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Du P, Wu X, Lv K, Xiong J, Geng D. A Pituitary Carcinoma Patient With Cerebrospinal Fluid Dissemination Showing a Good Response to Temozolomide Combined With Whole-Brain and Spinal Cord Radiotherapy: A Case Report and Literature Review. Front Oncol 2022; 12:890458. [PMID: 35903687 PMCID: PMC9321396 DOI: 10.3389/fonc.2022.890458] [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: 03/06/2022] [Accepted: 06/20/2022] [Indexed: 12/03/2022] Open
Abstract
Pituitary carcinoma (PC) is extremely rare, with its incidence only accounting for 0.1%-0.2% of pituitary tumor (PT). Existing histological features, including invasiveness, cellular pleomorphism, nuclear atypia, mitosis, necrosis, etc., can be observed in pituitary adenoma (PA), invasive PA (IPA) and PC. Invasion is not the basis for the diagnosis of PC. The diagnosis of PC is often determined after the metastases are found, hence early diagnosis is extraordinarily difficult. Owing to the conventional treatment for PC may not be effective, a large portion of patients survived less than one year after diagnosis. Therefore, it is of great significance to find an efficacious treatment for PC. We report a rare case of sparsely granulated somatotroph carcinoma with cerebrospinal fluid dissemination showing a favorable treatment response to temozolomide (TMZ) combined with whole-brain and spinal cord radiotherapy.
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Affiliation(s)
- Peng Du
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
- Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Research, Huashan Hospital, Fudan University, Shanghai, China
| | - Xuefan Wu
- Department of Radiology, Shanghai Gamma Hospital, Huashan Hospital, Fudan University, Shanghai, China
| | - Kun Lv
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ji Xiong
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
- Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Research, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Daoying Geng,
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2
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Agarwal R, Jain VK, Singh S, Charlotte A, Kanaujia V, Mishra P, Sharma K. Segmented retinal analysis in pituitary adenoma with chiasmal compression: A prospective comparative study. Indian J Ophthalmol 2021; 69:2378-2384. [PMID: 34427226 PMCID: PMC8544063 DOI: 10.4103/ijo.ijo_2086_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: The aim of this study was to determine the alteration in ganglion cell complex and its relationship with retinal nerve fiber layer (RNFL) thickness as measured by spectral-domain optical coherence tomography (OCT) in pituitary adenoma cases and also its correlation with visual field (VF). Methods: This is a prospective comparative study wherein detailed neuro-ophthalmic examination including perimetry, RNFL and ganglion cell layer inner plexiform layer (GCL-IPL) thickness were measured preoperatively in the cases of pituitary adenoma with chiasmal compression with visual symptoms and field changes who were planned for neuro-surgical intervention. These parameters were repeated 1 year after the surgery. GCL-IPL, RNFL parameters were compared with controls and were correlated with VF mean deviation (MD). The diagnostic power of GCL-IPL was tested using the receiver operating characteristic (ROC) curve. Healthy age and sex-matched controls without any ocular and systemic abnormality were taken for comparison. Results: Twenty-four patients qualified the inclusion criteria. A significant thinning of GCL-IPL (P = 0.002) and RNFL (P = 0.039) was noticed in the pituitary adenoma group. GCL-IPL (r = 0.780 P < 0.001) and RNFL (r = 0.669, P < 0.001) were significantly correlated with the MD. The ROC curve values of GCL-IPL were 0.859 (95% confidence interval 0.744% to 0.973) and of RNFL were 0.731 (95% confidence interval 0.585–0.877). The diagnostic ability of GCL-IPL was more as compared to the RNFL analysis, although it was statistically insignificant (P = 0.122). Conclusion: GCL-IPL measurements on the OCT are a sensitive tool to detect early anterior visual pathway changes in chiasmal compression for pituitary adenoma patients.
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Affiliation(s)
- Rachna Agarwal
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vaibhav K Jain
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shalini Singh
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Akshata Charlotte
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vikas Kanaujia
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kumudini Sharma
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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3
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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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4
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van Essen MJ, Muskens IS, Lamba N, Belunek SFJ, van der Boog ATJ, Amelink GJ, Gosselaar PH, van Doormaal TPC, Stades AME, Verhoeff JJC, van Genderen MM, Eenhorst CAE, Broekman MLD. Visual Outcomes after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas: Our Institutional Experience. J Neurol Surg B Skull Base 2020; 82:e79-e87. [PMID: 34306920 DOI: 10.1055/s-0039-3402020] [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: 03/20/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022] Open
Abstract
Objectives Visual dysfunction in patients with pituitary adenomas is a clear indication for endoscopic endonasal transsphenoidal surgery (EETS). However, the visual outcomes vary greatly among patients and it remains unclear what tumor, patient, and surgical characteristics contribute to postoperative visual outcomes. Methods One hundred patients with pituitary adenomas who underwent EETS between January 2011 and June 2015 in a single institution were retrospectively reviewed. General patient characteristics, pre- and postoperative visual status, clinical presentation, tumor characteristics, hormone production, radiological features, and procedural characteristics were evaluated for association with presenting visual signs and visual outcomes postoperatively. Suprasellar tumor extension (SSE) was graded 0 to 4 following a grading system as formulated by Fujimoto et al. Results Sixty-six (66/100) of all patients showed visual field defects (VFD) at the time of surgery, of whom 18% (12/66) were asymptomatic. VFD improved in 35 (35%) patients and worsened in 4 (4%) patients postoperatively. Mean visual acuity (VA) improved from 0.67 preoperatively to 0.84 postoperatively ( p = 0.04). Nonfunctioning pituitary adenomas (NFPAs) and Fujimoto grade were independent predictors of preoperative VFD in the entire cohort ( p = 0.02 and p < 0.01 respectively). A higher grade of SSE was the only factor independently associated with postoperative improvement of VFD ( p = 0.03). NFPA and Fujimoto grade 3 were independent predictors of VA improvement (both p = 0.04). Conclusion EETS significantly improved both VA and VFD for most patients, although a few patients showed deterioration of visual deficits postoperatively. Higher degrees of SSE and NFPA were independent predictors of favorable visual outcomes.
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Affiliation(s)
- Max J van Essen
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo S Muskens
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, California, United States
| | - Nayan Lamba
- Department of Neurosurgery, Computational Neurosurgical Outcome Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Stephan F J Belunek
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arthur T J van der Boog
- Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Johan Amelink
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter H Gosselaar
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Aline M E Stades
- Department of Internal medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria M van Genderen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christine A E Eenhorst
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marike L D Broekman
- Department of Neurosurgery, Computational Neurosurgical Outcome Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, United States.,Department of Neurosurgery, Haaglanden Medical Center, Den Haag, The Netherlands.,Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
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5
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Vlasak AL, Shin DH, Kubilis PS, Roper SN, Karachi A, Hoh BL, Rahman M. Comparing Standard Performance and Outcome Measures in Hospitalized Pituitary Tumor Patients with Secretory versus Nonsecretory Tumors. World Neurosurg 2019; 135:e510-e519. [PMID: 31863896 DOI: 10.1016/j.wneu.2019.12.059] [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: 09/05/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patient safety indicators (PSIs) and hospital-acquired conditions (HACs) are reported quality measures. We compared their prevalence in patients with secretory and nonsecretory pituitary adenoma using the National (Nationwide) Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. METHODS The NIS was queried for hospitalizations 2002-2014 involving pituitary adenomas. Prevalence of PSI, HAC, and 9 pituitary-related complications was determined using International Classification of Diseases, Ninth Revision codes. Patient risk factors were evaluated through multivariate analysis. RESULTS A total of 20,743 patients with nonsecretory tumor and 3385 patients with secretory tumor were identified. Among patients with nonsecretory tumor, 3.79% experienced any PSI or HAC. Of patients with secretory tumor, 2.54% had any PSI or HAC. Before adjusting for covariation, secretory patients were less likely to have any PSI or HAC (odds ratio [OR], 0.652; P = 0.0002), experience any pituitary-related complication (OR, 0.804; P < 0.0001), have a poor outcome (hazard ratio [HR], 0.435; P < 0.0001), and die during hospitalization (HR, 0.293; P = 0.0015). Secretory patients had significantly shorter mean hospital length of stay (secretory/nonsecretory percent difference, -11.95%; P < 0.0001). However, inverse propensity score-weighted ORs comparing the groups' outcomes showed that there was no significant difference in the prevalence of any PSIs and HACs (OR, 0.963; P = 0.8570), pituitary-related complications (OR, 0.894; P = 0.1321), poor outcomes (HR, 0.990; P = 0.9287), in-hospital death (HR, 0.663; P = 0.2967), and length of stay (percent difference, -2.31%; P = 0.2967) between groups. CONCLUSIONS Lack of significant difference in outcome measures after controlling for covariation is consistent with our finding that patients with nonsecretory tumor have more comorbidities on presentation for treatment. PSIs and HACs have limited ability to measure complications specific to pituitary tumors.
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Affiliation(s)
- Alexander L Vlasak
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - David H Shin
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
| | - Paul S Kubilis
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Steven N Roper
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Aida Karachi
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Brian L Hoh
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Maryam Rahman
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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A PHLDB1 variant associated with the nonfunctional pituitary adenoma. J Neurooncol 2019; 142:223-229. [PMID: 30868356 DOI: 10.1007/s11060-018-03082-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Previous studies have revealed that PHLDB1 single-nucleotide polymorphisms (SNPs) are associated with glioma risk. Nonetheless, the association between PHLDB1 SNPs and the risk of pituitary adenoma has not been studied. The present study evaluated the association of PHLDB1 SNPs with the risk of pituitary adenomas. METHODS We genotyped 27 PHLDB1 tagging and exon SNPs in a case-control study that included 148 patients who got a diagnosis of nonfunctional pituitary adenoma (NFPA) and 375 normal controls within the Korean population. Statistical analyses of the association between PHLDB1 SNPs and the NFPA risk were conducted using logistic regression. RESULTS We detected an association between a PHLDB1 SNP and the risk of NFPA in the Korean population. Rs67307131 in intron 2 was significantly associated with NFPA (odds ratio [OR] = 2.15, 95% confidence interval [CI] 1.44-3.20; P = 0.0002 in the dominant model). In the referent analysis, a higher OR and stronger association (lower P value) were observed among patients with the "C/T" genotype (OR = 2.39, 95% CI 1.60-3.58; P = 0.00002). In a functional analysis with a SNP annotation tool, this SNP was predicted to be a CpG site and copy number variant; these properties are associated with susceptibility to diseases. CONCLUSIONS Our findings suggest that genetic variation of PHLDB1 may be associated with the risk of NFPA. This is the first report of an association between PHLDB1 variants and NFPA. Further research is needed to confirm the impact of this SNP on NFPA susceptibility.
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Petiti JP, Sosa LDV, Picech F, Moyano Crespo GD, Arevalo Rojas JZ, Pérez PA, Guido CB, Leimgruber C, Sabatino ME, García P, Bengio V, Papalini FR, Estario P, Berhard C, Villarreal M, Gutiérrez S, De Paul AL, Mukdsi JH, Torres AI. Trastuzumab inhibits pituitary tumor cell growth modulating the TGFB/SMAD2/3 pathway. Endocr Relat Cancer 2018; 25:837-852. [PMID: 29875136 DOI: 10.1530/erc-18-0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/04/2018] [Indexed: 12/12/2022]
Abstract
In pituitary adenomas, early recurrences and resistance to conventional pharmacotherapies are common, but the mechanisms involved are still not understood. The high expression of epidermal growth factor receptor 2 (HER2)/extracellular signal-regulated kinase (ERK1/2) signal observed in human pituitary adenomas, together with the low levels of the antimitogenic transforming growth factor beta receptor 2 (TBR2), encouraged us to evaluate the effect of the specific HER2 inhibition with trastuzumab on experimental pituitary tumor cell growth and its effect on the antiproliferative response to TGFB1. Trastuzumab decreased the pituitary tumor growth as well as the expression of ERK1/2 and the cell cycle regulators CCND1 and CDK4. The HER2/ERK1/2 pathway is an attractive therapeutic target, but its intricate relations with other signaling modulators still need to be unraveled. Thus, we investigated possible cross-talk with TGFB signaling, which has not yet been studied in pituitary tumors. In tumoral GH3 cells, co-incubation with trastuzumab and TGFB1 significantly decreased cell proliferation, an effect accompanied by a reduction in ERK1/2 phosphorylation, an increase of SMAD2/3 activation. In addition, through immunoprecipitation assays, a diminution of SMAD2/3-ERK1/2 and an increase SMAD2/3-TGFBR1 interactions were observed when cells were co-incubated with trastuzumab and TGFB1. These findings indicate that blocking HER2 by trastuzumab inhibited pituitary tumor growth and modulated HER2/ERK1/2 signaling and consequently the anti-mitogenic TGFB1/TBRs/SMADs cascade. The imbalance between HER2 and TGFBRs expression observed in human adenomas and the response to trastuzumab on experimental tumor growth may make the HER2/ERK1/2 pathway an attractive target for future pituitary adenoma therapy.
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Affiliation(s)
- Juan Pablo Petiti
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Liliana Del Valle Sosa
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Florencia Picech
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Gabriela Deisi Moyano Crespo
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Jean Zander Arevalo Rojas
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Pablo Anibal Pérez
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Carolina Beatriz Guido
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Carolina Leimgruber
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - María Eugenia Sabatino
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Pedro García
- Instituto de RadioterapiaFundación Marie Curie, Córdoba, Argentina
| | | | | | - Paula Estario
- Servicio de EndocrinologíaHospital Córdoba, Córdoba, Argentina
| | - Celina Berhard
- Servicio de PatologíaClínica Reina Fabiola, Córdoba, Argentina
| | - Marcos Villarreal
- Instituto de Investigaciones en Físico-Química de Córdoba (INFIQC)Facultad de Ciencias Químicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Silvina Gutiérrez
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Ana Lucía De Paul
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Jorge Humberto Mukdsi
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Alicia Inés Torres
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)Centro de Microscopía Electrónica-Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
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Gounden V, Rampursat YD, Jialal I. Secretory tumors of the pituitary gland: a clinical biochemistry perspective. ACTA ACUST UNITED AC 2018; 57:150-164. [DOI: 10.1515/cclm-2018-0552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 07/16/2018] [Indexed: 12/24/2022]
Abstract
Abstract
The pituitary gland is responsible for the production and/or secretion of various hormones that play a vital role in regulating endocrine function within the body. Secretory tumors of the anterior pituitary predominantly, pituitary adenomas, collectively account for 10%–25% of central nervous system tumors requiring surgical treatment. The most common secretory tumors are prolactinomas, which can be diagnosed by basal prolactin levels. Acromegaly can be diagnosed by basal insulin growth-like factor 1 levels and the failure of growth hormone (GH) to suppress during an oral glucose tolerance test. Cushing disease can be diagnosed by demonstrating hypercortisolemia evidenced by increased salivary cortisol levels in the evening, increased urine free cortisol excretion and failure of plasma cortisol to suppress following oral dexamethasone given overnight (1.0 mg). We also discuss the diagnosis of the rarer thyroid-stimulating hormone and gonadotrophin secretory tumors. Morbidity is associated with tumor occurrence, clinical sequelae as well as the related medical, surgical and radiological management. This review focuses on the pathogenesis of secretory tumors of the anterior pituitary with emphasis on molecular mechanisms associated with tumorigenesis and the major role of the clinical chemistry laboratory in diagnosis and management of these tumors.
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Affiliation(s)
- Verena Gounden
- Department of Chemical Pathology , University of KwaZulu Natal and National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital , Durban , South Africa
| | - Yashna D. Rampursat
- Department of Chemical Pathology , University of KwaZulu Natal and National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital , Durban , South Africa
| | - Ishwarlal Jialal
- California North-State University, College of Medicine , Elk Grove, CA 95757 , USA
- Director, Section of Clinical Chemistry, VA Medical Center , Sacramento, CA , USA
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9
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Shimanskaya VE, Wagenmakers MA, Bartels RH, Boogaarts HD, Grotenhuis JA, Hermus AR, van de Ven AC, van Lindert EJ. Toward Shorter Hospitalization After Endoscopic Transsphenoidal Pituitary Surgery: Day-by-Day Analysis of Early Postoperative Complications and Interventions. World Neurosurg 2018; 111:e871-e879. [DOI: 10.1016/j.wneu.2017.12.174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 12/27/2017] [Accepted: 12/30/2017] [Indexed: 11/30/2022]
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10
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Proliferaton index in pituitary adenomas from a black African population. ALEXANDRIA JOURNAL OF MEDICINE 2017. [DOI: 10.1016/j.ajme.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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11
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Zhang J, Gao H, Zhang Y. Differential expression of the Notch1 receptor, and its ligands Dll1, Dll3 and Dll4 in distinct human pituitary adenoma subtypes. Oncol Lett 2017; 13:4533-4539. [PMID: 28599454 DOI: 10.3892/ol.2017.5997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 02/07/2017] [Indexed: 12/14/2022] Open
Abstract
Pituitary adenoma (PA) is a common type of benign tumor of the pituitary gland that is characterized by specific signs and symptoms, primarily associated with hypersecretion of pituitary glycoprotein hormones (thyroid-stimulating, growth and adrenocorticotrophic hormones, and prolactin). Surgery is the first-line treatment, although postoperative residual tissues/cells and subsequent recurrence remain notable complications. Gene therapy is an effective approach for treatment, as previous studies have demonstrated that the Notch signaling pathway participates in the pathogenesis of PA. The focus of the present study was on the associations between the expression of the Notch1 receptor and its ligands δ-like canonical Notch ligand (Dll) 1, Dll3 and Dll4 in patients with PA. Using reverse transcription-quantitative polymerase chain reaction and western blot analyses, to the best of our knowledge, this is the first study to provide a description of the differential expression of the Notch1 receptor and its ligands Dll1, Dll3, and Dll4 in various types of human PA at the mRNA and protein levels. The results of the present study demonstrated that Notch1 protein expression was positively correlated with Dll4 protein expression, but negatively correlated with Dll3 protein expression, indicating synergistic effects between the Notch1 receptor and Dll4 ligand. Furthermore, the Dll3 ligand may be an inhibitor of the Notch1 receptor, indicating an antagonistic association between Notch1 and the Dll3 ligand. These results have identified a potential target for the treatment of patients with PA.
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Affiliation(s)
- Jianfu Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P.R. China.,Neurosurgical Department, Weihai Municipal Hospital, Huancui, Weihai 264200, P.R. China
| | - Hua Gao
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P.R. China
| | - Yazhuo Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P.R. China
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12
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Tamrazi B, Pekmezci M, Aboian M, Tihan T, Glastonbury CM. Apparent diffusion coefficient and pituitary macroadenomas: pre-operative assessment of tumor atypia. Pituitary 2017; 20:195-200. [PMID: 27734275 DOI: 10.1007/s11102-016-0759-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES Pituitary macroadenomas are predominantly benign intracranial neoplasms that can be locally aggressive with invasion of adjacent structures. Biomarkers of aggressive behavior have been identified in the pathology literature, including the proliferative marker MIB-1. In the radiology literature, diffusion weighted imaging and low ADC values provide similar markers of aggressive behavior in brain tumors. The purpose of this study was to determine if there is a correlation between ADC and MIB-1 in pituitary macroadenomas. MATERIALS AND METHODS A retrospective review of diffusion imaging and immunohistochemical characteristics of pituitary macroadenomas was performed. The ADC ratio and specimen Ki-67 (MIB-1) indices were measured. Linear regression analysis of normalized ADC values and MIB-1 indices was used to compare these parameters. RESULTS There were 17 patients with available ADC maps and MIB-1 indices. Local invasion was confirmed by imaging and intraoperative visualization in 11 patients. The mean ADC ratio for the invasive group was 0.68, with a mean MIB-1 index of 2.21 %. In the noninvasive group, the mean ADC ratio was 1.05, with a mean MIB-1 index of 0.9 %. Linear regression analysis of normalized ADC values versus MIB-1 demonstrates a negative correlation, with a linear slope significantly different from zero (p = 0.003, correlation coefficient of 0.77, and r squared = 0.59). CONCLUSION We determine a strong correlation of low ADC values and MIB-1, demonstrating the potential of diffusion imaging as a possible biomarker for atypical, proliferative adenomas, which may ultimately affect the surgical approach and postoperative management.
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Affiliation(s)
- Benita Tamrazi
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143-0628, USA.
- Department of Radiology #81, Children's Hospital Los Angeles, Los Angeles, CA, 90027, USA.
| | - Melike Pekmezci
- Department of Pathology, University of California San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143-0628, USA
| | - Mariam Aboian
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143-0628, USA
| | - Tarik Tihan
- Department of Pathology, University of California San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143-0628, USA
| | - Christine M Glastonbury
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143-0628, USA
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13
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Naguib MM, Mendoza PR, Jariyakosol S, Grossniklaus HE. Atypical pituitary adenoma with orbital invasion: Case report and review of the literature. Surv Ophthalmol 2017; 62:867-874. [PMID: 28131872 DOI: 10.1016/j.survophthal.2017.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 11/26/2022]
Abstract
Pituitary adenoma invasion into the orbit is a rare phenomenon with only 22 cases, including the present case, in the literature. Our case is a 31-year-old man who presented with biopsy-proven atypical pituitary adenoma invading the right orbit after a prior resection. We compare his clinical course with previous cases and discuss clinical features, radiological features, management considerations, histologic features, and prognosis. Cases are organized by specific pituitary tumor type to aid in determining appropriate management. Early surgical intervention is the key, especially in the setting of pathologic features indicating aggressive tumor behavior or worsening visual function but is generally not indicated in prolactin-secreting adenomas that may respond to medical therapy. The role of radiation therapy is not fully established; however, it should be strongly considered in conjunction with or after surgery, especially in cases where complete resection is not achieved or histological and molecular analyses indicate a high likelihood of recurrence. More uniform and comprehensive data about management and outcomes are needed to determine the optimal treatment approach for this rare entity.
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Affiliation(s)
- Mina M Naguib
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pia R Mendoza
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Supharat Jariyakosol
- Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand; King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Hans E Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA.
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Sui D, Ma L, Li M, Shao W, Du H, Li K, Li Z, Li Z. Mucin 1 and poly I:C activates dendritic cells and effectively eradicates pituitary tumors as a prophylactic vaccine. Mol Med Rep 2016; 13:3675-83. [PMID: 26935338 DOI: 10.3892/mmr.2016.4964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 12/02/2015] [Indexed: 11/05/2022] Open
Abstract
Pituitary tumors are the most common type of cancer within the central nervous system. In the present study, the expression levels of mucin 1 (Muc1) were examined in invasive and non‑invasive pituitary tumor samples, and the results of immunohistochemical staining and Western blot analysis demonstrated marked positive expression of Muc1. In addition, Muc1 + polyinosinic:polycytidylic acid (poly I:C) was found to stimulate the expression levels of the surface molecules cluster of differentiation (CD)40, CD83 and CD80, and HLA‑DRm and decreased the expression of CD14 in the dendritic cells, determined using fluorescence‑activated cell sorting. The secretions of interleukin (IL)‑6, tumor necrosis factor‑α and IL‑1β cytokines were also significantly induced, in a dose‑dependent manner. In in vivo experiments, a higher percentage of CD3+CD4+ T lymphocytes was detected, and the levels of interferon‑γ and IL‑2 in the splenocytes were also upregulated. Furthermore, the combination treatment of Muc1 with poly I:C increased anti‑Muc1 IgM and anti‑Muc1 IgG titers, and altered the balance of IgG2a and IgG1, all of which increased the T helper (Th)1 polarized immune response. Thus, the tumor antigen, Muc1, with poly I:C may produce potent protective effects, which polarize immune responses towards Th1, and elicit antitumor immunity to inhibit the progression of pituitary tumors.
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Affiliation(s)
- Dehua Sui
- Department of Neurosurgery, Affiliated Hospital of Binzhou Medical College, Binzhou, Shandong 256603, P.R. China
| | - Lixin Ma
- Department of Neurosurgery, Affiliated Hospital of Binzhou Medical College, Binzhou, Shandong 256603, P.R. China
| | - Meng Li
- Department of Neurosurgery, Affiliated Hospital of Binzhou Medical College, Binzhou, Shandong 256603, P.R. China
| | - Wei Shao
- Department of Neurosurgery, Affiliated Hospital of Binzhou Medical College, Binzhou, Shandong 256603, P.R. China
| | - Hongpeng Du
- Department of Neurosurgery, Affiliated Hospital of Binzhou Medical College, Binzhou, Shandong 256603, P.R. China
| | - Ke Li
- Department of Neurosurgery, Affiliated Hospital of Binzhou Medical College, Binzhou, Shandong 256603, P.R. China
| | - Zhenzhu Li
- Department of Neurosurgery, Affiliated Hospital of Binzhou Medical College, Binzhou, Shandong 256603, P.R. China
| | - Zefu Li
- Department of Neurosurgery, Affiliated Hospital of Binzhou Medical College, Binzhou, Shandong 256603, P.R. China
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15
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Anvari K, Kalantari MR, Samini F, Shahidsales S, Seilanian-Toussi M, Ghorbanpour Z. Assessment of clinicopathologic features in patients with pituitary adenomas in Northeast of Iran: A 13-year retrospective study. IRANIAN JOURNAL OF NEUROLOGY 2015; 14:185-9. [PMID: 26885336 PMCID: PMC4754596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Intracranial lesions of the pituitary gland are common pituitary adenomas, accounting for 6-10% of all symptomatic intracranial tumors. In this retrospective study, the clinicopathologic features and survival rate of pituitary adenomas were evaluated. METHODS The present retrospective study was conducted on 83 patients with pituitary adenomas, referring to radiation oncology departments of Ghaem and Omid Hospitals, Mashhad, Iran, over a period of 13 years (1999-2012). Data obtained from clinical records including clinical features, type of surgery (if performed), treatment modality, overall survival rate, and progression-free survival rate were analyzed. RESULTS Eighty-three patients including 44 males (53%) and 39 females (47%) participated in this study. The median age was 40 years (age range: 10-69 years). Chiasm compression was reported in 62 patients (74.4%), and 45.78% of the subjects suffered from headaches. Functional and non-functional adenomas were reported in 44 (53.01%) and 39 (46.99%) patients, respectively. In cases with functional and non-functional adenomas, the disease was controlled in 95 and 84.5% of the subjects for 3 years, respectively. Furthermore, 1- and 3-year survival rates for functional adenoma were 84.6 and 23%, respectively; the corresponding values were 90.9 and 22.7% in non-functional adenomas, respectively. CONCLUSION In this study, a significant correlation between headache severity and type of adenoma was observed. So, application of surgery and radiotherapy together could be a highly effective approach for treating functional adenomas, although it is less efficient for the non-functional type.
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Affiliation(s)
- Kazem Anvari
- Cancer Research Center AND Department of Radiation Oncology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Reza Kalantari
- Department of Pathology, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariborz Samini
- Department of Neurosurgery, School of Medicine, Shahid Kamiab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soodabeh Shahidsales
- Cancer Research Center AND Department of Radiation Oncology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Seilanian-Toussi
- Cancer Research Center AND Department of Radiation Oncology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zakiyeh Ghorbanpour
- Department of Radiation Oncology, School of Medicine, Omid Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Miermeister CP, Petersenn S, Buchfelder M, Fahlbusch R, Lüdecke DK, Hölsken A, Bergmann M, Knappe HU, Hans VH, Flitsch J, Saeger W, Buslei R. Histological criteria for atypical pituitary adenomas - data from the German pituitary adenoma registry suggests modifications. Acta Neuropathol Commun 2015; 3:50. [PMID: 26285571 PMCID: PMC4545559 DOI: 10.1186/s40478-015-0229-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/06/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The term atypical pituitary adenoma (APA) was revised in the 2004 World Health Organization (WHO) classification of pituitary tumors. However, two of the four parameters required for the diagnosis of APAs were formulated rather vaguely (i.e., "extensive" nuclear staining for p53; "elevated" mitotic index). Based on a case-control study using a representative cohort of typical pituitary adenomas and APAs selected from the German Pituitary Tumor Registry, we aimed to obtain reliable cut-off values for both p53 and the mitotic index. In addition, we analyzed the impact of all four individual parameters (invasiveness, Ki67-index, p53, mitotic index) on the selectivity for differentiating both adenoma subtypes. METHODS Of the 308 patients included in the study, 98 were diagnosed as APAs (incidence 2.9 %) and 10 patients suffered from a pituitary carcinoma (incidence 0.2 %). As a control group, we selected 200 group matched patients with typical pituitary adenomas (TPAs). Cut-off values were attained using ROC analysis. RESULTS We determined significant threshold values for p53 (≥2 %; AUC: 0.94) and the mitotic index (≥2 mitosis within 10 high power fields; AUC: 0.89). The most reliable individual marker for differentiating TPAs and APAs was a Ki-67-labeling index ≥ 4 % (AUC: 0.98). Using logistic regression analysis (LRA) we were able to show that all four criteria (Ki-67 (p < 0.001); OR 5.2// p53 (p < 0.001); OR 3.1// mitotic index (p < 0.001); OR 2.1// invasiveness (p < 0.001); OR 8.2)) were significant for the group of APAs. Furthermore, we describe the presence of nucleoli as a new favorable parameter for TPAs (p = 0.008; OR: 0.4; CI95 %: 0.18; 0.77). CONCLUSIONS Here we present a proposed rectification of the current WHO classification of pituitary tumors describing an additional marker for TPA and specific threshold values for p53 and the mitotic index. This will greatly help in the reliable diagnosis of APAs and facilitate further studies to ascertain the prognostic relevance of this categorization.
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Affiliation(s)
- Christian P Miermeister
- Departments of Neuropathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Stephan Petersenn
- ENDOC Center for Endocrine Tumors, Hamburg & University of Duisburg-Essen, Essen, Germany
| | - Michael Buchfelder
- Departments of Neurosurgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rudolf Fahlbusch
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany
| | - Dieter K Lüdecke
- Departments of Neurosurgery, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Annett Hölsken
- Departments of Neuropathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Markus Bergmann
- Department of Neuropathology, Klinikum Bremen Mitte, Bremen, Germany
| | - Hans Ulrich Knappe
- Department of Neurosurgery, Johannes Wesling Hospital Minden, Minden, Germany
| | - Volkmar H Hans
- Department of Pathology, Ruhr University Bochum, Bochum, Germany
| | - Jörg Flitsch
- Departments of Neurosurgery, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Saeger
- Departments of Neuropathology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Rolf Buslei
- Departments of Neuropathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
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17
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Zacharia BE, Gulati AP, Bruce JN, Carminucci AS, Wardlaw SL, Siegelin M, Remotti H, Lignelli A, Fine RL. High response rates and prolonged survival in patients with corticotroph pituitary tumors and refractory Cushing disease from capecitabine and temozolomide (CAPTEM): a case series. Neurosurgery 2014; 74:E447-55; discussion E455. [PMID: 24226425 DOI: 10.1227/neu.0000000000000251] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Rarely, corticotrophic pituitary tumors take on an aggressive form characterized by rapid growth, invasion into local structures, compression of cranial nerves, and possible spread to distant sites. When conventional surgery, radiation therapy, and hormones fail to control progression and symptoms, alternative therapies are needed. A novel chemotherapeutic regimen of capecitabine and temozolomide (CAPTEM), originally designed in our laboratory, demonstrated dramatic antineoplastic effects against corticotrophic pituitary tumors. CLINICAL PRESENTATION We present a case series of 4 patients with aggressive, adrenocorticotrophic hormone--producing pituitary tumors who had previously depleted all surgical, radiation, and hormonal therapies and were then treated with CAPTEM. Dramatic clinical improvements in neurological deficits and Cushing symptoms were evident in all patients after treatment was initiated. Confirmed by radiographic imaging, 2 of 4 patients demonstrated complete regression of disease, 1 patient had a 75% regression, and the fourth patient has ongoing stable disease for > 4.5 years at the time of this writing. Immunohistochemical analysis of patients' tumor samples showed low O-methyguanyl methyltransferase expression and adequate levels of mismatch repair enzymes (MLH-1, MSH-2, MSH-6, and PMS-2), which are important for the in vivo efficacy of CAPTEM. CONCLUSION This is the first report of prolonged antitumor response to and radiographic complete remissions as a result of CAPTEM in patients with aggressive pituitary tumors who had exhausted all other therapies.
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Affiliation(s)
- Brad E Zacharia
- *Department of Neurological Surgery, ‡Experimental Therapeutics Program, Department of Medicine, Division of Medical Oncology, Pancreas Center at Columbia, §Department of Medicine, Neuroendocrine Unit, and ¶Department of Pathology, Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital-Columbia University Medical Center, New York, NY
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18
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Magalhães JF, Bacchin RP, Costa PS, Alves GM, Fraige Filho F, Stella LC. Breast cancer metastasis to the pituitary gland. ACTA ACUST UNITED AC 2014; 58:869-72. [DOI: 10.1590/0004-2730000002950] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 09/01/2014] [Indexed: 11/22/2022]
Abstract
Metastatic tumors to the pituitary gland are an unusual complication typically seen in elderly patients with diffuse malignant disease. Breast and lung are the commonest sites of the primary tumor. Prognosis of patients with breast cancer metastasis is poor and depends on the primary neoplastic extension. We report a 54 year-old woman with breast cancer metastasis to the pituitary stalk first diagnosed because of visual disturbance with no other symptoms. Pituitary gland stalk metastasis is a very uncommon find and this case report includes a literature review.
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Abstract
Recent studies have reported a higher prevalence of pituitary tumors than previously thought. Among these tumors, prolactinomas occur in up to 66% of cases. Since the mid-1980s, the widespread use of dopamine agonists has facilitated the management of the majority of prolactinomas, allowing biological and tumoral control in most cases. The less frequent cases of resistant prolactinomas remain challenging despite a multimodal therapy approach. The understanding of genetic alterations in familial and aggressive pituitary tumors provides new perspectives in the management of some prolactinomas. Genetic screening should be considered, particularly in familial cases but also in young patients with macroprolactinomas, as some mutations can predict potential aggressiveness.
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Affiliation(s)
- Laurent Vroonen
- a Department of Endocrinology, CHU de Liège, University of Liège, 4000 Liège, Belgium
| | - Adrian F Daly
- a Department of Endocrinology, CHU de Liège, University of Liège, 4000 Liège, Belgium
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20
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del Pliego MG, Aguirre-Benítez E, Paisano-Cerón K, Valdovinos-Ramírez I, Rangel-Morales C, Rodríguez-Mata V, Solano-Agama C, Martín-Tapia D, de la Vega MT, Saldoval-Balanzario M, Camacho J, Mendoza-Garrido ME. Expression of Eag1 K+ channel and ErbBs in human pituitary adenomas: cytoskeleton arrangement patterns in cultured cells. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:458-68. [PMID: 23413122 PMCID: PMC3563198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 01/15/2013] [Indexed: 06/01/2023]
Abstract
Pituitary adenomas can invade surrounded tissue, but the mechanism remains elusive. Ether à go-go-1 (Eag1) potassium channel and epidermal growth factor receptors (ErbB1 and ErbB2) have been associated to invasive phenotypes or poor prognosis in cancer patients. However, cells arrange their cytoskeleton in order to acquire a successful migration pattern. We have studied ErbBs and Eag1 expression, and cytoskeleton arrangements in 11 human pituitary adenomas. Eag1, ErbB1 and ErbB2 expression were studied by immunochemistry in tissue and cultured cells. The cytoskeleton arrangement was analyzed in cultured cells by immunofluorescence. Normal pituitary tissue showed ErbB2 expression and Eag1 only in few cells. However, Eag1 and ErbB2 were expressed in all the tumors analyzed. ErbB1 expression was observed variable and did not show specificity for a tumor characteristic. Cultured cells from micro- and macro-adenomas clinically functional organize their cytoskeleton suggesting a mesenchymal pattern, and a round leucocyte/amoeboid pattern from invasive clinically silent adenoma. Pituitary tumors over-express EGF receptors and the ErbB2 repeated expression suggests is a characteristic of adenomas. Eag 1 was express, in different extent, and could be a therapeutic target. The cytoskeleton arrangements observed suggest that pituitary tumor cells acquire different patterns: mesenchymal, and leucocyte/amoeboid, the last observed in the invasive adenomas. Amoeboid migration pattern has been associated with high invasion capacity.
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Affiliation(s)
| | - Elsa Aguirre-Benítez
- Department of Embryology, Medical Faculty, Autonomous National University of MexicoMéxico D.F., México
| | - Karina Paisano-Cerón
- Department of Physiology, Biophysics and Neurosciences , Center for Research and Advanced Studies, I.P.N.México D.F., México
| | - Irene Valdovinos-Ramírez
- Department of Physiology, Biophysics and Neurosciences , Center for Research and Advanced Studies, I.P.N.México D.F., México
| | - Carlos Rangel-Morales
- Neurosurgery Service, Medical Center “La Raza”, Social Security Medical InstituteMéxico D.F., México
| | - Verónica Rodríguez-Mata
- Department of Histology, Medical Faculty, Autonomous National University of MexicoMéxico D.F., México
| | - Carmen Solano-Agama
- Department of Physiology, Biophysics and Neurosciences , Center for Research and Advanced Studies, I.P.N.México D.F., México
| | - Dolores Martín-Tapia
- Department of Physiology, Biophysics and Neurosciences , Center for Research and Advanced Studies, I.P.N.México D.F., México
| | - María Teresa de la Vega
- Department of Physiology, Biophysics and Neurosciences , Center for Research and Advanced Studies, I.P.N.México D.F., México
| | | | - Javier Camacho
- Department of Pharmacology, Center for Research and Advanced Studies, I.P.N.México D.F., México
| | - María Eugenia Mendoza-Garrido
- Department of Physiology, Biophysics and Neurosciences , Center for Research and Advanced Studies, I.P.N.México D.F., México
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Hightower E, Cabanillas ME, Fuller GN, McCutcheon IE, Hess KR, Shah K, Waguespack SG, Corley LJ, Devin JK. Phospho-histone H3 (pHH3) immuno-reactivity as a prognostic marker in non-functioning pituitary adenomas. Pituitary 2012; 15:556-61. [PMID: 22120760 PMCID: PMC3852837 DOI: 10.1007/s11102-011-0367-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Nonfunctioning pituitary adenomas (NFPA) are typically benign neoplasms that can cause significant morbidity through local mass effects. MIB-1/Ki-67 and p53 immuno-reactivity are used to predict aggressive behavior but have known limitations. No marker to date is widely used to reliably predict tumor progression. Phospho-histone H3 (pHH3) is a protein phosphorylated during chromatin condensation in mitosis, and thus anti-pHH3 immunocytochemistry is able to assess mitotic activity. Study objectives were to determine the relationship among pHH3, MIB-1/Ki-67, and p53 in NFPA, and to evaluate the relationship between these indices and time to progression (TTP). Seventy-six patients with NFPA operated on by a single neurosurgeon at University of Texas M. D. Anderson Cancer Center from 1992 to 2006 were identified from a database and met all criteria for inclusion in this clinicopathology study. PHH3, MIB-1/Ki-67, and p53 immuno-reactivity was evaluated in each case. Retrospective review was used to determine TTP. With 282 person-years of follow-up, 19 progression events were observed. A correlation was found between MIB-1/Ki-67 and p53 immuno-reactivity (r = 0.25, p = 0.031). PHH3 did not correlate with either. When markers were dichotomized at the median, only MIB-1/Ki-67 correlated with TPP (log rank p = 0.018). Rank correlation analysis confirmed a significant inverse correlation between both MIB-1/Ki-67 (Dxy = -0.33, p = 0.036) and p53 (Dxy = -0.40, 0.016) immuno-reactivity and TTP. Our results support previous data suggesting that MIB-1/Ki-67 and p53 have clinical utility as prognostic markers for tumor progression. PHH3 did not prove to be associated with TTP in this retrospective study limited by few progression events.
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Affiliation(s)
- Erica Hightower
- Endocrinology, University of Texas Medical School at Houston, Houston, TX, USA
| | - Maria E. Cabanillas
- Division of Endocrine Neoplasia & Hormonal Disorders, Univeristy of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Greg N. Fuller
- Pathology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Ian E. McCutcheon
- Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Kenneth R. Hess
- Biostatistics, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Komal Shah
- Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Steven G. Waguespack
- Division of Endocrine Neoplasia & Hormonal Disorders, Univeristy of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Lynda J. Corley
- Pathology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jessica K. Devin
- Division of Endocrine Neoplasia & Hormonal Disorders, Univeristy of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Tanemura E, Nagatani T, Aimi Y, Kishida Y, Takeuchi K, Wakabayashi T. Quality of life in nonfunctioning pituitary macroadenoma patients before and after surgical treatment. Acta Neurochir (Wien) 2012; 154:1895-902. [PMID: 22922980 DOI: 10.1007/s00701-012-1473-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 08/05/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Nonfunctioning pituitary macroadenoma (NFMA) is a benign neoplasm that causes visual function disturbances and headaches and can be treated by transsphenoidal surgery (TSS). It is unclear how quality of life (QOL) changes with surgery and which QOL factors are affected by treatment. METHODS The aim is to assess the temporal transition of QOL in NFMA patients undergoing TSS and to identify influential factors. The QOL of NFMA patients who underwent endoscopic TSS was investigated with the short-form 36 (SF-36) health survey questionnaire, general health questionnaire 30 (GHQ30), and numerical rating scale (NRS) of pain at the following three time points: immediately before, 1 month after, and 6 months after surgery. RESULTS Twenty-four of 30 patients had visual deterioration. The SF-36 baseline value of visual function-impaired NFMA patients was lower than that of the normal population. SF-36 results showed that physical summary scores decreased at 1 month after the operation, but recovered up to the normal population level by 6 months. Mental summary scores generally increased at 1 month after surgery and remained stable until 6 months later. The GHQ30 results were similar to the SF-36 mental summary scores. The strongest factor related to the QOL was visual function. The amount of pain and the necessity of hormonal replacement were also influencing factors. CONCLUSIONS The QOL of NFMA patients is affected both physically and mentally by surgical treatment and symptoms. This QOL assessment is important for planning treatment strategies.
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Affiliation(s)
- Eriko Tanemura
- Department of Neurosurgery, Nagoya University, Graduate School of Medicine, 65 Tsurumai Showa-ku, Nagoya City, 466-8550, Japan.
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Bhargav PRK. Pituitary metastasis as a presenting manifestation of silent systemic malignancy: A retrospective analysis of four cases. Indian J Endocrinol Metab 2012; 16:147-148. [PMID: 22276271 PMCID: PMC3263189 DOI: 10.4103/2230-8210.91215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- P. R. K. Bhargav
- Department of Endocrine and Metabolic Surgery, Mamata Medical College and Superspeciality Hospital, Khammam, Andhra Pradesh, India
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Dekkers OM, Pereira AM, Romijn JA. Treatment and follow-up of clinically nonfunctioning pituitary macroadenomas. J Clin Endocrinol Metab 2008; 93:3717-26. [PMID: 18682516 DOI: 10.1210/jc.2008-0643] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Although the majority of pituitary macroadenomas are clinically nonfunctioning, treatments as well as follow-up strategy for this condition lack evidence from randomized studies. EVIDENCE ACQUISITION We evaluated the evidence of treatment and follow-up strategies for clinically nonfunctioning adenomas. PubMed was searched for articles on nonfunctioning adenomas in November 2007, and references of selected articles were assessed for potentially relevant articles. EVIDENCE SYNTHESIS All evidence for treatment and follow-up for nonfunctioning adenomas is based on observational studies. The most effective treatment is transsphenoidal surgery, indicated in patients with visual field defects. A wait-and-see approach may be considered in nonfunctioning macroadenomas not reaching to the optic chiasm. Some of these tumors ( approximately 10%) will show spontaneous regression, whereas in approximately 50% there will be progression within 5 yr observation. Postoperative radiotherapy should not be applied to all patients after surgery but can be considered in patients with large postoperative remnants of the tumor. During follow-up careful assessment and replacement of pituitary insufficiencies should be performed. Magnetic resonance imaging is advised with intervals of 1-3 yr and evaluation of visual fields when appropriate. Recurrence rates are reported to be 6-46% after transsphenoidal surgery, whereas after postoperative radiotherapy, recurrence rates of 0-36% are reported. Long-term sequelae of nonfunctioning macroadenomas are hypopituitarism, persistent visual field defects, and decreased quality of life. Whether nonfunctioning macroadenomas are associated with an increased mortality is still a matter of debate. CONCLUSION Clinically nonfunctioning pituitary macroadenomas, although benign in nature, need individualized treatment and lifelong radiological and endocrinological follow-up.
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Affiliation(s)
- O M Dekkers
- Department of Endocrinology and Metabolic Diseases C4-R, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
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Hands KE, Alvarez A, Bruder JM. Gonadotropin-releasing hormone agonist-induced pituitary apoplexy in treatment of prostate cancer: case report and review of literature. Endocr Pract 2008; 13:642-6. [PMID: 17954421 DOI: 10.4158/ep.13.6.642] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe a case and review the literature on the rare complication of pituitary apoplexy after administration of a gonadotropin-releasing hormone agonist (GnRHa) for treatment of patients with prostate cancer. METHODS We present a detailed case report of a patient with immediate signs of pituitary apoplexy after receiving a GnRHa and review the 6 previously reported cases in the literature. A 60-year-old man presented to a local hospital with severe headache, nausea, vomiting, and diplopia. Prostate cancer had recently been diagnosed, and he had received his first dose of a GnRHa 4 hours before this presentation. On physical examination, he was confused and had ptosis of the left eye. A head computed tomographic scan without contrast enhancement showed soft tissue filling the sella, without intracranial hemorrhage or mass effect. He was discharged with the diagnosis of viral meningitis. Three weeks later, he presented again with severe headache and diplopia. He had confusion, lethargy, disorientation, a blood pressure of 88/64 mm Hg, and left cranial nerve III, IV, and VI paralysis. Magnetic resonance imaging of the brain revealed an enhancing pituitary mass with hemorrhage extending to the optic chiasm, consistent with pituitary apoplexy. Laboratory results were consistent with panhypopituitarism. Surgical excision revealed a necrotic pituitary macroadenoma with hemorrhage. Tumor immunohistochemical staining was positive only for luteinizing hormone. CONCLUSION We describe a rare adverse effect of GnRHa therapy, which unmasked a gonadotropin-secreting pituitary macroadenoma. This case adds to the 6 previously reported cases of GnRHa administration inducing pituitary apoplexy in men with prostate cancer.
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Affiliation(s)
- Kathleen E Hands
- Department of Medicine, Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Abstract
The hypothalamus is susceptible to involvement by a variety of processes, including developmental abnormalities, primary tumors of the central nervous system (CNS), vascular tumors, systemic tumors affecting the CNS, and inflammatory and granulomatous diseases. The hypothalamus may also be involved by lesions arising from surrounding structures such as the pituitary gland. Magnetic resonance (MR) imaging is the modality of choice for evaluating the anatomy and pathologic conditions of the hypothalamus. The MR imaging differential diagnosis depends on accurate anatomic localization and tissue characterization of hypothalamic lesions through the recognition of their signal intensity and contrast material enhancement patterns. Diffusion-weighted imaging and proton MR spectroscopy can be helpful in differentiating among various types of hypothalamic lesions. Key MR imaging features, in addition to the patient's age and clinical findings at presentation, may be helpful in developing the differential diagnosis for lesions involving the hypothalamic region.
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Affiliation(s)
- Sahar N Saleem
- Department of Diagnostic Radiology, Faculty of Medicine, Cairo University-Kasr Al Ainy Hospital, 4 St 49 Mokattam, Cairo 11451, Egypt.
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Taoda T, Hara Y, Takekoshi S, Itoh J, Teramoto A, Osamura RY, Tagawa M. Effect of mitotane on pituitary corticotrophs in clinically normal dogs. Am J Vet Res 2006; 67:1385-94. [PMID: 16881851 DOI: 10.2460/ajvr.67.8.1385] [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: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of mitotane administration on the function and morphology of pituitary corticotrophs in clinically normal dogs. ANIMALS 12 clinically normal adult Beagles. PROCEDURES Dogs were randomly assigned to the control group or the mitotane treatment group. In mitotane treatment group dogs, mitotane was administered for 1 month. In both groups, ACTH stimulation testing and corticotrophin-releasing hormone (CRH) stimulation testing were performed. Magnetic resonance imaging (MRI) of the pituitary gland and brain was performed in mitotane treatment group dogs before and after administration of mitotane. After CRH stimulation testing and MRI, dogs were euthanatized and the pituitary gland and adrenal glands were excised for gross and histologic examination. RESULTS ACTH concentrations in mitotane treatment group dogs were significantly higher than in the control group dogs following CRH stimulation. Magnetic resonance imaging revealed that pituitary glands were significantly larger in treatment group dogs after administration of mitotane, compared with before administration. On gross and histologic examinations, the adrenal cortex was markedly atrophied. Immunohistochemistry revealed hypertrophy of corticotrophs in pituitary glands of mitotane treatment group dogs. CONCLUSIONS AND CLINICAL RELEVANCE These findings indicate that inhibition of the adrenal cortex by continuous administration of mitotane leads to functional amplification and morphologic enhancement of corticotrophs in clinically normal dogs. In instances of corticotroph adenoma, hypertrophy of individual corticotrophs induced by mitotane may greatly facilitate enlargement of the pituitary gland and increases in ACTH secretion.
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Affiliation(s)
- Takahiro Taoda
- Department of Veterinary Science, Division of Veterinary Surgery, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musasino-shi, Tokyo 180-8602, Japan
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Tena-Suck ML, Salinas-Lara C, Sánchez-García A, Rembao-Bojórquez D, Ortiz-Plata A. Late development of intraventricular papillary pituitary carcinoma after irradiation of prolactinoma. ACTA ACUST UNITED AC 2006; 66:527-33; discussion 533. [PMID: 17084204 DOI: 10.1016/j.surneu.2006.02.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 02/04/2006] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intracranial dissemination of pituitary adenomas is a rare event that does not equate malignancy. Most of the cases have been reported as metastases from pituitary carcinoma. A case of papillary pituitary carcinoma developed 12 years after radiotherapy for prolactin-secreting hormone pituitary adenoma is presented. CASE DESCRIPTION A 37-year-old woman was admitted for the second time with neurologic disturbance and hypertension. A gadolinium-enhanced magnetic resonance scan of the brain demonstrated a 50-mm enhanced mass (absent on previous studies) on the lateral ventricle, involving the left temporal lobe. The patient underwent a craniotomy and biopsy of the lesion that was consistent with pituitary carcinoma; it was immunoreactive to follicle-stimulating hormone, adrenocorticotropic hormone, pituitary tumor-transforming gene, and epithelial cell adhesion molecule. Transmission electron microscopy analysis confirmed the secretory pituitary tumor diagnosis. CONCLUSIONS The tumor was considered a primary pituitary papillary carcinoma. The clinical course indicated that this tumor was the seedling of a pituitary tumor, although it could be interpreted as metastases from a pituitary carcinoma.
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Affiliation(s)
- Martha Lilia Tena-Suck
- Department of Neuropathology, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Delegación Tlalpan CP 14269, Mexico City, Mexico
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