Cystic lesion at the foramen magnum disseminated from a pituitary adenoma--case report

A 38-year-old male presented with a cystic lesion at the foramen magnum due to intracranial dissemination from a pituitary adenoma. The primary tumor had required reoperation for regrowth twice. The tumor at the foramen magnum was removed surgically. Two smaller solid tumors were located in the left parietal convexity and the right temporal lobe. The former tumor was also removed surgically and the latter was observed. Histological examination showed the typical characteristics of pituitary adenoma in both surgical specimens. Immunohistochemical staining with MIB-1 and p53 antibodies showed low (< 1%) and negative reaction. Patients with pituitary adenoma, even benign tumors, must be carefully followed up for signs of metastasis.

Morphological characterization and subtyping of silent somatotroph adenomas

GH-producing adenomas clinically are endocrine-active tumors accompanied with acromegaly in most instances. However, GH-producing adenomas apparently unassociated with acromegaly, or so-called silent somatotroph adenomas (SSA), have recently been reported but rarely. The reported cases are characterized by normal or slightly elevated serum levels of GH but without acromegaly. Tumor cells contain moderate, trace or no GH immunoreactivity. We experienced 7 cases of SSA which were not always similar in morphology and pathogenetic mechanism. They could be further divided into the following 3 subtypes. Subtype 1 (N = 2): a moderate number of cells were immunopositive for GH, and GH mRNA was also expressed in moderate or numerous cells. Densely granulated cells were noted. It is assumed that inhibition of hormone release into circulation. Subtype 2 (N = 3): a small number of cells were immunopositive for GH, while GH mRNA was expressed in numerous tumor cells. They were sparsely granulated cells containing fibrous bodies. These findings suggest that posttranslational processing of the gene product may be defective. Subtype 3 (N = 2): Only a scattered number of cells were immunopositive for GH and GH mRNA was co-localized in immunopositive cells. They were sparsely granulated cells containing poorly developed organelles that did not resemble those of typical sparsely granulated GH cells. The findings indicate that adenoma cells are largely immature with minimal GH lineage differentiation.

Significance of growth hormone-releasing hormone receptor mRNA in non-neoplastic pituitary and pituitary adenomas: a study by RT-PCR and in situ hybridization

This study examined the expression of human growth hormone-releasing hormone receptor (GHRH-R) mRNA in both non-neoplastic pituitary tissues and pituitary adenomas by reverse transcriptase-polymerase chain reaction (RT-PCR) and in situ hybridization (ISH). RT-PCR analysis showed that all of the non-neoplastic pituitaries and all GH-producing adenomas, one prolactinoma and one third of the non-functioning adenomas expressed GHRH-R mRNA. ISH demonstrated that all of GH-producing adenomas and two prolactinomas expressed GHRH-R mRNA. The expression of GHRH-R mRNA in GH-producing adenomas was greater than that in the other adenomas by RT-PCR and ISH. GHRH-R mRNA detected by ISH was observed only in GH cells from the pituitary gland of a young girl. In pituitary adenomas, a diffuse signal was observed in the cytoplasm of all of the GH-producing adenomas and in two prolactinomas. Expression of GHRH-R mRNA was not seen in normal prolactin cells, or in any adenomas other than GH-producing adenomas and a few prolactinomas. These results suggest that GHRH-R mRNA plays a role mainly in the function of GH-producing adenomas but may also play a role in function of some prolactinomas.

A functional thyrotropin- and growth hormone-secreting pituitary adenoma with a ultrastructurally monomorphic feature: a case study

A 38-yr-old female with a TSH- and GH-secreting pituitary adenoma is described, who had both overt symptoms, hyperthyroidism and acromegaly. Her serum TSH was not suppressed despite high concentrations of free T3 and free T4, and her alpha-subunit/TSH molar ratio was high. Her serum GH was consistently high, and was not suppressed by an oral glucose tolerance test. Preoperative testing revealed that, although the TSH response was impaired, TSH, alpha-subunit and GH were increased by TRH injection, and that these hormones were reduced by bromocriptine or somatostatin analog. Although she did not have hyperprolactinemia, the in vitro culture and immunohistochemical studies revealed that the adenoma cells produced and released PRL, in addition to TSH, alpha-subunit and GH. Immunohistochemical studies showed the presence of GH in the cytoplasm of many adenoma cells. TSH beta-positive adenoma cells were less frequently seen than GH-positive adenoma cells. No cells showed the coexistence of GH and TSH beta, and a few cells were positive for PRL. By electron microscopy, the adenoma was found to be composed of a single cell type resembling thyrotrophs, and did not have any characteristics of somatotrophs. This case was considered to be of interest, because the adenoma was ultrastructurally monomorphous, but immunohistochemically polymorphous.

Clinical and ultrastructural comparison of immunohistochemically inactive and gonadotropin-producing pituitary adenomas

A clinicoendocrinological and ultrastructural comparison of immunohistochemically inactive pituitary adenomas from 14 patients and gonadotropin-positive pituitary adenomas from 26 patients was carried out. Clinicoendocrinological characteristics were similar except the male to female ratios. The immunohistochemically unstable antigenicity of gonadotropin prevents clear immunohistochemical characterization, but the difference between the two types is not absolute and may be an indication of a cell line relationship.

Colocalization of growth hormone (GH) and glycoprotein subunit alpha in GH-producing pituitary adenomas in acromegalic patients

Thirty-one consecutive cases of pituitary adenoma in acromegalic patients were studied by immunohistochemistry. All adenomas contained cells immunoreactive with the anti-alpha-subunit of gonadotropic hormones (alpha; 0.6-53% of tumor cells) as well as with anti-growth hormone (GH; 4-74% of tumor cells). In serial section study, most cells immunoreactive with anti-alpha were identical to cells immunoreactive with anti-GH. There was a positive correlation between the percentages of cells immunoreactive for alpha in GH cells [alpha (%)/GH(%)] and those for prolactin (PRL) in immunoreactive tumor cells (PRL(%)/[PRL(%) + GH(%)]) in mixed GH cell-PRL cell adenomas, suggesting that the alpha-subunit may play a role in emergence of PRL cells.