Multiple tumorous lesions of the pituitary gland

Abstract

Purpose/Objective Multiple tumorous lesions in one pituitary gland are rare and mostly described in case reports. Their incidences and combinations are defined in larger collectives. Therefore, we analyzed our large collection for double tumors and combinations of tumors, cysts, and inflammation. Methods The German Registry of Pituitary Tumors, including cases from 1990 to 2018, served as the database. Our collection comprises a total of 16,283 cases up until the end of 2018. Of these cases, 12,673 originated from surgical and 3,610 from autopsy material. All specimens were fixed in formalin and embedded in paraffin. The sections were stained with hematoxylin–eosin and PAS. Monoclonal (prolactin, TSH, FSH, LH, and α subunit) or polyclonal (GH and ACTH) antibodies were used to detect pituitary hormones in the lesions. Since 2017, antibodies against the transcription factors Pit-1, T-Pit, and SF-1 have been used in difficult cases. The criteria of the 2017 WHO classification have been basic principles for classification since 2018 (Osamura et al. 2017). For differentiation of other sellar tumors, such as meningiomas, chordomas, or metastases, the use of additional antibodies was necessary. For these cases, it was possible to use a broad antibody spectrum. Autopsy pituitaries were generally studied by H&E and PAS sections. If any lesions were demonstrated in these specimens, additional immunostaining was performed. Results Multiple tumorous lesions with more than one pituitary neuroendocrine tumor (PitNET) respectively adenoma make up 1.4% (232 cases) in our collection. Within the selected cases, synchronous multiple pituitary neuroendocrine tumors (PitNETs) account for 17.3%, PANCH cases (pituitary adenoma with neuronal choristoma) for 14.7%, PitNETs and posterior lobe tumors for 2.2%, PitNETs and metastases for 5.2%, PitNETs and mesenchymal tumors for 2.6%, PitNETs and cysts for 52.2%, and PitNETs and primary inflammation for 6.0%. The mean patient age was 53.8 years, with a standard deviation of 18.5 years. A total of 55.3% of the patients were female and 44.7% were male. From 1990 to 2018, there was a continuous increase in the number of multiple tumorous lesions. Conclusion From our studies, we conclude that considering possible tumorous double lesions during surgeries and in preoperative X-ray analyses is recommended.

Pituitary Adenoma Coexistent with Sellar Clear Cell Meningioma Unattached to the Dura: Case Report and Treatment Considerations

“…Dual PitNETS are the most frequent type of sellar collision tumor, some of which are separate and some of which are contiguous. 1 38 However, the second most common combination of tumor types varies significantly. Secondary tumors that have been described as co-occurring with pituitary adenomas include gangliocytomas, pilocytic astrocytomas, craniopharyngiomas, spindle cell astrocytomas, pituicytomas, granular cell tumors, and Rathke's cleft cysts.…”

“…An urgent MRI brain demonstrated a large homogeneously enhancing sellar mass with suprasellar extension (►Fig. 1). It was noted to cause significant mass effect on adjacent neural structures including the optic chiasm/nerves with significant cavernous sinus invasion.…”

“…A literature review was conducted using PubMed to identify available case reports and case series on collision tumors occurring in the sellar or suprasellar region of the brain from 1986 to 2022, linking “collision tumor” and “sella” or “suprasellar” or “parasellar” or “pituitary.” The search regarding clear cell meningioma utilized the search terms “clear cell meningioma” and “without dural attachment.” After independent evaluation for content and relevance, we identified a total of 30 articles published from the years 1986 to 2022 that describe collision tumors comprising PitNETs and various co-occurring tumors, and 6 articles published from 2009 to 2021 describing the diagnosis of clear cell meningioma without a dural attachment. The results of this literature review are shown in Tables 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 and 2 . 31 32 33 34 35 36 37 …”

“…A recent study that reviewed 16,283 autopsy and surgical pathology cases found that double or triple pituitary adenomas/pituitary neuroendocrine tumors (PitNETs) were the most frequent combination, comprising 40/232 (17.2%) of cases presenting with dual lesions. 1 The combination of meningioma and PitNET was one of the rarest combinations (6/232 [2.6%]), far behind PitNET + gangliocytoma (34/232 [14.7%) or PitNET + sellar metastasis (12/232 [5.2%]). 1 Individually, both PitNETs and sellar meningiomas can attain large sizes and cause similar symptoms due to compromise of the optic apparatus, making the diagnosis and treatment of coexisting sellar tumors, or “collision tumors,” difficult.…”

“… 1 The combination of meningioma and PitNET was one of the rarest combinations (6/232 [2.6%]), far behind PitNET + gangliocytoma (34/232 [14.7%) or PitNET + sellar metastasis (12/232 [5.2%]). 1 Individually, both PitNETs and sellar meningiomas can attain large sizes and cause similar symptoms due to compromise of the optic apparatus, making the diagnosis and treatment of coexisting sellar tumors, or “collision tumors,” difficult.…”