Antitumour effects of temozolomide in a man with a large, invasive prolactin-producing pituitary neoplasm.
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The authors described the direct transseptal approach in transsphenoidal surgery for hypophyseal tumors. This route gives a good insight into the area of the sella. The above mentioned method is also less destructive to nasal structures in the nasal cavity, because preserves the anterior nasal septum. It is uniformity of actually views of rhinological school. 20 patients were operated using this method and none of them noticed the changes of nasal airway and the sense of smell.
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Fifty patients undergoing cranial CT had expanded-high-iodine-dose (EHID) scans. The EHID was given either as an additional bolus dose (37--40 g iodine) after a routine infusion contrast scan (42.3 g), or as a continuous infusion (total 74--80 g). Diseases presented include primary and metastatic neoplasm, pituitary neoplasm, and demyelinating disease. The results suggest that the primary usefulness of the EHID is in (a) detecting multiple rather than solitary brain lesions, (b) the definitive demonstration of an equivocal area of abnormal enhancement, and (c) differentiating solid histologically microcystic from frankly macrocystic neoplasms.
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Pituitary adenomas may cause significant difficulties in histological diagnosis when presenting in unusual sites either as extension from an intrasellar lesion or as ectopic tumor. Three such cases, involving the sinonasal tract are described herein, and the differential diagnoses are discussed. Two of them were invasive intrasellar macroadenomas that presented as unilateral nasal polyp, and one was an ectopic pituitary adenoma involving the sphenoid sinus. There was notable cellular atypia in two cases, with nuclear pleomorphism, giant cells, chromatin clumping, and distinct nucleoli, leading to serious consideration of the possibility of poorly differentiated carcinoma. In none of the cases was the diagnosis of pituitary adenoma suspected clinically. The clues to diagnosis were an endocrine growth pattern comprising tumor cells arranged in packets, ribbons, or rosettes, with prominent delicate vascularized stroma; a high index of suspicion; and immunohistochemical showing of neuroendocrine markers and pituitary hormones in the tumor cells. A correct diagnosis is important because in contrast to neuroendocrine carcinoma as a whole or to poorly differentiated carcinoma, pituitary neoplasms have a much more favorable prognosis and a low metastatic potential.
OBJECTIVE: To explore the anesthesia selection in resection of pituitary neoplasms by endoscopic transnasal sphenoidal approach. METHOD: Fifty-six cases with pituitary tumor underwent transnasal sphenoidal endoscopic surgery . Among the 56 cases, 8 cases accepted general anesthesia and 48 cases accepted local anesthesia and sedation. RESULT: All patients had no complains of surgery. 48 cases who accepted local anesthesia and sedation were completed surgery successfully, without graining and struggling during the operation. CONCLUSION: Local anesthesia and sedation is a simple, safe and good selection for resection of pituitary neoplasms by endoscopic transnasal sphenoidal approach.
The gene for multiple endocrine neoplasia type 1 (MEN-1) has recently been cloned and encodes a putative tumor suppressor protein named menin. We have previously reported inactivating MEN-1 gene mutations associated with loss of heterozygosity (LOH) of the normal allele in tumors of patients with MEN-1 and in some sporadic pituitary tumors. These genetic alterations, however, are noted in no more than 10% of sporadic adenomas. To investigate whether other mechanisms may result in down-regulation of menin gene expression in pituitary adenomas, we examined menin gene expression by semiquantitative RT-PCR in 60 sporadic pituitary adenomas. Ribonucleic acid (RNA) was extracted from surgically resected, morphologically characterized tumors. Primers were designed to amplify a 257-bp fragment spanning exons 4-6 of the MEN-1 gene. A product of the predicted size was amplified from normal pituitary samples as well as from adenomas. Competitive PCR was performed with the housekeeping gene PGK-1 to quantitate menin gene expression. A comparable ratio of menin/PGK-1 messenger RNA was identified in all but three samples; in two tumors with LOH, menin expression was weak, and in one tumor, menin messenger RNA was undetectable, associated with LOH and mutation of the other allele. Reduced expression of menin in some sporadic adenomas is consistent with a putative tumor suppressor role for this gene product. However, lack of menin down-regulation in the majority of these tumors, which exhibit LOH at 11q13 in up to 20% of cases, provides compelling evidence for an additional tumor suppressor gene at this locus, which is more commonly involved in the pathogenesis of pituitary neoplasms.
Of 1,106 New World primates necropsied from the National Zoological Park (Washington, D.C.) and the Department of Comparative Pathology, Johns Hopkins University School of Medicine (Baltimore, Maryland) 22 (1.9%) animals were identified with 27 neoplasms. Of this group, nine animals (two females, seven males) had a total of 13 endocrine neoplasms. All animals were adults, with an age range of 2.7-25 years (average, 12.1 years). Seven were Callitrichidae and two were Cebidae. The adrenal gland was the most affected organ, with seven (53.8%) neoplasms, followed by the pituitary and thyroid gland with two (15.4%) cases each, and the pancreas and parathyroid gland with one tumor (7.7%) each. All neoplastic disorders were benign. Immunocytochemistry assays for growth hormone, adrenocorticotropic hormone, prolactin, follicle-stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, and chromogranin A were performed on two pituitary neoplasms. Pheochromocytoma was the most frequent neoplasm, representing 5 (38.4%) of the 13 neoplasms. The remaining were thyroid cystadenoma (two, 15.4%), corticotrophic cell pituitary adenoma (two, 15.4%), adrenal ganglioneuroma (one, 7.7%), adrenal cortical adenoma (one, 7.7%), parathyroid chief-cell adenoma (one, 7.7%), and pancreatic islet-cell adenoma (one, 7.7%).
Metastases from pituitary carcinomas are rare lesions that can mimic other tumors on fine-needle aspiration biopsies. Two patients with primary pituitary neoplasms developed cervical lymph node metastases, which were sampled and diagnosed correctly using the fine-needle aspiration biopsy technique. These two cases demonstrate the varied cytologic patterns of pituitary neoplasms, ranging from uniform bland cells to cells with striking anaplastic features. The time period between the onset of symptoms and subsequent metastases is unpredictable as well, underscoring the need for an accurate clinical history before a meaningful cytologic interpretation is made.
The frequency of growth hormone (GH) deficiency in patients operated for pituitary neoplasms of various size and type was investigated using the insulin tolerance test. 45 patients were included in the study. 20 of the patients had a non-hormone secreting pituitary neoplasm, 9 had GH-, 6 ACTH-, 7 prolactin secreting adenomas and 3 had a craniopharyngeoma. Complete endocrinological examination was obtained in all patients after pituitary surgery. Apart from patients operated for GH secreting adenomas, GH deficiency was very common after pituitary surgery (92%), even in patients operated for small lesions. Among the 45 patients LH/FSH deficiency was found in 33%, ACTH in 33%, TSH in 18% and ADH deficiency in 9% of the patients. In this study, impaired GH secretion was found to be independent of the size of the tumors and was present in nearly all patients after pituitary surgery (with exception of GH secreting adenomas). Deficiencies of other pituitary hormones were predominantly observed after surgery for large tumors.
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Morphologic studies of pituitary neoplasms removed by srugery from 36 human patients revealed 8 chromophobe adenomas which differed clearly from the remaining tumors. The cytoplasm of the adenoma cells failed to stain with PAS, aniline blue, adehyde fuchsin, aldehyde thionin, orange G or light green, but positively stained granules were found by using erythrosine or carmosine. Immunoperoxidase technique disclosed the presence of prolactin in the cytoplasm of some adenoma cells. The adenoma cells exhibited distinct ultrastructural features such as well developed rough surfaced endoplasmic reticulum with Nebenkern formation, prominence of Golgi apparatus, presence of misplaced exocytosis as well as pleomorphism of secretory granules with a considerable variation of size ranging from 130 to 500 nm in diameter. Thus, by electron nicroscopy the adenoma cells showed a close resemblance to prolactin cells of the non-tumouous pituitary glands except for the reduced size and number of secretory granules. Thes chromophobe adenomas are regarded as representing a distinct pathological entity clearly distinguishable from other forms of pituitary neoplasms. In view of the morphologic findings and the elevation of blood prolactin level (measured in 3 patients) the term, "sparsely granulated prolactin producing pituitary adenoma", appears to be the most appropriate one to designate these tumors.
A study was undertaken to determine the length of time that human pituitary tumours are capable of releasing anterior pituitary polypeptide hormones in vitro under basal conditions and to study the spectrum of hormone release by functioning and "non-functioning" pituitary neoplasms. Fragments from the pituitary tumours of 10 patients in the following categories: 1 Cushing's disease, 2 with amenorrhoea-galactorrhoea, 3 with acromegaly, and 4 with "non-functioning" pituitary tumours and from 2 normal human anterior pituitary glands were placed in primary culture immediately after surgery. The in vitro release of human growth hormone (hGH), prolactin (Prl), thyrotrophin (TSH), adrenocorticotrophin (ACTH), luteinizing hormone (LH), and follicle stimulating hormone (FSH) was measured by specific radioimmunoassays at the end of each week in culture. Hormone release was surveyed from 6 weeks to 6 months depending upon the survival of the culture. Hormone release patterns were compared with clinical and pathological data. In the initial week of the study, all 6 anterior pituitary polypeptides were detected in the media from the 2 control pituitaries and from 4 of the tumours (1 amenorrhoea-galactorrhoea and 3 acromegaly) in concentrations up to 100 ng/ml of medium while 5 of the 6 hormones were readily detectable in the media from 2 additional tumour samples (Cushing's disease and 1 "non-functioning" pituitary tumour). The media of the remaining 4 tumours contained at least 3 of the 6 hormones (1 amenorrhoea-galactorrhoea and 3 "non-functioning" pituitary tumours). After 6 months in culture, the 6 hormones were readily detectable in at least 1 of the 5 surviving cultures and hGH (up to 800 ng/ml) and LH were each detectable in the media from 2 cultures. Although most of the hormone concentrations in the media decreased with length of time in culture, there were 2 exceptions. First in the media from 5 of the 12 cultures from both controls and tumours, Prl concentrations increased after 50 to 80 days culture. This increase usually lasted for several weeks before Prl levels again began to decline. The second unusual finding occurred in a tumour from a patient with acromegaly in the media of which hGH levels rose from 60 ng/ml to 800 ng/ml between days 125 and 174. These findings of prolonged hormone release in vitro give promise of future usefulness of tissue culture methods for study of polypeptide hormone releasing mechanisms and long-term production of human anterior pituitary hormones for use in research and possible therapy.