Ossifying Pituitary Gonadotroph Adenoma: A Case Report

Zahariadis, George; Kontogeorgos, George; Liberopoulos, K.; George, Susan R.; Kovács, Kálmán

doi:10.1007/s007010050407

Cited by 13 publications

(23 citation statements)

References 7 publications

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“…Fernandez et al published the only case report of an anaplastic astrocytoma presenting in a patient with acromegaly (5). The current tumor showed a bony structure that is similar to the earlier three reports (10,19,26). Microscopically, the round to oval neoplastic cells in moderate cellularities with eosinophilic cytoplasm were arranged in sheets and traversed by fine fibrovascular channels and distributed among anastomosing, well-differentiated lamellar bone trabeculae, showing the unique histological features.…”

Section: Discussionsupporting

confidence: 82%

“…Only five cases of pituitary adenoma with bone formation have been reported in the English literature (10,16,17,19,26). Two of these were pre-menopausal women, presenting with prolactin producing adenoma and GH-producing adenoma.…”

Section: Discussionmentioning

confidence: 99%

“…Intratumoral pituitary stone has also rarely been described (25). However, the ossification of pituitary adenomas is extremely rare and has been described just five times in literature (10,16,17,19,26). Bone formation in the pituitary gland was first described by Shanklin, with an incidence of 1%, based on the results of an autopsy case series (21).…”

Section: Introductionmentioning

confidence: 99%

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Ossifying pituitary adenoma co-existing with astrocytoma and gangliocytoma associated with pituitary adenoma. two unusual conditions

Jaiswal¹,

Vij²,

Jaiswal³

et al. 2010

Turkish Neurosurgery

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Bone formation in pituitary adenoma is an extremely rare finding. Only five previous cases have been published. This is the sixth case report of an ossifying pituitary adenoma and the first case report of a pituitary adenoma with bone formation coexisting with WHO grade II astrocytoma. MRI imaging revealed an unusual eggshell cap-like calcified structure surrounding the tumor. Histologically, the adenoma contained irregularly anastomosing trabeculae with well-formed lacunae and osteoblasts along the margins. Our second case concerns a 25-year-old male patient who presented with complains of off and on headache for 12 months. MRI (head) revealed a 4x3cm well defined rounded lesion in the sella and suprasellar extension that was isointense in T1, hyperintense on T2 with cystic areas and homogenous contrast enhancement. On morphological examination, a cellular tumor admixed with foci of large ganglion cells embedded in a neuropil stroma was noted. On immunohistochemistry, tumor cells were focally positive for pancytokeratin, growth hormone and synaptophysin; and ganglion cells were positive for neurofilament and synaptophysin. No GFAP positive cells were seen. The Ki67 index was < 1%. Based on these findings, a diagnosis of gangliocytoma associated with pituitary adenoma was considered.KeywOrds: Pituitary, Pituitary adenoma, Bone formation, Astrocytoma, Gangliocytoma ÖZHipofiz adenomlarında kemik oluşumu oldukça nadir görülen bir bulgudur. Toplam 5 hipofiz adenomu olgusunda kemikleşme oluşumu rapor edilmiştir. Sunulan ilk vaka kemikleşme gösteren hipofiz adenomu olması yanı sıra gonadotropin üreten bir hipofiz adenomu ve grade 2 astrositom ile birlikteliği ile bu özellikteki ilk olgu sunumudur. Manyetik rezonans görüntülemede; kemik dokusunun hipofiz adenomunun etrafını yumurta kabuğu gibi sardığı görüldü. Histolojik olarak adenomanın düzensiz bir şekilde birbiri ile ilişkili trabeküler yapılar yanı sıra; iyi gelişmiş lakünler ve osteoblastları da içerdiği görüldü. Diğer vaka ise 25 yaşında erkek hasta 1 yıldan bu yana ara sıra olan başağrıları nedeni ile çekilen manyetik görüntülemesinde sella ve parasellar bölgede 4x 3 cm'lik iyi sınırlı, oval görünümlü ve T1 kesitlerde isointens, T2 kesitlerde hiperintens görünümün yanı sıra kistik alanlar ve homojen kontrast tutulumu izlendi. Morfolojik incelemede, nöropil doku içerisinde ganglion hücre odakları görüldü. İmmunohistokimya çalışmasında tümör hücrelerinin pansitokeratin, büyüme hormonu ve sinaptofizin ile fokal olarak pozitif reaksiyon verdiği görüldü. Ganglion hücreleri nörofilament ve sinaptofizinle pozitif reaksiyon verdi. GFAP ile tutulum görülmedi. Ki 67 indeksi yüzde 1'in altında idi. Bu bulguların ışığında gangliositoma ile ilişkili hipofiz adenomu olgusu tanısı konulmuştur.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ossifying pituitary adenoma co-existing with astrocytoma and gangliocytoma associated with pituitary adenoma. two unusual conditions

Jaiswal¹,

Vij²,

Jaiswal³

et al. 2010

Turkish Neurosurgery

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“…Likewise, sellar meningiomas may harbor psammoma bodies [22]. In this context, two exceptional case reports on metaplastic ossification in a somatotroph cell adenoma and a gonadotroph cell adenoma have to be mentioned [23,24]. Considering the high frequency of gonadotroph adenomas and the ''first ever'' character of the constellation documented here, the coexistence of a gonadotroph adenoma and a chondroma is very likely coincidental.…”

Section: Discussionmentioning

confidence: 92%

Sellar collision tumor involving pituitary gonadotroph adenoma and chondroma: a potential clinical diagnosis

et al. 2009

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We report on a 74-year-old male patient who presented with progressive neuroophthalmologic symptoms soon after the administration of a long-acting gonadotropin-releasing hormone agonist for treatment of a prostate cancer. Imaging revealed a destructively growing and extensively calcified sellar mass inconsistent with a pituitary adenoma. A transseptal transsphenoidal tumor mass reduction yielded a histological diagnosis of a collision tumor comprised of a gonadotroph adenoma intermingled with osteochondroma. We discuss a potential causal relationship between the administration of the long-acting gonadotropin-releasing hormone agonist and the sudden appearance of the previously unsuspected sellar lesion. Although the association of these two tumors is very likely coincidental, the possibility of causal relationship is addressed.

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“…Between 0.2 and 14% of pituitary adenomas display radiological evidence of calcification (1) (2), but microscopic calcification is more common, occurring in 5.4–25% of the cases (3) (4). Eleven cases have been described in the literature, comprising five patients with prolactinomas (5) (6) (7) (8) (9), three patients with growth hormone (GH)-secreting adenomas (4) (10) (11), two patients with TSHomas (12) and one patient with a gonadotrophin-secreting tumour (13). It is important to recognise the presence of calcification in pituitary adenomas, as it may influence the choice of surgical approach (transsphenoidal vs transcranial).…”

Section: Introductionmentioning

confidence: 99%

Dense calcification in a GH-secreting pituitary macroadenoma

Ibrahim

Kalhan

Lammie

et al. 2014

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryA 30-year-old female presented with a history of secondary amenorrhoea, acromegalic features and progressive visual deterioration. She had elevated serum IGF1 levels and unsuppressed GH levels after an oral glucose tolerance test. Magnetic resonance imaging revealed a heterogeneously enhancing space-occupying lesion with atypical extensive calcification within the sellar and suprasellar areas. Owing to the extent of calcification, the tumour was a surgical challenge. Postoperatively, there was clinical, radiological and biochemical evidence of residual disease, which required treatment with a somatostatin analogue and radiotherapy. Mutational analysis of the aryl hydrocarbon receptor-interacting protein (AIP) gene was negative. This case confirms the relatively rare occurrence of calcification within a pituitary macroadenoma and its associated management problems. The presentation, biochemical, radiological and pathological findings are discussed in the context of the relevant literature.Learning points Calcification of pituitary tumours is relatively rare.Recognising calcification in pituitary adenomas on preoperative imaging is important in surgical decision-making.Gross total resection can be difficult to achieve in the presence of extensive calcification and dictates further management and follow-up to achieve disease control.

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Ossifying Pituitary Gonadotroph Adenoma: A Case Report

Abstract: Insufficient tumor blood supply may trigger proliferation of connective tissue that subsequently undergoes osteoid metaplasia. Pituitary adenoma with osteoid metaplasia should be included in the differential diagnosis of calcifying tumors in the sella region.

Cited by 13 publications

References 7 publications

Ossifying pituitary adenoma co-existing with astrocytoma and gangliocytoma associated with pituitary adenoma. two unusual conditions

Ossifying pituitary adenoma co-existing with astrocytoma and gangliocytoma associated with pituitary adenoma. two unusual conditions

Sellar collision tumor involving pituitary gonadotroph adenoma and chondroma: a potential clinical diagnosis

Dense calcification in a GH-secreting pituitary macroadenoma

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