathology 2016; 37:64-68. [PMID: 27400662 DOI: 10.1111/neup.12322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/08/2016] [Accepted: 06/08/2016] [Indexed: 12/29/2022]
Abstract
The occurrence of ganglion cells in the sella turcica, in association or not with a pituitary adenoma, has been rarely reported. Various names have been employed for this rare entity, gangliocytoma being frequently used and recommended by WHO classification. Expression of cytokeratin in these ganglion cells has been previously occasionally reported, a very intriguing observation raising questions on the possible nature and derivation of these cells. We describe the pathological findings in three cases of growth hormone-producing adenomas, all sparsely granulated, showing the presence of a ganglion cell population admixed with an adenomatous component. A review of the literature is also provided.
Collapse
Affiliation(s)
| | - Marco Gessi
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | | | - Carmelo Anile
- Department of Neurosurgery, Catholic University, Rome, Italy
| | - Libero Lauriola
- Department of Anatomic Pathology, Catholic University, Rome, Italy
| | - Antonella Coli
- Department of Anatomic Pathology, Catholic University, Rome, Italy
| |
Collapse
|
61
|
Pu J, Wang Z, Zhou H, Zhong A, Jin K, Ruan L, Yang G. Isolated double adrenocorticotropic hormone-secreting pituitary adenomas: A case report and review of the literature. Oncol Lett 2016; 12:585-590. [PMID: 27347184 DOI: 10.3892/ol.2016.4673] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/12/2016] [Indexed: 11/06/2022] Open
Abstract
Only a few cases of double or multiple pituitary adenomas have previously been reported in the literature; however, isolated double adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas are even more rare. The present study reports a rare case of a 50-year-old female patient who presented with typical clinical features of Cushing's disease and was diagnosed with isolated double ACTH-secreting pituitary adenomas. Endocrinological examination revealed an ACTH-producing pituitary adenoma, and preoperative magnetic resonance imaging (MRI) demonstrated a microadenoma with a lower intensity on the right side of the pituitary gland. The patient underwent endoscopic endonasal transsphenoidal surgery, which revealed another pituitary tumor in the left side of the pituitary gland. The two, clearly separated, pituitary adenomas identified in the same gland were completely resected. Immunohistochemistry and pathology revealed that the clearly separated double pituitary adenomas were positive for ACTH, thyroid-stimulating, growth and prolactin hormones. Postoperatively, the levels of ACTH and cortisol hormone decreased rapidly. The case reported in the present study is considerably rare, due to the presence of a second pituitary adenoma in the same gland, which was not detected by preoperative MRI scan, but was noticed during surgery. Intraoperative evaluation may be important in the identification of double or multiple pituitary adenomas.
Collapse
Affiliation(s)
- Jiujun Pu
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 410000, P.R. China
| | - Zhiming Wang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 410000, P.R. China
| | - Hui Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 410000, P.R. China
| | - Ailing Zhong
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 410000, P.R. China
| | - Kai Jin
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 410000, P.R. China
| | - Lunliang Ruan
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 410000, P.R. China
| | - Gang Yang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 410000, P.R. China
| |
Collapse
|
62
|
Neidert MC, Leske H, Burkhardt JK, Kollias SS, Capper D, Schrimpf D, Regli L, Rushing EJ. Synchronous pituitary adenoma and pituicytoma. Hum Pathol 2016; 47:138-43. [DOI: 10.1016/j.humpath.2015.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/13/2015] [Accepted: 08/26/2015] [Indexed: 11/24/2022]
|
63
|
Budan RM, Georgescu CE. Multiple Pituitary Adenomas: A Systematic Review. Front Endocrinol (Lausanne) 2016; 7:1. [PMID: 26869991 PMCID: PMC4740733 DOI: 10.3389/fendo.2016.00001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 01/08/2016] [Indexed: 12/20/2022] Open
Abstract
PubMed, Scopus, and Web of Science Core Collection databases were systematically searched for studies reporting synchronous double or multiple pituitary adenomas (MPA), a rare clinical condition, with a vague pathogenesis. Multiple adenomas of the pituitary gland are referred to as morphologically and/or immunocytochemically distinct tumors that are frequently small-sized and hormonally non-functional, to account for the low detection rate. There is no general agreement on how to classify MPA, various criteria, such as tumor contiguity, immunoreactivity, and clonality analysis are being used. Among the component tumors, prolactin (PRL)-immunopositive adenomas are highly prevalent, albeit mute in the majority of cases. The most frequent clinical presentation of MPA is Cushing's syndrome, given the fact that in more than 50% of reported cases at least one lesion stains for adrenocorticotrophic hormone (ACTH). Plurihormonal hyperactivity may be diagnosed in a patient with MPA when more than one tumor is clinically active (e.g., ACTH and PRL) or in cases with at least one composite tumor (e.g., GH and PRL), to complicate the clinical scenario. Specific challenges associated with MPA include high surgical failure rates, enforcing second-look surgery in certain cases, and difficult preoperative neuroradiological imaging evaluation, with an overall sensitivity of only 25% for magnetic resonance imaging to detect distinct multiple tumors. Alternatively, minor pituitary imaging abnormalities may raise suspicion, as these are not uncommon. Postoperative immunohistochemistry is mandatory and in conjunction to electron microscopy scanning and testing for transcription factors (i.e., Pit-1, T-pit, and SF-1) accurately define and classify the distinct cytodifferentiation of MPA.
Collapse
Affiliation(s)
- Renata M. Budan
- Department of Endocrinology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Carmen E. Georgescu
- Department of Endocrinology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Endocrinology Clinic, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
- *Correspondence: Carmen E. Georgescu,
| |
Collapse
|
64
|
Ikeda H, Ohhashi G. Demonstration of high coincidence of pituitary adenoma in patients with ruptured Rathke's cleft cyst: Results of a prospective study. Clin Neurol Neurosurg 2015; 139:144-51. [DOI: 10.1016/j.clineuro.2015.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/30/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
|
65
|
Nguyen MT, Lavi E. Pituitary adenoma-neuronal choristoma is a pituitary adenoma with ganglionic differentiation. Exp Mol Pathol 2015; 99:628-31. [PMID: 26551086 DOI: 10.1016/j.yexmp.2015.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/04/2015] [Indexed: 11/25/2022]
Abstract
The presence of ganglion cells within an endocrine pituitary tumor has been named hamartoma, choristoma, gangliocytoma, or most recently pituitary adenoma-neuronal choristoma (PANCH). The presence of neuronal differentiation in regular pituitary adenomas has been previously suggested, however, its origin, the extent of its presence, and the relationship between the neuronal elements and the pituitary adenoma remain uncertain. Thus, to further explore the neuronal potential of pituitary tumors, we used immunohistochemistry on pituitary tumors of different grades, with a neuronal antigen protein (NeuN) antibody as a specific marker for mature neuronal differentiation. We found NeuN expression in 26.47% (9/34) cases of pituitary tumors without ganglionic differentiation (7 adenomas, 1 atypical adenoma and 1 pituitary carcinoma), in addition to NeuN expression in pituitary adenomas with ganglionic cells (2/2). Thus, neuronal expression is an innate property of pituitary adenomas. We propose that the rare presence of ganglionic cells in pituitary adenomas is not the result of a separate lesion or "collision sellar tumors", as previously suggested, but a ganglionic neuronal differentiation in an endocrine neoplasm. The ganglionic cells may be arising from uncommitted stem/progenitor cells that contain both neuronal and endocrine properties. A label of "pituitary adenoma with ganglionic differentiation" would better reflect the dual differentiation in a neuroendocrine tumor than the current label "PANCH".
Collapse
Affiliation(s)
- Michaela T Nguyen
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital - Weill Cornell Medicine, New York, NY 10065, United States
| | - Ehud Lavi
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital - Weill Cornell Medicine, New York, NY 10065, United States
| |
Collapse
|
66
|
Domingue ME, Marbaix E, Do Rego JL, Col V, Raftopoulos C, Duprez T, Vaudry H, Maiter D. Infrasellar pituitary gangliocytoma causing Cushing's syndrome. Pituitary 2015; 18:738-44. [PMID: 25183169 DOI: 10.1007/s11102-014-0595-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pituitary gangliocytomas are uncommon neuronal tumours that may present with endocrine disorders, the most frequent being acromegaly caused by growth hormone hypersecretion. Cushing's syndrome is very rarely seen with gangliocytomas. MATERIAL AND METHODS We report the unique case of a 62 year-old woman whose clinical picture and endocrine testing clearly demonstrated adrenocorticotropin (ACTH)-dependent Cushing's syndrome. Pituitary magnetic resonance imaging showed a 12-mm homogeneous, infra- and retrosellar mass first diagnosed as pituitary macroadenoma. Transsphenoidal surgery was performed and allowed complete resection of the tumour with sparing of normal anterior pituitary. Very low postoperative serum cortisol and ACTH levels were observed in the early postoperative period and the patient is still in remission 18 months after surgery, thus demonstrating that the resected lesion was entirely responsible for the clinical picture. RESULTS Histological and immunocytochemical analyses demonstrated a benign tumour composed of mature neuronal cells suggestive of a gangliocytoma, expressing both ACTH and corticotropin-releasing hormone (CRH). The tumour was surrounded by a rim of pituitary tissue containing ACTH-producing endocrine cells. Careful analysis of the resected lesion did not reveal any pituitary microadenoma. We search literature for similar cases and retraced only nine cases of gangliocytomas associated with Cushing's syndrome. In most of them, the tumour was combined with either pituitary corticotroph adenoma or hyperplasia. CONCLUSIONS Our case represents a unique case of an infrasellar pituitary gangliocytoma which was able to cause Cushing's syndrome by both direct ACTH production and CRH-induced stimulation of neighbour normal corticotroph cells.
Collapse
Affiliation(s)
- Marie-Eve Domingue
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 54.74, 1200, Brussels, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
67
|
Sharifi G, Bakhtevari MH, Alghasi M, Saberi M, Dehghan M, Bidari F, Rezaei O. Hard calcified intrasellar schwannoma mimicking pituitary adenoma: a case report and review of the literature. Clin Neurol Neurosurg 2015; 137:38-43. [PMID: 26142086 DOI: 10.1016/j.clineuro.2015.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/23/2015] [Accepted: 06/02/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intrasellar location of schwannoma is extremely rare, although intracranial schwannomas are common in the central nervous system. The aim of the present study is to describe a calcified intrasellar schwannoma case. MATERIALS AND METHODS We represent a 45-year-old woman who had suffered from headaches; right side facial pain and visual disturbance which had worsen during the last week prior to admission. Physical examinations were normal except for the bitemporal visual field hemianopia which match with perimetry examination. MRI demonstrated an unusual seemingly calcified mass lesion in the sellar region which was mimicking pituitary macro adenoma. RESULT Total resection of the tumor achieved through endoscopic transnasal transsphenoidal approach by extracapsular dissection and pathologic examination of the tumor revealed calcified schwannoma. CONCLUSION The differential diagnoses of sellar and suprasellar lesions include pituitary adenomas, craniopharyngiomas, meningiomas, and many others. However, schwannoma is not usually included, because the occurrence of schwannoma in the sellar or suprasellar region is extremely rare. Only few cases of intrasellar schwannomas have been reported in the literature, all of which presented a suprasellar extension similar to that of our case. Fascinating surgical point is managing very firm tumor through transsphenoidal corridor which we handle it by very sharp, debulking and extracapsular removal.
Collapse
Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Alghasi
- Department of Neurosurgery, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Masood Saberi
- Department of Neurosurgery, Erfan General Hospital, Tehran, Iran
| | - Mahmood Dehghan
- Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Bidari
- Department of Neuropathology, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omidvar Rezaei
- Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
68
|
Guo SY, Cai XQ, Ma J, Wang WY, Lu G. Diagnosis of concomitant pituitary adenoma and Rathke's cleft cyst with magnetic resonance imaging. Int J Surg 2015; 18:191-5. [PMID: 25959251 DOI: 10.1016/j.ijsu.2015.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/29/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The diagnosis of concomitant pituitary adenoma (PA) and Rathke's cleft cyst (RCC) is difficult because PA and RCC cause similar symptoms. This study aimed to investigate magnetic resonance imaging (MRI) characteristics and surgical management of sellar lesions for concomitant PA and RCC. METHODS A retrospective study was performed in 18 patients with concomitant PA and RCC who visited our hospital between June 2008 and May 2014. MRI features, surgical management, histopathological diagnosis and prognosis of concomitant PA and RCC were summarized. RESULTS Of the 18 patients, 3 cases were diagnosed with concomitant PA and RCC and 2 with concomitant PA and intermedia cyst by preoperative MRI. The remaining 8 cases were misdiagnosed as cystic formation of PA, 3 cases were bleeding of PA, and 2 cases were RCC. Surgery via the trans-sphenoidal route was performed in 17 cases and trans-frontal approach was chosen for one patient. All PAs resected were diagnosed by histological examination and the diagnosis of concomitant PA and RCC was histologically confirmed. CONCLUSION A non-enhancing cyst-like structure within the pars intermedia of PA usually located in the midline is a prominent MRI feature of coexisted PA and RCC. Total resection of coexisted RCC must be achieved and fat graft should be avoided during surgery because of high recurrence rate of RCC and complicated hypophysitis.
Collapse
Affiliation(s)
- Shun-yuan Guo
- Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China
| | - Xue-qiang Cai
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China
| | - Jie Ma
- Department of Pathology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China
| | - Wei-yu Wang
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China
| | - Gang Lu
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China.
| |
Collapse
|
69
|
GH-Producing Pituitary Adenoma and Concomitant Rathke's Cleft Cyst: A Case Report and Short Review. Case Rep Neurol Med 2015; 2015:948025. [PMID: 25883817 PMCID: PMC4389828 DOI: 10.1155/2015/948025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/13/2015] [Accepted: 03/15/2015] [Indexed: 11/17/2022] Open
Abstract
Concomitant pituitary adenoma (PA) and Rathke's cleft cyst (RCC) are rare. In some cases, such PA is known to produce pituitary hormones. A 53-year-old man was admitted to our hospital with a diagnosis of lacunar infarction in the left basal ganglia. Magnetic resonance imaging (MRI) incidentally showed a suprasellar mass with radiographic features of RCC. When he consulted with a neurosurgical outpatient clinic, acromegaly was suspected based on his appearance. A diagnosis of growth hormone- (GH-) producing PA was confirmed from hormonal examinations and additional MRI. Retrospectively, initial MR images also showed intrasellar mass that is compatible with the diagnosis of PA other than suprasellar RCC. The patient underwent endonasal-endoscopic removal of the PA. Since we judged that the RCC of the patient was asymptomatic, only the PA was completely removed. The postoperative course of the patient was uneventful and GH levels gradually normalized. Only 40 cases of PA with concomitant RCC have been reported to date, including 13 cases of GH-producing PA. In those 13 cases, RCC tended to be located in the sella turcica, and suprasellar RCC like this case appears rare. In a few cases, concomitant RCCs were fenestrated, but GH levels normalized postoperatively as in the cases without RCC fenestration. If radiographic imaging shows typical RCC, and PA is not obvious at first glance, the possibility of concomitant PA still needs to be considered. In terms of treatment, removal of the RCC is not needed to achieve hormone normalization.
Collapse
|
70
|
Teasdale S, Hashem F, Olson S, Ong B, Inder WJ. Recurrent pituitary apoplexy due to two successive neoplasms presenting with ocular paresis and epistaxis. Endocrinol Diabetes Metab Case Rep 2015; 2015:140088. [PMID: 25755879 PMCID: PMC4322370 DOI: 10.1530/edm-14-0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/19/2015] [Indexed: 11/08/2022] Open
Abstract
UNLABELLED A case of recurrent pituitary apoplexy is described in a 72-year-old man who initially presented with haemorrhage in a non-functioning pituitary adenoma. Five years later, he re-presented with a severe pituitary haemorrhage in an enlarging sellar mass invading both cavernous sinuses causing epistaxis and bilateral ocular paresis. Subsequent histology was consistent with a sellar malignant spindle and round cell neoplasm. Multiple pituitary tumours have previously been reported to coexist in the same individual, but to our knowledge this is the only case where two pathologically distinct pituitary neoplasms have sequentially arisen in a single patient. This case is also notable with respect to the progressive ocular paresis, including bilateral abducens nerve palsies, and the presentation with epistaxis. LEARNING POINTS Ocular paresis in pituitary apoplexy can result from tumour infiltration of nerves, or by indirect compression via increased intrasellar pressure.Epistaxis is a very rare presentation of a pituitary lesion.Epistaxis more commonly occurs following trans-sphenoidal surgery, and can be delayed.
Collapse
Affiliation(s)
- Stephanie Teasdale
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Fahid Hashem
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Sarah Olson
- Department of Neurosurgery, Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Benjamin Ong
- Department of Radiology, Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital , Brisbane, Queensland , Australia ; School of Medicine, The University of Queensland Brisbane, Queensland , Australia
| |
Collapse
|
71
|
Balci S, Saglam A, Oruckaptan H, Erbas T, Soylemezoglu F. Pituitary adenoma with gangliocytic component: report of 5 cases with focus on immunoprofile of gangliocytic component. Pituitary 2015; 18:23-30. [PMID: 24430434 DOI: 10.1007/s11102-013-0551-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pituitary adenomas with gangliocytic component are rare tumors of the sellar region that are composed of pituitary adenoma cells and a ganglion cell component. Their histogenesis and hence nosology is not yet resolved because of the small number of cases reported and lack of large series in the literature. METHODS Herein we report five cases of pituitary adenoma with gangliocytic component to add knowledge to this rare neoplasm. RESULTS Three cases are functional mammosomatotroph adenomas, one case is functional sparsely granulated somatotroph adenoma and the other is functional corticotroph adenoma. Gangliocytic component showed immunohistochemical expression of hormones in three cases. The ganglion cells were prolactin immunoreactive in case 1, GH and TSH immunoreactive in case 5 and showed expression of prolactin, TSH, ACTH and FSH in case 4. Three cases had undergone more than one surgery of which two had gangliocytic cells only in the recurrent tumors whereas the third case showed gangliocytic cells only in the initial tumor. DISCUSSION The cases are discussed with clinical and histological features and a brief review of the literature considering the histogenesis is included.
Collapse
Affiliation(s)
- Serdar Balci
- Patoloji Anabilim Dalı, Hacettepe Üniversitesi Tıp Fakültesi, Morfoloji Binası 5.Kat. Sıhhiye, 06100, Ankara, Turkey
| | | | | | | | | |
Collapse
|
72
|
Gangliocytomas in the sellar region. Clin Neurol Neurosurg 2014; 126:156-61. [DOI: 10.1016/j.clineuro.2014.08.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/19/2014] [Accepted: 08/31/2014] [Indexed: 11/23/2022]
|
73
|
Endoscopic Approach to a Collision Tumor of Growth Hormone-Secreting Adenoma and Gangliocytoma in the Pituitary Gland. J Craniofac Surg 2014; 25:1277-9. [DOI: 10.1097/scs.0000000000000580] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
74
|
Babu R, Back AG, Komisarow JM, Owens TR, Cummings TJ, Britz GW. Symptomatic Rathke's cleft cyst with a co-existing pituitary tumor; Brief review of the literature. Asian J Neurosurg 2014; 8:183-7. [PMID: 24551002 PMCID: PMC3912769 DOI: 10.4103/1793-5482.125662] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Pituitary adenomas and Rathke's cleft cysts (RCCs) share a common embryological origin. Occasionally, these two lesions can present within the same patient. We present a case of a 39-year-old male who was found to have a large sellar lesion after complaints of persistent headaches and horizontal nystagmus. Surgical resection revealed components of a RCC co-existing with a pituitary adenoma. A brief review of the literature was performed revealing 38 cases of co-existing Rathke's cleft cysts and pituitary adenomas. Among the cases, the most common symptoms included headache and visual changes. Rathke's cleft cysts and pituitary adenomas are rarely found to co-exist, despite having common embryological origins. We review the existing literature, discuss the common embryology to these two lesions and describe a unique case from our institution of a co-existing Rathke's cleft cyst and pituitary adenoma.
Collapse
Affiliation(s)
- Ranjith Babu
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Adam G Back
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Jordan M Komisarow
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Timothy R Owens
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Thomas J Cummings
- Division of Pathology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Gavin W Britz
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
75
|
|
76
|
Abstract
Modern imaging techniques play a vital role in the diagnosis, surveillance, and treatment monitoring of patients with pituitary disease. For its high soft tissue contrast, magnetic resonance (MR) imaging provides detailed information about the localization and extent of a lesion. It is thus, to date, the most important imaging technique for documenting or ruling out structural lesions. It is usually the first and only imaging procedure to be employed in pituitary pathology. While large pituitary adenomas are reliably depicted in standard T1-weighted sequences, small microadenomas, such as in Cushing's disease, may only become visible if repeat studies, sophisticated techniques and high-field scanners are employed. For monitoring treatment effects after surgical procedures, drug applications, or irradiation, follow-up studies with identical parameters should be employed, preferably at the same investigation site. Some space is devoted to intraoperative imaging, which not only allows assessment of how radical tumor resection needs to be during pituitary tumor surgery, but also provides extremely accurate structural data for neuronavigation. Less frequent lesions, such as craniopharyngiomas, meningiomas, germ cell tumors, gliomas, skull base tumors, hypothalamic hamartomas, vascular malformations, inflammatory and developmental lesions and other, even less frequent pathologies should be considered in the differential diagnosis. The particular strength of computed tomography (CT) is the direct depiction of calcification, a weakness of MRI, and the high resolution of bone structures at the skull base. This chapter presents the characteristics of both frequent and less commonly encountered tumoral lesions, with an emphasis on computed tomography and magnetic resonance imaging.
Collapse
Affiliation(s)
- Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany.
| | - Sven Schlaffer
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
77
|
Sogani J, Yang W, Lavi E, Zimmerman RD, Gupta A. Sellar collision tumor involving metastatic lung cancer and pituitary adenoma: radiologic-pathologic correlation and review of the literature. Clin Imaging 2013; 38:318-21. [PMID: 24444708 DOI: 10.1016/j.clinimag.2013.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/18/2013] [Accepted: 12/09/2013] [Indexed: 11/30/2022]
Abstract
Collision tumors of the sella turcica involving metastases to pituitary adenomas are rare. We report a case of a collision tumor involving metastatic lung cancer with an emphasis on the neuroimaging and histopathological studies. A review of the literature including the diagnostic and management implications as well as pathogenetic mechanisms is also discussed.
Collapse
Affiliation(s)
- Julie Sogani
- Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Wanhua Yang
- Department of Pathology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Ehud Lavi
- Department of Pathology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Robert D Zimmerman
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
| |
Collapse
|
78
|
Jin G, Hao S, Xie J, Mi R, Liu F. Collision tumors of the sella: coexistence of pituitary adenoma and craniopharyngioma in the sellar region. World J Surg Oncol 2013; 11:178. [PMID: 23919255 PMCID: PMC3750462 DOI: 10.1186/1477-7819-11-178] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 07/30/2013] [Indexed: 11/20/2022] Open
Abstract
Collision tumors of the sellar region are relatively uncommon and consist mainly of more than one type of pituitary adenoma or a cyst or cystic tumor. The association of a pituitary adenoma and a craniopharyngioma is particularly rare. This study describes a rare occurrence in which a pituitary adenoma and a craniopharyngioma coexisted in the sellar region. The case involves a 47-year-old woman who underwent transsphenoidal surgery with subtotal tumor resection and reoperation using an interhemispheric transcallosal approach for total microsurgical resection of the tumor because the visual acuity in her left eye had re-deteriorated. Histopathological and immunohistochemical examinations of the excised tissue revealed a pituitary adenoma in the first operation and a craniopharyngioma in the second operation. Retrospective analysis found the coexistence of a pituitary adenoma and a craniopharyngioma, known as a collision tumor. Instead of the transsphenoidal approach, a craniotomy should be performed, to explore the suprasellar region.
Collapse
Affiliation(s)
- Guishan Jin
- Brain Tumor Research Center, Beijing Neurosurgical Institute & Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China
| | | | | | | | | |
Collapse
|
79
|
Miller BA, Tanaka T, Ioachimescu AG, Vincentelli C, Appin CL, Oyesiku NM. Transformation of a Silent Adrencorticotrophic Pituitary Tumor Into Central Nervous System Melanoma. J Investig Med High Impact Case Rep 2013; 1:2324709613494008. [PMID: 26425577 PMCID: PMC4528794 DOI: 10.1177/2324709613494008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Silent adrenocorticotrophic pituitary adenomas are nonfunctioning pituitary adenomas that express adrenocorticotrophic hormone (ACTH) but do not cause the clinical or laboratory features of hypercortisolemia. Primary central nervous system (CNS) melanoma is well documented, but rarely originates in the sellar region or pituitary gland. Here we report transformation of an aggressive silent adrenocorticotrophic pituitary adenoma that transformed into CNS melanoma and review other presentations of pituitary melanoma. A 37-year-old woman initially presented with apoplexy and an invasive nonfunctioning pituitary macroadenoma for which she underwent transphenoidal surgery. The patient underwent 3 subsequent surgeries as the tumor continued to progress. Pathology from the first 3 operations showed pituitary adenoma or carcinoma. Pathology from the final surgery showed melanoma and the magnetic resonance imaging characteristics of the tumor had changed to become consistent with CNS melanoma. Dermatologic and ophthalmologic examinations did not identify cutaneous or ocular melanoma. The patient’s disease progressed despite aggressive surgical, medical and radiologic treatment. To our knowledge, this is the first report demonstrating transformation of a primary pituitary tumor into melanoma. The mechanism of tumor transformation is unclear, but it is possible that a mutation in the original ACTH-producing tumor lead to increased cleavage of pro-opiomelanocortin or ACTH into α-melanocyte-stimulating hormone, which in turn stimulated the expression of microopthalmia transcription factor, leading to melanocytic phenotype transformation.
Collapse
Affiliation(s)
| | - Tomoko Tanaka
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | |
Collapse
|
80
|
Iacovazzo D, Bianchi A, Lugli F, Milardi D, Giampietro A, Lucci-Cordisco E, Doglietto F, Lauriola L, De Marinis L. Double pituitary adenomas. Endocrine 2013; 43:452-7. [PMID: 23325364 DOI: 10.1007/s12020-013-9876-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
Abstract
Double pituitary adenomas represent up to 2.6 % of pituitary adenomas in large surgical series and up to 3.3 % of patients with Cushing's disease have been found to have double or multiple pituitary adenomas. We report the case of a 60-year-old male patient whose medical history began in 2002 with erectile dysfunction; hyperprolactinemia was found and MRI showed a 6-mm area of delayed enhancement in the lateral portion of the right pituitary lobe. Treatment with cabergoline was started with normalization of prolactin levels; the following MRI, performed in 2005 and 2008, showed shrinkage of the pituitary lesion. In 2005, the patient began to manifest weight gain, hypertension, and facial plethora, but no further evaluations were done. In January 2010, the patient came to our attention and underwent multiple tests that suggested Cushing's disease. A new MRI was negative. Bilateral inferior petrosal sinus sampling showed significant pituitary-to-peripheral ratio and, in May 2010, the patient underwent exploratory pituitary surgery with evidence of a 1-2-mm white-coloured midline area compatible with pituitary adenoma that was surgically removed. Post-operatively, the patient's clinical conditions improved with onset of secondary hypoadrenalism. The histologic examination confirmed a pituitary adenoma (immunostaining was found to be positive for ACTH and negative for prolactin). We report the case of an ACTH-producing microadenoma metachronous to a prolactin secreting microadenoma although not confirmed histologically, shrunk by medical treatment. A review of data in the literature regarding double or multiple pituitary adenomas has also been done.
Collapse
Affiliation(s)
- D Iacovazzo
- Department of Endocrinology, Catholic University, Policlinico A. Gemelli, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
81
|
Sarmiento JM, Wi MS, Piao Z, Boon-Unge K, Stiner ES. Two collision sellar lesions: Rathke's cleft cyst with non-functional pituitary adenoma and Rathke's cleft cyst with plurihormonal adenoma. ACTA ACUST UNITED AC 2013. [DOI: 10.7243/2049-7962-2-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
82
|
Neurocysticercosis, meningioma, and silent corticotroph pituitary adenoma in a 61-year-old woman. Case Rep Pathol 2012; 2012:340840. [PMID: 23346440 PMCID: PMC3546452 DOI: 10.1155/2012/340840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/15/2012] [Indexed: 01/14/2023] Open
Abstract
We report here the case of a 61-year-old woman who presented with hydrocephalus and cystic and solid lesions in sella turcica, suprasellar areas, and third ventricle. After ventriculoperitoneal shunt she developed cognitive changes and the cystic lesions enlarged. Magnetic resonance imaging (MRI) demonstrated multiple cysts and a solid lesion in the sella and around the anterior clinoid process. With diagnosis of neurocysticercosis she underwent craniotomy. Pathologic examination documented two different lesions: viable and dead cysticerci with inflaming infiltration and a left anterior clinoidal meningioma. At the second surgery, six weeks later via transnasal transsphenoidal approach a silent corticotroph pituitary adenoma was removed which was studied by histology, immunohistochemistry, and electron microscopy. To our knowledge, the occurrence of these three different lesions in the sellar area was not described before.
Collapse
|
83
|
Schwannoma intraselar: un caso excepcional de incidentaloma hipofisario. ACTA ACUST UNITED AC 2012; 59:336-8. [PMID: 22227172 DOI: 10.1016/j.endonu.2011.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 10/05/2011] [Accepted: 10/17/2011] [Indexed: 11/30/2022]
|
84
|
Sahli R, Christ E, Kuhlen D, Giger O, Vajtai I. Sellar collision tumor involving pituitary gonadotroph adenoma and chondroma: a potential clinical diagnosis. Pituitary 2011; 14:405-8. [PMID: 19760170 DOI: 10.1007/s11102-009-0199-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
Abstract
We report on a 74-year-old male patient who presented with progressive neuroophthalmologic symptoms soon after the administration of a long-acting gonadotropin-releasing hormone agonist for treatment of a prostate cancer. Imaging revealed a destructively growing and extensively calcified sellar mass inconsistent with a pituitary adenoma. A transseptal transsphenoidal tumor mass reduction yielded a histological diagnosis of a collision tumor comprised of a gonadotroph adenoma intermingled with osteochondroma. We discuss a potential causal relationship between the administration of the long-acting gonadotropin-releasing hormone agonist and the sudden appearance of the previously unsuspected sellar lesion. Although the association of these two tumors is very likely coincidental, the possibility of causal relationship is addressed.
Collapse
Affiliation(s)
- Rahel Sahli
- Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital and University of Bern, Bern, Switzerland.
| | | | | | | | | |
Collapse
|
85
|
The coexistence of an intrasellar adenoma, lymphocytic hypophysitis, and primary pituitary lymphoma in a patient with acromegaly. Case Rep Endocrinol 2011; 2011:941738. [PMID: 22937293 PMCID: PMC3420670 DOI: 10.1155/2011/941738] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 08/07/2011] [Indexed: 11/18/2022] Open
Abstract
The concomitant presence of three histopathologically different entities in the pituitary gland is a rare occurrence. Most publications identify at least two distinct pathologies, mainly, a pituitary adenoma coexisting with a second intrasellar lesion. We present a case of a 71-year-old female referred for evaluation and treatment of acromegaly. Questioning revealed she was experiencing facial palsy, visual disturbances, and syncopal spells for several weeks. When laboratory evaluation showed elevated somatomedin (IGF-I) levels and an oral glucose tolerance test failed to demonstrate any suppression of her growth hormone (GH) values, an MRI of the pituitary revealed a sellar mass. A presumptive diagnosis of pituitary adenoma was established. The patient underwent transsphenoidal resection of the sellar mass, which proved to be a large B-cell lymphoma (Stage I-E) associated with areas of adenoma and lymphocytic hypophysitis.
Collapse
|
86
|
Abstract
Our aim is to describe a case of acromegaly that was associated with symptomatic Rathke's cyst. We describe a young male student without any significant family history who presented with clinical and biochemical features consistent with growth hormone excess, which was confirmed with dynamic testing. He also described a persistent headache predating symptoms of growth hormone excess by 4 years. Magnetic resonance imaging (MRI) of the pituitary showed a large sellar mass which was thought to be a somatotroph adenoma. Trans-sphenoidal surgery was performed; however, a colloid lesion was identified by the neurosurgeon that proved to be a Rathke's cyst. The association of acromegaly with Rathke's cyst is very rare, with less than 10 cases found to be reported on review of literature. This is the first report from India.
Collapse
Affiliation(s)
- Vishal Gupta
- Department of Endocrinology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashley Grossman
- Department of Medicine and Endocrinology, Bart and The London NHS Trust, London
| | - Aneesa Kapadia
- Department of Medicine and Endocrinology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Kiran Thorat
- Department of Histopathology, Saifee Hospital, Mumbai, India
| |
Collapse
|
87
|
Gangliocitoma hipofisario no funcionante. ACTA ACUST UNITED AC 2011; 58:52-3. [DOI: 10.1016/j.endonu.2010.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 08/26/2010] [Accepted: 09/01/2010] [Indexed: 11/18/2022]
|
88
|
Yunoue S, Arita K, Kawano H, Uchida H, Tokimura H, Hirano H. Identification of CD133+ cells in pituitary adenomas. Neuroendocrinology 2011; 94:302-12. [PMID: 21912092 DOI: 10.1159/000330625] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 06/25/2011] [Indexed: 11/19/2022]
Abstract
Stem-like cells in tumors are capable of self-renewal and pluri-differentiation; they are thought to play important roles in tumor initiation and maintenance. Stem-like cells in malignant glioma express CD133. We examined samples from human pituitary adenoma, a generally benign neoplasm, for CD133 expression using routine immunohistochemical and biochemical methods. Our study of 70 pituitary adenomas (clinically nonfunctioning adenomas and growth hormone-, prolactin-, adrenocorticotropic hormone-, and thyroid-stimulating hormone-producing adenomas) showed that 18 (25.7%) expressed CD133. This rate was higher in clinically nonfunctioning (33.3%) than functioning adenomas (12.0%) (p = 0.085). Real-time PCR assay revealed the expression of CD133 mRNA in samples immunohistochemically positive for CD133. Neither the patient age and gender, nor the tumor size or postoperative recurrence rate correlated with CD133 positivity. CD133+ cells ubiquitously coexpressed CD34, nestin, and VEGFR2 (KDL1). S-100 and GFAP were not coexpressed with CD133. Chromogranin A, Pit-1, SF-1, and NeuroD1 were immune-negative, indicating that CD133+ cells did not have the potential to differentiate into functional endocrine cells. Our data suggest that the expression of CD133 in pituitary adenomas is related to immature endothelial progenitor cells that may play a role in the neovascularization of pituitary adenomas. Further studies are needed to elucidate the significance of CD133+ cells with respect to neovascularization and their sustainable growth in pituitary adenomas.
Collapse
Affiliation(s)
- Shunji Yunoue
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | | | | | | | | | | |
Collapse
|