[ON THE SUBJECT OF A FEW PROBLEMS POSED BY THE TREATMENT OF CHROMOPHOBE ADENOMAS OF THE PITUITARY].
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Of 20 female and 14 male patients with chromophobe adenomas, 4 male patients, aged 38 to 47 years, and one female patient, aged 54, showed above normal basal plasma levels of follicle-stimulating hormone (FSH). An in vitro tissue culture study that was performed using chromophobe cells obtained from 3 of the 4 male patients and the 1 female patient showed moderate FSH secretion into the culture media. The secretion of FSH by pituitary chromophobe adenomas might be more frequent than hitherto suspected.
1) Nine of 25 cases of chromophobe adenoma revealed abnormally high plasma prolactin level. The plasma prolactin level of these 9 cases ranged from 5300 to 15000 ng/ml, and those of other 16 cases ranged from negligible to 53 ng/ml. 2) Five cases with abnormally high plasma prolactin level had a poor clinical course. 3) Quantitative determination on PEG according to our own method showed that tumor size of these patients with abnormally high plasma prolactin level was larger than that of relatively lower plasma prolactin level. 4) Three of all 25 cases of chromophobe adenoma were histologically diagnosed as pleomorphic. Each of those three cases showed abnormally high plasma prolactin level.
Abnormal calcification on skull films in the region of the sella turcica is not commonly found with chromophobe adenoma. A patient with such calcification in a verified chromophobe adenoma is presented. From the literature the incidence of calcification in these tumours is reviewed. The importance of considering a chromophobe adenoma in the differential diagnosis of parasellar calcification from the surgical point of view is mentioned.
An unusual case of chromophobe adenoma occurring in the third ventricle is reported. Ventriculography revealed a filling defect in the third ventricle and at autopsy the tumour was found in the posterior part of the third ventricle. No tumour was detected in the pituitary gland.
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The work is based on 20 cases of hypophyseal chromophobe adenoma in children of school age. The incidence of hypophyseal chromophobe adenomas grows with age. In distinction from adults, the disease in children follows a more rapid course and usually begins with visual disorders and less frequently with endocrine and metabolic disorders. The visual disorders are mostly manifested by disturbances in the field of vision and diminished visual acuity. Among the auxiliary diagnostic methods, the most informative are X-ray of the sella turcica region and pneumocisterno-encephalography.
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The fine structure of filamentous masses in three cases of chromophobe adenoma of the pituitary gland is reported. These three were among 18 cases of chromophobe adenoma, 13 non-functioning and five with acromegaly, studied by electron microscopy. All the three cases with fine filamentous masses were adenomas with acromegaly and none of the non-functioning adenomas showed these structures. The cells containing filamentous masses were rich in rough endoplasmic reticulum and poor in secretory granules. These masses were composed of fine filaments and, in some, tubular structures and granules were also present. Prominent RER and sometimes an extensive Golgi system was seen in the adjacent cytoplasm. It is suggested that the filamentous masses arise as a result of degeneration and disintegration of RER and Golgi apparatus.
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