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Kleinschmidt-DeMasters BK. Mixed pituitary adenoma/pituitary neuroendocrine tumor-gangliocytoma: Immunohistochemical insights. J Neuropathol Exp Neurol 2024; 83:708-721. [PMID: 38917431 DOI: 10.1093/jnen/nlae050] [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] [Indexed: 06/27/2024] Open
Abstract
Mixed pituitary adenoma/PitNET-gangliocytomas (PA/PitNET-GC) have been reported in small series over the past 20 years; some had limited immunohistochemistry (IHC) data. We interrogated our experience over 20 years, focusing on patterns of the GC component and IHC results for anterior pituitary hormones, transcription factors, NFP, and CAM5.2. A search of cases from 2002 to 2023 yielded 20 cases: 7M:13F, ages 20-71 years; 17 macroadenomas, 1 microadenoma, 2 ectopic. GC was co-associated with 4 corticotroph, 2 densely granulated lactotroph, 5 mixed lactotroph-somatotroph, 1 immature PIT1-lineage tumor, and 8 sparsely granulated GH; the latter all had a minor lactotroph component. Patterns were: discrete nodular foci of GC (9/20), extensive GC differentiation often overshadowing the PA/PitNET (7/20), and intimate admixture of smaller bands of neuropil and individual metaplastic ganglion cells within PA/PitNET (4/20). NFP highlighted small cohesive regions of neuropil and identified greater axonal content, including individual axons within "pure" PA/PitNET areas, than appreciated on H&E. CAM5.2 IHC often revealed cells with neuronal morphologies to a greater extent than NFP and in different areas within the same tumor. These data suggest that the combined use of NFP and CAM5.2 IHC best reveals transition from PA to GC phenotype, with CAM5.2 positivity reflecting earlier stages of transformation.
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Affiliation(s)
- Bette K Kleinschmidt-DeMasters
- Departments of Pathology, Neurology, Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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2
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Zou D, Jiang L, Yang T, Cheng J, Ma Y. IgG4-associated hypophysitis coexisting with MALT lymphoma and gangliocytoma: first case report and literature review. Front Neurol 2023; 14:1253821. [PMID: 38020670 PMCID: PMC10666160 DOI: 10.3389/fneur.2023.1253821] [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: 07/06/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
IgG4-related or IgG4-associated hypophysitis is a rare disease characterized by the infiltration of IgG4-positive plasma cells into pituitary gland tissue. Gangliocytomas in the sellar region are also extremely rare and are associated with pituitary adenomas in the majority of cases. Sellar mucosa-associated lymphoid tissue (MALT) lymphoma is an exceedingly rare condition. In this study, we present a case of IgG4-associated hypophysitis coexisting with MALT lymphoma and gangliocytoma. However, to elucidate the potential pathophysiological relationship, it is imperative to gather additional cases of IgG4-related hypophysitis accompanied by MALT lymphoma and gangliocytoma.
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Affiliation(s)
- Dongbo Zou
- Department of Neurosurgery, General Hospital of Western Theater Command, Chengdu, China
| | - Li Jiang
- Department of Rheumatology and Immunology, The Second People's Hospital of Chengdu, Chengdu, China
| | - Tao Yang
- Department of Neurosurgery, General Hospital of Western Theater Command, Chengdu, China
| | - Jingmin Cheng
- Department of Neurosurgery, General Hospital of Western Theater Command, Chengdu, China
| | - Yuan Ma
- Department of Neurosurgery, General Hospital of Western Theater Command, Chengdu, China
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3
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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.
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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,
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4
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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.
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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
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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.
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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
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Zheng L, Yan X, Hu C, Zhang P, Chen Y, Zheng Q, Hu L, Wang M, Li G, Wu P, Jiang C, Tian J, Zhang S, Wang X. Observation of Clinicopathologic Features of Pituitary Adenoma With Neuronal Differentiation. Front Endocrinol (Lausanne) 2022; 13:848762. [PMID: 35370935 PMCID: PMC8965364 DOI: 10.3389/fendo.2022.848762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the clinicopathologic features of pituitary adenoma with neuronal differentiation. METHODS Four patients with mixed gangliocytoma-pituitary adenomas between January 2011 and January 2021 and 111 new-onset patients with adenomas between January 2019 and June 2021 who attended the First Affiliated Hospital of Fujian Medical University were included in the study. The histological and immunohistochemical findings were analyzed. Neuronal differentiation marker staining was performed on new-onset adenomas, and the related literature was reviewed. RESULTS Altogether, more than 100 mixed gangliocytoma-pituitary adenoma cases have been reported in the literature until now, of which pituitary-specific POU-class homeodomain transcription 1 (PIT1) positive adenomas are more frequently observed. In the present study, all 4 patients we described were female, aged 29 to 53 years (mean 39 years). Clinically, 3/4 patients presented with acromegaly, and 1/2 patients presented with headache. Histologically, the tumor was composed of two distinct mixed components. The one was a population of neoplastic ganglionic cells with large nuclei, prominent nucleoli, and abundant basophilic cytoplasm embedded in a fibrillary background. Stains of chromograninA (CgA), synaptophysin (Syn), Calretinin (CR) were positive. Axotomy-like expression was observed in neurofilament (NF) staining. PIT1 was expressed in partial ganglionic cells in all cases. The other component was a population of small uniform cells with round nuclei and acidophilic cytoplasm. Prolactin (PRL) and growth hormone (GH) were positive in all 4 cases. PIT1 was positive in the nuclei of adenomas. Although adenomas and ganglionic regions varied in histology, there was a population of cells with neuronal differentiation expressing PIT1. Additionally, axotomy-like expression of NF staining could be seen in a distant area of adenoma regions. A total of 111 cases of adenomas without ganglionic cells were included in this study, including 7 cases with neuronal differentiation. Among them, 4 cases were prolactinomas, 2 cases were somatotroph adenomas, and 1 case was corticotroph adenoma. 6/7 cases were PIT1-positive adenomas. And the remaining one case is T-PIT-positive adenoma. CONCLUSIONS Mixed gangliocytoma-pituitary adenomas are rare tumors with neuronal differentiation. The majority of MGAs are associated with endocrinopathies, mainly acromegaly. Our results suggest that PIT1-positive pituitary adenomas may have neural differentiation potential, which may not be unusual. This indication supports the possibility that the neuronal transdifferentiation of adenomatous cells is a possible mechanism, and the underlying mechanism requires further elucidation.
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Affiliation(s)
- Limei Zheng
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaorong Yan
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chengcong Hu
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Peng Zhang
- Department of Cardiovascular Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yupeng Chen
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qiaoyan Zheng
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Liwen Hu
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Mi Wang
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guoping Li
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ping Wu
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Changzhen Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jing Tian
- Department of Immunology and Microbiology, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sheng Zhang
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xingfu Wang
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- *Correspondence: Xingfu Wang,
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Zendran I, Gut G, Kałużny M, Zawadzka K, Bolanowski M. Acromegaly Caused by Ectopic Growth Hormone Releasing Hormone Secretion: A Review. Front Endocrinol (Lausanne) 2022; 13:867965. [PMID: 35757397 PMCID: PMC9218487 DOI: 10.3389/fendo.2022.867965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Ectopic acromegaly is a rare condition caused most frequently by growth hormone releasing hormone (GHRH) secretion from neuroendocrine tumors. The diagnosis is often difficult to establish as its main symptoms do not differ from those of acromegaly of pituitary origin. OBJECTIVES To determine most common clinical features and diagnostic challenges in ectopic acromegaly. PATIENTS AND METHODS A search for ectopic acromegaly cases available in literature was performed using PubMed, Cochrane, and MEDline database. In this article, 127 cases of ectopic acromegaly described after GHRH isolation in 1982 are comprehensively reviewed, along with a summary of current state of knowledge on its clinical features, diagnostic methods, and treatment modalities. The most important data were compiled and compared in the tables. RESULTS Neuroendocrine tumors were confirmed in 119 out of 121 patients with histopathological evaluation, mostly of lung and pancreatic origin. Clinical manifestation comprise symptoms associated with pituitary hyperplasia, such as headache or visual field disturbances, as well as typical signs of acromegaly. Other endocrinopathies may also be present depending on the tumor type. Definitive diagnosis of ectopic acromegaly requires confirmation of GHRH secretion from a tumor using either histopathological methods or GHRH plasma concentration assessment. Hormonal evaluation was available for 84 patients (66%) and histopathological confirmation for 99 cases (78%). Complete tumor resection was the main treatment method for most patients as it is a treatment of choice due to its highest effectiveness. When not feasible, somatostatin receptor ligands (SRL) therapy is the preferred treatment option. Prognosis is relatively favorable for neuroendocrine GHRH-secreting tumors with high survival rate. CONCLUSION Although ectopic acromegaly remains a rare disease, one should be aware of it as a possible differential diagnosis in patients presenting with additional symptoms or those not responding to classic treatment of acromegaly.
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Affiliation(s)
- Iga Zendran
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Gabriela Gut
- Department of Endocrinology, Diabetes and Isotope Therapy, Students research association, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Kałużny
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
- *Correspondence: Marcin Kałużny,
| | - Katarzyna Zawadzka
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
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Ryder S, Robusto J, Robertson T, Alexander H, Duncan EL. Unilateral hydrocephalus from a gangliocytoma-somatotrophinoma: first reported case. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM210037. [PMID: 34236040 PMCID: PMC8284954 DOI: 10.1530/edm-21-0037] [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: 04/28/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Although pituitary macroadenomas often cause mass effects on surrounding structures, it is extremely rare for pituitary lesions to disturb cerebrospinal fluid circulation. Sellar gangliocytoma-pituitary adenomas (SGPAs) are also extremely rare. Here we report the unique case of a man with the unusual combination of acromegaly from an SGPA, who presented with unilateral hydrocephalus. A 60-year-old man presented with rapid neurological deterioration, bitemporal hemianopia, and acromegalic features. Neuroimaging revealed a large sellar lesion extending superiorly into the left foramen of Monro, causing acute obstructive unilateral hydrocephalus. External ventricular drain placement improved consciousness immediately. Biochemical assessment confirmed acromegaly. Following trans-sphenoidal debulking, histology revealed a mixed gangliocytoma/sparsely-granulated somatotrophinoma. Despite the residual disease, his vision recovered remarkably, low-dose cabergoline controlled residual excess growth hormone (GH) secretion, and the residual tumour has remained extremely stable over 2 years. Hydrocephalus is an extremely rare complication of pituitary lesions, and unilateral hydrocephalus has never been reported previously. GH secretion in SGPAs is more common than for pituitary adenomas in general, raising questions regarding the aetiology and therapeutic approach to this rare combination tumour. LEARNING POINTS Pituitary tumours most commonly present with symptoms related to endocrine disturbance or mass effects upon visual pathways (e.g. optic chiasm, nerves in the lateral cavernous sinus). However, extremely rarely, pituitary masses may disrupt cerebrospinal fluid (CSF) circulation resulting in hydrocephalus. Sellar gangliocytomas are very rare tumours and most of them are hybrid tumours with pituitary adenomas (SGPAs). SGPAs are typically indolent and may be functioning or non-functioning tumours. Growth hormone (GH)-producing SGPAs are less likely to respond to somatostatin agonists than classic somatotrophinomas. Primary surgical debulking via a trans-sphenoidal approach was effective in this individual, leading to the restoration of CSF circulation and improvement in visual disturbance, while also negating the need for permanent CSF diversion despite the residual tumour burden.
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Affiliation(s)
- Simon Ryder
- Department of Endocrinology and Diabetes, Faculty of Medicine, Royal Brisbane and Women’s Hospital, University of Queensland, Queensland, Australia
| | - Jed Robusto
- Kenneth J Jamison Neurosurgery Department, Royal Brisbane and Woman’s Hospital, Queensland, Australia
| | - Thomas Robertson
- Pathology Queensland, Faculty of Medicine, Royal Brisbane and Women’s Hospital, University of Queensland, Queensland, Australia
| | - Hamish Alexander
- Kenneth J Jamison Neurosurgery Department, Faculty of Medicine, Royal Brisbane and Woman’s Hospital, University of Queensland, Queensland, Australia
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Faculty of Health and Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, University of Queensland, Queensland, Australia
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Soukup J, Cesak T, Hornychova H, Manethova M, Michnova L, Netuka D, Vitovcova B, Cap J, Ryska A, Gabalec F. Cytokeratin 8/18-negative somatotroph pituitary neuroendocrine tumours (PitNETs, adenomas) show variable morphological features and do not represent a clinicopathologically distinct entity. Histopathology 2021; 79:406-415. [PMID: 33738859 DOI: 10.1111/his.14366] [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: 02/08/2021] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
AIMS In somatotroph pituitary neuroendocrine tumours (adenomas), a pattern of cytokeratin (CK) 18 expression is used for tumour subclassification, with possible clinical implications. Rare somatotroph tumours do not express CK 18. We aimed to characterise this subset clinically and histologically. METHODS AND RESULTS Clinical and pathological data for the study were derived from a previously published data set of a cohort of 110 patients with acromegaly. Data included serum levels of insulin-like growth factor 1 (IGF1), growth hormone (GH), prolactin and thyroid-stimulating hormone (TSH), tumour diameter, tumour invasion defined by Knosp grade and immunohistochemical data concerning the expression of Ki67, p53, E-cadherin, somatostatin receptor (SSTR)1, SSTR2A, SSTR3, SSTR5 and D2 dopamine receptor. Additional immunohistochemical analysis (AE1/3, CK 8/18, vimentin, neurofilament light chain, internexin-α) was performed. CK 18 was negative in 10 of 110 (9.1%) tumours. One of these tumours was immunoreactive with CK 8/18 antibody, while the remainder expressed only internexin-α intermediate filament in patterns similar to CK 18 (perinuclear fibrous bodies). CK-negative tumours showed no significant differences with respect to biochemical, radiological or pathological features. They showed significantly higher expression of SSTR2A compared to the sparsely granulated subtype and significantly lower expression of E-cadherin compared to the non-sparsely granulated subtypes of tumours. The tumours showed divergent morphology and hormonal expression: two corresponded to densely granulated tumours and three showed co-expression of prolactin and morphology of either mammosomatotroph or somatotroph-lactotroph tumours. Four tumours showed morphology and immunoprofile compatible with plurihormonal Pit1-positive tumours. CONCLUSIONS CK-negative somatotroph tumours do not represent a distinct subtype of somatotroph tumours, and can be further subdivided according to their morphology and immunoprofile.
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Affiliation(s)
- Jiri Soukup
- The Fingerland Department of Pathology, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Tomas Cesak
- Department of Neurosurgery, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Helena Hornychova
- The Fingerland Department of Pathology, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Monika Manethova
- The Fingerland Department of Pathology, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Ludmila Michnova
- Department of Pathology, Military University Hospital Prague, Praha, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, 1st Medical Faculty, Charles University, Military University Hospital Prague, Prague, Czech Republic
| | - Barbora Vitovcova
- Department of Medical Biology and Genetics, Faculty of Medicine Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Jan Cap
- 4th Department of Internal Medicine, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Ales Ryska
- The Fingerland Department of Pathology, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Filip Gabalec
- 4th Department of Internal Medicine, Faculty of Medicine Hradec Kralove, University Hospital, Charles University, Hradec Kralove, Czech Republic
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10
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Wiesnagrotzki N, Bernreuther C, Saeger W, Flitsch J, Glatzel M, Hagel C. Co-expression of intermediate filaments glial fibrillary acidic protein and cytokeratin in pituitary adenoma. Pituitary 2021; 24:62-67. [PMID: 33001343 PMCID: PMC7864846 DOI: 10.1007/s11102-020-01087-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE To analyze the co-expression of the intermediate filaments GFAP and cytokeratin in 326 pituitary adenomas with regard to the distribution pattern, the subtype of the adenoma and clinical prognostic data. METHODS Tissue from 326 pituitary adenomas and 13 normal anterior pituitaries collected in the Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, between 2006 and 2009 was investigated by immunohistochemistry, immunofluorescence and electron microscopy. RESULTS Co-expression of intermediate filaments GFAP and cytokeratin was associated with hormone expression in 62/278 cases (22%), but only found in 2/48 (4%) of null cell adenomas (p < 0.01). Simultaneous co-expression of GFAP and cytokeratin in the same cells was demonstrated in 26 out of 326 pituitary adenomas and in all 13 pituitaries. In pituitary intermediate filaments were demonstrated in a larger area of the cytoplasm than in adenoma (p < 0.01), however, overlapping expression was seen in 2.6% of the total area in both, pituitary and adenoma. Congenially, cells with overlapping expression were found near vessels and in follicles. Furthermore, adenomas with cellular co-expression of GFAP and cytokeratin were associated with a lower recurrence rate (7.7%) compared to adenomas without co-expression of intermediate filaments (17.8%). CONCLUSIONS Cellular co-expression of the intermediate filaments GFAP and cytokeratin in pituitary adenomas and the pituitary was demonstrated and shown to be associated with hormone expression and low recurrence rate. The results are discussed with regard to the biology of folliculostellate cells, neural transformation and tumor stem cells. This study may complement the understanding of pituitary adenoma biology.
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Affiliation(s)
- Nina Wiesnagrotzki
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Wolfgang Saeger
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jörg Flitsch
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Sakata K, Fujimori K, Komaki S, Furuta T, Sugita Y, Ashida K, Nomura M, Morioka M. Pituitary Gangliocytoma Producing TSH and TRH: A Review of "Gangliocytomas of the Sellar Region". J Clin Endocrinol Metab 2020; 105:5876003. [PMID: 32706866 PMCID: PMC7451506 DOI: 10.1210/clinem/dgaa474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Pituitary gangliocytomas (GCs) are rare neuronal tumors that present with endocrinological disorders, such as acromegaly, amenorrhea-galactorrhea syndrome, and Cushing's disease. Most pituitary GCs coexist with pituitary adenomas pathologically and are diagnosed as mixed gangliocytoma-adenomas. Herein, we report a case of 45-year-old man who presented with the syndrome of inappropriate secretion of thyroid-stimulating hormone (SITSH) and discuss the pathogenesis of pituitary GCs. METHODS Pituitary magnetic resonance imaging showed an 8-mm homogeneous and poorly enhanced mass inside the pituitary gland. Endoscopic transsphenoidal surgery was performed under a preoperative diagnosis of thyrotroph adenoma. However, the tumor was finally diagnosed as gangliocytoma without an adenomatous component. The tumor was further analyzed via immunohistochemistry and electron microscopy. Additionally, we searched MEDLINE and PubMed for previously published cases of isolated pituitary GCs and analyzed the reported clinicopathological findings. RESULTS The patient showed complete clinical and endocrinological recovery after an operation. The tumor was positive for thyrotropin (TSH), TSH-releasing hormone (TRH), Pit-1, GATA-2, and most neuronal markers. Electron microscopy demonstrated the presence of intracytoplasmic secretory granules and neuronal processes. Co-secreting hypothalamic and pituitary hormone inside the tumor indicated autocrine/paracrine endocrinological stimulation. CONCLUSION Herein, we report a case of SITSH caused by an isolated pituitary gangliocytoma, expressing both TSH and TRH, which, to our best knowledge, is the first reported case of such a condition. The multidirectional differentiation and multihormonal endocrine characteristics of these tumors indicate that they are a member of neuroendocrine neoplasms, further supporting that they are derived from neural crest cells.
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Affiliation(s)
- Kiyohiko Sakata
- Department of Neurosurgery, Kurume University, School of Medicine, Fukuoka, Japan
- Correspondence and Reprint Requests: Kiyohiko Sakata, MD, Department of Neurosurgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan. E-mail: .
| | - Kana Fujimori
- Department of Neurosurgery, Kurume University, School of Medicine, Fukuoka, Japan
| | - Satoru Komaki
- Department of Neurosurgery, Kurume University, School of Medicine, Fukuoka, Japan
| | - Takuya Furuta
- Department of Pathology, Kurume University, School of Medicine, Fukuoka, Japan
| | - Yasuo Sugita
- Department of Neuropathology, Neurology Center, St. Mary’s Hospital, Fukuoka, Japan
| | - Kenji Ashida
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Masatoshi Nomura
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University, School of Medicine, Fukuoka, Japan
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Neuronal Differentiation in a Pituitary Macroadenoma with Focal Small Blue Round Cell Morphology: Report of a Rare Pattern. Case Rep Pathol 2020; 2020:6450930. [PMID: 32455041 PMCID: PMC7232727 DOI: 10.1155/2020/6450930] [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: 01/06/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/17/2022] Open
Abstract
Ganglion cell-containing pituitary adenomas that are neurofilament protein-positive are the exceedingly rare form of pituitary ganliocytomas. We report a case of a 23-year-old male patient who presented with a clinical picture of acromegaly in addition to raised prolactin level. Histopathology showed areas exhibiting pseudopapillary and solid proliferation of round and monotonous blue cells. The immunohistochemistry showed strong reactivity for synaptophysin and growth hormone and focal reactivity to prolactin. Fibrous bodies are confirmed using cytokeratin immunostain, in keeping with sparsely granulated somatotroph component. The patient remained free of recurrence after one year of radiological follow-up.
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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.
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Teramoto S, Tange Y, Ishii H, Goto H, Ogino I, Arai H. Mixed gangliocytoma-pituitary adenoma containing GH and GHRH co-secreting adenoma cells. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190099. [PMID: 31581122 PMCID: PMC6790896 DOI: 10.1530/edm-19-0099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 11/23/2022] Open
Abstract
SUMMARY A 67-year-old woman with a past history of type 2 diabetes mellitus presented with worsening glycemic control. She had some acromegaly symptoms and magnetic resonance imaging demonstrated a pituitary tumor. Endocrinological examination found the resting growth hormone (GH) level within the normal range, but elevated insulin-like growth factor 1 level. A 75 g oral glucose tolerance test showed inadequate suppression of nadir GH levels. Acromegaly due to GH-secreting pituitary tumor was diagnosed. The patient underwent endoscopic transsphenoidal surgery resulting in gross total removal of the tumor and recovered well postoperatively. Histological examination of the tumor showed coexistence of relatively large gangliocytoma cells and pituitary adenoma cells, suggesting mixed gangliocytoma-pituitary adenoma. In addition, colocalization of GH and GH-releasing hormone (GHRH) in pituitary adenoma cells was revealed, so the adenomatous components were more likely to produce GHRH in our mixed gangliocytoma-pituitary adenoma case. Mixed gangliocytoma-pituitary adenoma is very rare, and the present unique case demonstrated only the adenomatous components associated with GHRH production. LEARNING POINTS Sellar gangliocytoma coexisting with pituitary adenoma is recognized as a mixed gangliocytoma-pituitary adenoma and is very rare. A proposed developmental mechanism of growth hormone (GH)-secreting mixed gangliocytoma-pituitary adenoma involves GH-releasing hormone (GHRH) produced by the gangliocytic components promoting the growth of tumor including GH-secreting adenomatous components. Since our present case indicated that the adenomatous components of mixed gangliocytoma-pituitary adenoma could secrete both GH and GHRH simultaneously, progression of GH-secreting mixed gangliocytoma and pituitary adenoma may involve exposure to spontaneously produced GHRH due to the adenomatous components.
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Affiliation(s)
- Shinichiro Teramoto
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuichi Tange
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hisato Ishii
- Department of Neurosurgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hiromasa Goto
- Department of Metabolism and Endocrinology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ikuko Ogino
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
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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.
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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.
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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.
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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
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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.
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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
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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]
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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.
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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.
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Lee MH, McKelvie P, Krishnamurthy B, Wang YY, Caputo C. An intrasellar pituitary adenoma-gangliocytoma presenting as acromegaly. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170035. [PMID: 28469929 PMCID: PMC5409941 DOI: 10.1530/edm-17-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 11/19/2022] Open
Abstract
Most cases of acromegaly are due to growth hormone (GH)-secreting pituitary adenomas arising from somatotroph cells. Mixed pituitary adenoma and gangliocytoma tumours are rare and typically associated with hormonal hypersecretion, most commonly GH excess. Differentiating these mixed tumours from conventional pituitary adenomas can be difficult pre-operatively, and careful histological analysis after surgical resection is key to differentiating the two entities. There is little literature addressing the possible mechanisms for the development of mixed pituitary adenoma–gangliocytomas; however, several hypotheses have been proposed. It still remains unclear if these mixed tumours differ from a clinical perspective to pituitary adenomas; however, the additional neural component of the gangliocytoma does not appear to modify the aggressiveness or risk of recurrence after surgical resection. We report a unique case of acromegaly secondary to a mixed GH-secreting pituitary adenoma, co-existing with an intrasellar gangliocytoma.
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Affiliation(s)
| | - Penelope McKelvie
- Departments of Anatomical Pathology, St Vincent's Hospital Melbourne, VictoriaAustralia
| | | | - Yi Yuen Wang
- Department of Neurosurgery and Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, VictoriaAustralia
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Steenblock C, Rubin de Celis MF, Androutsellis-Theotokis A, Sue M, Delgadillo Silva LF, Eisenhofer G, Andoniadou CL, Bornstein SR. Adrenal cortical and chromaffin stem cells: Is there a common progeny related to stress adaptation? Mol Cell Endocrinol 2017; 441:156-163. [PMID: 27637345 DOI: 10.1016/j.mce.2016.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 12/14/2022]
Abstract
The adrenal gland is a highly plastic organ with the capacity to adapt the body homeostasis to different physiological needs. The existence of stem-like cells in the adrenal cortex has been revealed in many studies. Recently, we identified and characterized in mice a pool of glia-like multipotent Nestin-expressing progenitor cells, which contributes to the plasticity of the adrenal medulla. In addition, we found that these Nestin progenitors are actively involved in the stress response by giving rise to chromaffin cells. Interestingly, we also observed a Nestin-GFP-positive cell population located under the adrenal capsule and scattered through the cortex. In this article, we discuss the possibility of a common progenitor giving rise to subpopulations of cells both in the adrenal cortex and medulla, the isolation and characterization of this progenitor as well as its clinical potential in transplantation therapies and in pathophysiology.
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Affiliation(s)
- Charlotte Steenblock
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany.
| | | | - Andreas Androutsellis-Theotokis
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany; Stem Cells, Tissue Engineering and Modelling (STEM), Division of Cancer and Stem Cells, University of Nottingham, Nottingham, UK
| | - Mariko Sue
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | | | - Graeme Eisenhofer
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Cynthia L Andoniadou
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany; Department of Craniofacial Development and Stem Cell Biology, King's College London, London, UK
| | - Stefan R Bornstein
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany; Department of Endocrinology and Diabetes, King's College London, London, UK
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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.
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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
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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]
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Yano S, Hide T, Uekawa K, Honda Y, Mikami Y, Kuratsu JI. Mixed Pituitary Gangliocytoma and Prolactinoma Resistant to the Cabergoline Treatment. World Neurosurg 2016; 95:620.e17-620.e22. [PMID: 27535625 DOI: 10.1016/j.wneu.2016.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND A gangliocytoma rarely coexists with a pituitary adenoma in a sellar lesion. Herein, we describe our experience in treating a mixed gangliocytoma and prolactinoma of the pituitary gland. CASE DESCRIPTION A 16-year-old male presented with severe headache and vomiting. Magnetic resonance imaging showed a large pituitary tumor with hydrocephalus. Because of the increased levels of serum prolactin (PRL), we treated the patient with cabergoline, which decreased the tumor size and improved the hydrocephalus. Six months after the treatment, the tumor began to increase in size, despite the normalization of the PRL level with cabergoline treatment. An endoscopic transsphenoidal resection was performed and the tumor was mostly removed. Microscopic examination of the resected tumor showed a mixture of prototypical pituitary adenoma cells and the proliferation of mature ganglion cells. Immunohistochemistry showed that the ganglion cells were positively stained for synaptophysin, NeuN, and PRL as shown in the adenomatous component. A few cells were immunostained with both PRL and NeuN, and a few cells were immunopositive for nestin, but not PRL or synaptophysin. CONCLUSIONS Our findings showed the existence of cells that are phenotypically intermediate between ganglion cells and adenoma cells, and the existence of stem cell-like cells, which support the hypothesis that adenoma cells can transform into ganglion cells or that both ganglion and adenoma cells derive from common stem cells. Furthermore, the ganglion cells seemed to grow rapidly and independently of dopamine, which is in contrast to prototypical prolactinoma cells.
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Affiliation(s)
- Shigetoshi Yano
- Department of Neurosurgery, Faculty of Life Sciences Research, Kumamoto University Graduate School, Chuo-ku, Kumamoto, Japan.
| | - Takuichiro Hide
- Department of Neurosurgery, Faculty of Life Sciences Research, Kumamoto University Graduate School, Chuo-ku, Kumamoto, Japan
| | - Ken Uekawa
- Brain & Mind Research Institute, Weill Cornell Medical College, New York, New York, USA
| | - Yumi Honda
- Department of Diagnostic Pathology, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
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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.
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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
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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".
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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
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29
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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.
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Affiliation(s)
- Marie-Eve Domingue
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 54.74, 1200, Brussels, Belgium
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Schult D, Hölsken A, Buchfelder M, Schlaffer SM, Siegel S, Kreitschmann-Andermahr I, Fahlbusch R, Buslei R. Expression pattern of neuronal intermediate filament α-internexin in anterior pituitary gland and related tumors. Pituitary 2015; 18:465-73. [PMID: 25236435 DOI: 10.1007/s11102-014-0597-2] [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: 12/11/2022]
Abstract
PURPOSE α-Internexin (INA) is a class IV neuronal intermediate filament protein that maintains the morphogenesis of neurons. It is expressed in developing neuroblasts and represents the major component of the cytoskeleton in cerebellar granule cells of adult central nervous system tissue. Data concerning INA expression in the human frontal pituitary lobe and related adenomas (PA) is missing. METHODS Using immunohistochemistry we examined the distribution pattern of INA in a large cohort of 152 PA, 11 atypical PA, 4 pituitary carcinomas and 20 normal pituitaries (overall n = 187). Quantity of INA protein expression was semi-quantitatively evaluated and grouped into five categories (0 = 0%; 1 = >0-5%; 2 = >5-35%; 3 = >35-80%; 4 = >80% of cells). RESULTS Cellular staining intensity of INA appeared significantly higher in gonadotropinomas (Go, n = 62), null cell adenomas (NC, n = 7) and thyrotropinomas (TSHomas, n = 7) compared to the other tumor subtypes (p ≤ 0.001). Furthermore, Go and NC showed a peculiar pseudorosette-like staining pattern surrounding blood vessels in 85.5% (59/69) of cases. Interestingly, areas exhibiting homogenous INA staining were often associated with oncocytic cell changes and decreased immunohistochemically detectable hormone expression. Only 8.5% (8/94) of other PA showed a comparable INA distribution (p ≤ 0.001). CONCLUSION Go, NC as well as TSHomas exhibit high levels of intracellular INA protein indicating neuronal transdifferentiation. A possible impact on pathogenesis and endocrine activity needs further investigation.
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Affiliation(s)
- D Schult
- Department of Neuropathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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31
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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.
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Affiliation(s)
- Serdar Balci
- Patoloji Anabilim Dalı, Hacettepe Üniversitesi Tıp Fakültesi, Morfoloji Binası 5.Kat. Sıhhiye, 06100, Ankara, Turkey
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32
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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]
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33
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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
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34
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Lahoria R, Spinner RJ, Karam CY, Amrami KK, Dyck PJB, Folpe AL. Ganglion cell choristoma of the deep branch of the radial nerve: report of a singular case. J Clin Pathol 2013; 66:998-1000. [PMID: 23723303 DOI: 10.1136/jclinpath-2013-201685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rajat Lahoria
- Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, , Rochester, Minnesota, USA
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35
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Romero L, Arcos A, Bautista MD, Domínguez M, Medina JM, Arráez MA. Gangliocitoma selar asociado a adenoma hipofisario productor de hormona de crecimiento. Caso clínico. Neurocirugia (Astur) 2012; 23:264-9. [DOI: 10.1016/j.neucir.2012.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 05/28/2012] [Accepted: 05/29/2012] [Indexed: 10/27/2022]
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Wirmer A, Bradler S, Heinrich R. Homology of insect corpora allata and vertebrate adenohypophysis? ARTHROPOD STRUCTURE & DEVELOPMENT 2012; 41:409-417. [PMID: 22595331 DOI: 10.1016/j.asd.2012.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 04/25/2012] [Accepted: 04/25/2012] [Indexed: 05/31/2023]
Abstract
Animal species of various phyla possess neuroendocrine glands whose hormonal products regulate developmental and physiological mechanisms and directly impact behavior. Two examples, the corpora allata of insects and the vertebrate adenohypophysis have previously been regarded as analogous tissues that evolved independently from diffuse epidermal nerve nets of early metazoans. More recent developmental and functional studies accumulated evidence suggesting that the bilaterian nervous systems including its modern parts (e.g. pallium or cortex and mushroom bodies) and its neuroendocrine appendages (that are considered to be more ancient structures) possess a single evolutionary origin. The corpora allata of insects and the vertebrate adenohypophysis share a number of characteristics in respect of morphology, control of hormone release by RFamides, metabolites produced by closely related cytochrome P450 enzymes and gene expression during embryonic development. This review incorporates latest findings into an extensive description of similarities between insect corpora allata and vertebrate adenohypophysis that should encourage further studies about the onto- and phylogenetic origin of these neuroendocrine glands.
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Affiliation(s)
- Andrea Wirmer
- Institute for Neurobiology, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany.
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37
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Expanded endonasal endoscopic approach for resection of a growth hormone-secreting pituitary macroadenoma coexistent with a cavernous carotid artery aneurysm. J Clin Neurosci 2012; 19:1437-41. [PMID: 22836036 DOI: 10.1016/j.jocn.2011.11.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 11/16/2011] [Indexed: 11/23/2022]
Abstract
The co-existence of pituitary adenomas (PA) and carotid artery aneurysms has been described and may be particularly frequent in acromegaly. The co-occurrence of an intracranial aneurysm in the setting of a PA presents significant risk to the patient, particularly when the aneurysm is within or near the operative field. We describe a 48-year-old, right-handed female patient with a large skull base lesion who had a left cavernous carotid artery aneurysm detected on her preoperative imaging studies. This patient was managed using a staged approach. She first underwent endovascular stent-assisted coiling of the aneurysm followed, six months later, by resection of the tumor via an expanded endonasal endoscopic approach. Histopathological analysis revealed a pituitary macroadenoma with neuronal metaplasia. Angiographic embolization followed by an expanded endonasal endoscopic approach is a safe and effective treatment for such lesions. Vascular imaging studies and a low index for suspicion are required for preoperative identification of such complex situations.
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38
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Sato Y, Wada T, Nishikawa Y, Yoshida K, Kurose A, Ogawa A, Ogasawara K. Growth hormone-producing pituitary adenoma regrowing as pituitary adenoma with neuronal choristoma 14 years after tumor removal. World Neurosurg 2012; 80:436.e11-3. [PMID: 22728663 DOI: 10.1016/j.wneu.2012.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 04/03/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND We report a case of an uncommon association of pituitary adenoma with neuronal choristoma that usually is diagnosed at initial surgery. CASE DESCRIPTION A 50-year-old woman with acromegaly and bitemporal hemianopsia underwent removal of a pituitary adenoma via the transsphenoidal approach. Histologic examination of the first surgical specimen demonstrated only adenoma, which was eosinophilic and expressed growth hormone. Fourteen years later, bitemporal hemianopsia recurred, and magnetic resonance imaging revealed regrowth of the residual tumor. DISCUSSION The patient underwent removal of the regrown tumor via the transsphenoidal approach. Histologic examination of the second surgical specimen revealed gangliocytoma and a small component of pituitary adenoma. CONCLUSIONS The present case report supports the theory that pituitary adenoma with neuronal choristoma might represent the result of neuronal differentiation from pituitary adenoma.
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Affiliation(s)
- Yuichi Sato
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
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39
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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]
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Koutourousiou M, Kontogeorgos G, Wesseling P, Grotenhuis AJ, Seretis A. Collision sellar lesions: experience with eight cases and review of the literature. Pituitary 2010; 13:8-17. [PMID: 19551516 PMCID: PMC2807600 DOI: 10.1007/s11102-009-0190-2] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 06/09/2009] [Indexed: 11/29/2022]
Abstract
The concomitant presence of a pituitary adenoma with a second sellar lesion in patients operated upon for pituitary adenoma is an uncommon entity. Although rare, quite a great variety of lesions have been indentified coexisting with pituitary adenomas. In fact, most combinations have been described before, but an overview with information on the frequency of combined pathologies in a large series has not been published. We present a series of eight collision sellar lesions indentified among 548 transsphenoidally resected pituitary adenomas in two Neurosurgical Departments. The histological studies confirmed a case of sarcoidosis within a non-functioning pituitary adenoma, a case of intrasellar schwannoma coexisting with growth hormone (GH) secreting adenoma, two Rathke's cleft cysts combined with pituitary adenomas, three gangliocytomas associated with GH-secreting adenomas, and a case of a double pituitary adenoma. The pertinent literature is discussed with emphasis on pathogenetic theories of dual sellar lesions. Although there is no direct evidence to confirm the pathogenetic relationship of collision sellar lesions, the number of cases presented in literature makes the theory of an incidental occurrence rather doubtful. Suggested hypotheses about a common embryonic origin or a potential interaction between pituitary adenomas and the immune system are presented.
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Affiliation(s)
- Maria Koutourousiou
- Department of Neurosurgery, G. Gennimatas Athens General Hospital, 154 Messogion Ave, 115 27, Athens, Greece.
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41
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Abstract
A 59 year-old man presented with a large sellar mass. Pathologic examination revealed a tumor with two distinct cell populations. The majority of the tumor showed typical pituitary gonadotroph adenoma morphology and staining. Diffusely scattered throughout this tumor were nests of epithelial cells with an appearance typical of adamantinomatous craniopharyngioma and that were proliferating by Ki-67. Moreover, their diffuse distribution within the adenoma portion of the tumor suggests that these areas arose from within the adenoma where squamous rests are not observed. While pituitary adenomas juxtaposed to craniopharyngiomas have been reported, these cases have consisted of distinct masses unlike the intimately admixed tumor described in this case. Moreover, all previous reports of craniopharyngiomas with pituitary adenoma have consisted of prolactinomas. This is the first reported case of a craniopharyngioma with gonadotroph adenoma.
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42
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Xiao P, Xue L, Peng JJ, Feng ST, Liao B, Wen JM. An intrasellar mixed gangliocytoma-adenoma including ependymal component, and review of the literature. BMJ Case Rep 2009; 2009:bcr11.2008.1200. [PMID: 21686419 DOI: 10.1136/bcr.11.2008.1200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A rare case of intrasellar mixed gangliocytoma-adenoma including ependymal component, which presented clinically with acromegaly and menstrual disorder, is described here. The tumour was totally removed via trans-sphenoidal surgery. A histological examination of the resected specimen showed that the tumour was composed of ganglion cells, adenomatous cells and ependymal cells. Most intrasellar gangliocytomas are composed of two components: adenomatous cells and ganglion cells. In this case, in addition to mixed adenomatous and ganglion cells, focal ependymal cells forming small cysts were found. Based on these histopathological findings, it was inferred that stem cells existed in the pituitary gland during embryonic development. The stem cells were able to differentiate into three directions: ganglion cells, adenomatous cells and ependymal cells, and as a result an intrasellar mixed gangliocyto-adenoma including ependymal component developed.
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Affiliation(s)
- Ping Xiao
- The First Affiliated Hospital, Sun Yat-Sen University, Department of Pathology, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
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Dutta D, Munshi A, Gupta T, Nair P, Jalali R. Pituitary Adenoma Neuronal CHoristoma -- The PANCH syndrome. Acta Oncol 2008; 47:1611-3. [PMID: 18607864 DOI: 10.1080/02841860802123212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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44
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Mikami S, Kameyama K, Takahashi S, Yoshida K, Kawase T, Sano T, Mukai M. Combined gangliocytoma and prolactinoma of the pituitary gland. Endocr Pathol 2008; 19:117-21. [PMID: 18651251 DOI: 10.1007/s12022-008-9027-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Gangliocytomas of the pituitary gland are rare lesions that often occur in combination with pituitary adenomas, which are frequently associated with the hypersecretion of pituitary hormones, particularly growth hormones. We report a case of combined gangliocytoma and prolactinoma of the pituitary gland. A 49-year-old male presented with vertigo. Radiological examination revealed an intrasellar tumor with a suprasellar extension, which was removed via the trans-sphenoidal approach. Histologically, the tumor was composed of adenoma cells, mature ganglion cells and cells with features intermediate between those of adenoma cells and ganglion cells (intermediate cells). Immunohistochemical analysis revealed the ganglion cells and intermediate cells as well as adenoma cells to be positive for prolactin. No growth hormone-positive tumor cells were observed. The ganglion cells were positive for synaptophysin and neurofilament. The findings in this case are discussed in relation to hypotheses proposed for histogenesis, and the presence of intermediate cells supports three hypotheses. The first is that adenoma cells transform into ganglion cells, and the second is that both components originate from the embryonal pituitary cell rests, showing intermediate features between ganglion cells and adenoma cells. The last is that their common origin may be the same stem/progenitor cells in normal adult pituitaries.
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Affiliation(s)
- Shuji Mikami
- Division of Diagnostic Pathology, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
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45
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Johnson MD, Fan X, Bourne P, Walters D. Neuronal differentiation and expression of neural epitopes in pituitary adenomas. J Histochem Cytochem 2007; 55:1265-71. [PMID: 17875653 DOI: 10.1369/jhc.7a7311.2007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neural transdifferentiation is increasingly recognized in neural crest and neural stem cell tumors. Neuronal differentiation has been anecdotally described primarily in somatotroph cell adenomas associated with acromegaly, but its prevalence in adenomas and relationship to adenoma type has not been completely established. In this study we performed a retrospective morphological and immunohistochemical analysis of neurofilament, phosphoneurofilament, Neu-N, class III tubulin, and Hu in WHO grade I pituitary adenomas. Limited numbers of cells with neuronal features and neuron-associated epitopes may be more common in pituitary adenomas than previously recognized. These may occur in many forms of adenomas including somatotroph, lactotroph, mixed somatotroph and lactotroph, null cell/gonadotroph cell and, rarely, corticotroph cell adenomas.
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Affiliation(s)
- Mahlon D Johnson
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 626, Rochester, NY 14623, USA.
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