A high incidence of nasal complications after conventional transsphenoidal surgery observed through examination and not reported spontaneously point to the need of otorhinolaryngological investigation complemented by nasal endoscopy in patients submitted to procedures through this route.

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The role of prolactin (PRL) in the CNS remains uncertain. We evaluated the presence of hyperprolactinemia, intracellular prolactin (ICP), and prolactin receptor (PRL-R) in primary CNS tumors, and their relationship with cellular replication with a prospective cross-sectional study of 82 consecutive patients with primary CNS tumors admitted for neurosurgical resection between October 2003 and September 2005. Patients submitted to a questionnaire, and venous blood samples were obtained for measurement of serum PRL and TSH. Immunohistochemical analyses were performed to evaluate the presence of ICP, PRL-R, and Ki-67. Serum PRL levels ranged from 2 to 70 ng/ml, and hyperprolactinemia was detected in 25 cases (30.5%). ICP was detected in 18 patients (21.9%), in whom PRL ranged from 2 to 32 ng/ml. A positive correlation was found between PRL levels and the presence of ICP (Student's t test, P = 0.022). The PRL-R was observed immunohistochemically in 32 cases (39%). The frequencies of hyperprolactinemia, ICP, and PRL-R were similar across the several histological types of CNS tumors. Ki-67 index was similar in all groups. Hyperprolactinemia and intracellular presence of PRL and PRL-R were common findings in this population, suggesting a role for PRL in CNS tumor genesis.

Evidence suggests that sex hormones may play a role in the tumorigenesis of meningiomas, and studies have demonstrated the expression of hormone receptors in these tumors. Aromatase expression has been detected in several normal tissues, including neurons in the CNS, and tumor tissues. We aim to assess the expression of aromatase (ARO) and of progesterone receptor (PR), estrogen receptor (ER) and androgen receptor (AR) in both normal and neoplastic meningeal cells. A cross-sectional study was conducted with 126 patients diagnosed with meningioma (97 women and 29 men; mean age, 53.6 years) submitted to neurosurgery at Hospital São José, Complexo Hospitalar Santa Casa de Porto Alegre, southern Brazil. Control sections of normal meningeal cells, 19 patients, were obtained by evaluating the arachnoid tissue present in the arachnoid cyst resected material. Immunohistochemistry was applied to assess ARO, PR, ER and AR. Aromatase expression was detected in 100% of the control patients and in 0% of the patients with meningioma. ER was present in 24.6% of the meningiomas and in 0% of the controls, AR in 18.3% of the meningiomas and in 0% of the controls, and PR in 60.3% of the meningiomas and in 47.4% of the controls. A positive association was observed between the presence of AR and ER (OR 3.7; P = 0.01) in meningiomas. There were no significant differences in the presence of hormone receptors between meningioma histological subtypes. PR expression in women with meningioma was significantly higher than that found in men (OR 2.3; P = 0.08). Behavior pattern differences observed between aromatase expression, present in normal tissues and absent in meningiomas, and estrogen and androgen hormone receptors, absent in normal tissues and present in meningiomas, suggest that there is heterogeneity in modulation by sex steroids in the development of these tumors.

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Background and objectives: Recent studies have shown an association between prolactin (Prl) levels and body weight, with increased prevalence of obesity in patients with prolactinomas and weight loss associated with hyperprolactinemia. However, data on variations in body weight associated with different degrees of hyperprolactinemia remain scarce. This study aimed to evaluate the prevalence of obesity and overweight in patients with hyperprolactinemia of various causes and correlate Prl levels with body mass index (BMI). Methods: Medical records of patients with hyperprolactinemia were retrospectively reviewed. Patients were classified according to BMI as normal weight (19.0-24.9), overweight (25-29.9), and class I (30-34.9), class II (35-39.9) and class III (> 40) obesity. Disease etiology was divided into microprolactinoma, macroprolactinoma, and other causes for analysis. Results: Of 138 eligible patients, 52.9% had micro or macroprolactinoma and 65.2% were overweight or obese. Mean patient age was 36.2±13.6 years. Obesity was more prevalent in patients with macroprolactinoma (50%), and overweight in patients with other causes of hyperprolactinemia (37.9%), with no statistical difference between groups. Prl levels were higher in macroprolactinomas, with a statistically significant difference (p<0.001) compared to microprolactinomas and other causes of hyperprolactinemia. Prl was also significantly higher in microprolactinomas than in other causes of hyperprolactinemia (p<0.001). Conclusions: Prevalence of obesity was significantly high in hyperprolactinemic patients, regardless of the degree of obesity and the cause of hyperprolactinemia. It is important to monitor BMI in patients with elevated Prl levels to introduce measures aiming to maintain an ideal weight and reduce associated comorbidities.

According to Giorgio Vasari (1511-1574), the great genius of anatomy, Michelangelo Buonarroti (1475-1564), in painting the frescoes on the ceiling of the Sistine Chapel (1508-1512), demonstrated to the world a new dimension/perspective of painting, especially in the sublime manner with which the artist represented the anatomical details of the characters that made up his frescoes. Since then, the Sistine Chapel has received millions of tourists annually, who marvel at the anatomical beauty of the characters depicted on its ceiling. It has also received many scholars of art and even anatomists, who have often tried to infer theses and explanations regarding Michelangelo's real intentions in elaborating this great work. However, even after five centuries, the Vatican's own official explanations of the true intentions of the artist remain quite uncertain. In an attempt to elucidate Michelangelo's possible intentions in the design of this memorable work, this article presents unpublished evidence that all the frescoes on the ceiling of the Sistine Chapel were organized by the artist according to a code based on the number of characters in each fresco, the gematria of the Hebrew/Greek alphabet, and the Golden Ratio. This decoding process could reveal a key factor influencing the artist's intentions in ordering the elements in this work. Clin. Anat. 31:948-955, 2018. © 2018 Wiley Periodicals, Inc.

Metastatic tumors of the pituitary gland are very rare, representing only 1% of the pituitary mass submitted to surgeries, and are frequently related to primary neoplasia of breast and lung 1,2 . CASEA 50-year-old male patient sought medical care complaining of cephalalgia for 4 months, diplopia and ptosis of the left eyelid for 30 days. He reported loss of libido and erectile dysfunction in the previous six months. He was before a salutary individual. Physical examination: body mass index (BMI) 24, with ptosis and ophthalmoplegia of the left eye, arterial pressure of 140/80 mmHg. No other alterations.Magnetic resonance imaging ( Figure) showed heterogeneous mass into the sella turcica with suprasellar extension, causing displacement of optic chiasm and third ventricle floor, with intense opacification after contrast.The laboratory exams showed normal thyroid function, low levels of gonadotropins and total testosterone, normal levels of basal cortisol and IGF-1 and very small increase in serum prolactin. Renal function, serum sodium and urine density were within normal limits. Central hypogonadism and slight hyperprolactinemia were detected, without evidence of posterior pituitary alteration.An endoscopic transsphenoidal pituitary surgery were performed and anatomopathological exam showed metastasis of moderately differentiated adenocarcinoma of unknown primary site. Postoperative exams showed anemia, increased GGt, FA and CA 19-9. Immunohistochemical analysis indicated origin in the gastrointestinal tract, imaging of thorax and abdomen showed lymphadenopathies and small irregularities on the antral mucosa wall of the stomach. Upper gastrointestinal endoscopy with biopsy showed stomach antral adenocarcinoma. DISCUSSIONMetastatic tumors of the pituitary gland are rare complications 1 that occur between 1 and 3.6% of the patients with malign tumors 2 and represent between 0.14 and 28.1% of the brain metastases 3 .The metastasis reported here is from a gastric adenocarcinoma. In literature, the primary neoplasias more commonly associated with pituitary metastases are breast and lung cancer, corresponding to 30-47% and 19-30% of all cases, respectively. Other sites were reported with lower frequency [1][2][3][4][5] .The patient in question had no previous malignant history, in agreement with literature data which state that metastases may be the first manifestation of a malign tumor 1,2 . Pituitary metastases are symptomatic in only 7% of the cases 1,2 , with predominance of Diabetes insipidus (DI) [3][4][5] . This is an important characteristics in the differential diagnosis of invasive sellar lesions, as DI occurs in less than 1% of non-functioning pituitary adenomas in the first manifestation 2 . The patient in question did not present any clinical and laboratorial evidence of DI.Pituitary metastases may have symptoms caused