Endoscopic biopsies of lesions associated with a thickened pituitary stalk

Jinguji, Shinya; Nishiyama, Kenichi; Yoshimura, Junichi; Yoneoka, Yuichiro; Harada, Atsuko; Sano, Masakazu; Fujii, Yukihiko

doi:10.1007/s00701-012-1543-6

Cited by 30 publications

(25 citation statements)

References 8 publications

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“…In the setting of infundibular infiltration, it is thought that early treatment of the underlying condition may possibly reverse hypopituitarism as well as central DI (23,24). Unfortunately, our patient ultimately died (months following initial admission), as his lymphoma was refractory to treatment.…”

Section: Resultsmentioning

confidence: 91%

A Unique Case of Central Hypopituitarism and Central Diabetes Insipidus Caused By Diffuse Large B-Cell Lymphoma

Stegink

Sehgal

Кониг

2019

AACE Clinical Case Reports

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Objective: To present the case of a 39-year-old male admitted to the hospital with diabetes insipidus as a sequela of a previously undiagnosed diffuse large B-cell lymphoma. This case is unique, as the patient's disease was determined to be an infiltrative malignancy affecting the pituitary infundibular stalk, resulting in multifocal pituitary dysfunction.Methods: Case report.Results: Initially presenting with gastrointestinal bleed, later discovered to be from tumor infiltration of gastric vessels, diagnosis of lymphoma was made when gastrectomy became necessary for hemostasis.

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Section: Resultsmentioning

confidence: 91%

A Unique Case of Central Hypopituitarism and Central Diabetes Insipidus Caused By Diffuse Large B-Cell Lymphoma

Stegink

Sehgal

Кониг

2019

AACE Clinical Case Reports

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“…Neoplastic pathology accounted for the majority of lesions in three of the five case series, including the largest; diagnoses in these series were based on histopathology in 70–100% of subjects. Inflammatory and infective aetiologies predominated in the other series, however in these series the majority of diagnoses were based on clinical and imaging characteristics. In small case series and case reports, inflammatory or infective aetiologies accounted for 68% of PS lesions while 29% were attributed to neoplastic disease.…”

Section: Discussionmentioning

confidence: 95%

“…A review of 11 patients who underwent endoscopic biopsy of a PS lesion was performed by Jinguji et al . Of the 11 patients (four male, seven female; age range 6–75 years), seven had associated intrasellar lesions, three had associated intraventricular lesions and two had isolated PS thickening.…”

Section: Resultsmentioning

confidence: 99%

“…Although reported in only 28% of the Mayo cohort, it was evident in 51% of those specifically evaluated . CDI was present preoperatively in 75% ( n = 9) of patients with a thickened PS in the series by Jinguji, and was documented in 77% (58/75) of patients with isolated PS lesions from small case series and case reports.…”

Section: Clinical Approach To a Pituitary Stalk Lesionmentioning

confidence: 93%

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Pituitary stalk lesions: systematic review and clinical guidance

Catford

Wang

Wong

2016

Clinical Endocrinology

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SummaryThe spectrum of pituitary stalk (PS) pathology is vast, presenting a diagnostic challenge. Published large series of PS lesions demonstrate neoplastic conditions are most frequent, followed by inflammatory, infectious and congenital diseases. Inflammatory pathologies however, account for the majority of PS lesions in published small case series and case reports. Physicians must be familiar with the major differential diagnoses and necessary investigations. A comprehensive history and thorough clinical examination is critical. Although magnetic resonance imaging of the PS in disease is nonspecific, associated intracranial features may narrow the differential diagnosis. Initial investigations include basic pathology and computer tomography imaging of the neck, chest, abdomen and pelvis. Further investigations should be guided by the clinical context. PS biopsy should be considered when a diagnosis is regarded essential in centres where an experienced neurosurgeon is available. Treatment is dependent on the underlying disease process and may necessitate pituitary hormone replacement.

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“…Previously, although careful analysis of clinical, laboratory, and imaging find- ings may facilitate the diagnosis, transsphenoidal biopsy is necessary to confirm the disease, because the correct diagnosis directs the appropriate treatment [11,36] . In endoscopic biopsy, a granulomatous tissue response in germinoma is a diagnostic pitfall, although rare [13] .…”

Section: Discussionmentioning

confidence: 99%

Perifocal Inflammatory Reaction with Volume Fluctuation Caused by Diagnostic Radiation-Induced Regression in Germinoma Makes Histological Diagnosis Difficult despite Its Disappearance following Treatment: A Significant Pitfall and Countermeasures to It

Yoneoka

Yoshimura²,

Okada³

et al. 2016

Pediatr Neurosurg

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We present a pediatric case of neurohypophyseal germinoma with a perifocal inflammatory reaction (PIR) with volume fluctuation caused by diagnostic radiation-induced regression (DRIR). On-target biopsy failed to confirm the histology because PIR hardly contained any germinoma cells. DRIR-related fluctuation of the tumor volume disguised germinoma as inflammation. We analyzed the cerebrospinal fluid (CSF) and detected a high level of placental alkaline phosphatase (PLAP), which demonstrated the neurohypophyseal lesion to be germinoma and brought the patient from successful radiochemotherapy up to complete remission. PIR adjacent to the germinoma (PIRAG) disappeared completely following radiochemotherapy, although it contained almost no germinoma cells. Examination of the CSF-PLAP level can complement the diagnosis of germinoma and will decrease the risk of misdiagnosis. Neurosurgeons should keep in mind PIRAG, DRIR, and the diagnostic value of CSF-PLAP when germinoma is suspected.

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Endoscopic biopsies of lesions associated with a thickened pituitary stalk

Cited by 30 publications

References 8 publications

A Unique Case of Central Hypopituitarism and Central Diabetes Insipidus Caused By Diffuse Large B-Cell Lymphoma

A Unique Case of Central Hypopituitarism and Central Diabetes Insipidus Caused By Diffuse Large B-Cell Lymphoma

Pituitary stalk lesions: systematic review and clinical guidance

Perifocal Inflammatory Reaction with Volume Fluctuation Caused by Diagnostic Radiation-Induced Regression in Germinoma Makes Histological Diagnosis Difficult despite Its Disappearance following Treatment: A Significant Pitfall and Countermeasures to It

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