scholarly journals A Rare Case of Sellar Mass Composed of Primary Leiomyosarcoma and Pituitary Adenoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A567-A567
Author(s):  
Young Ki Kim ◽  
In Sun Goak ◽  
Yu Ji Kim ◽  
Heung Yong Jin ◽  
Tae Sun Park ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Rare Case ◽  
Smooth Muscle Actin ◽  
Brain Mri ◽  
Sinus Surgery ◽  
Pituitary Mass ◽  
Post Surgery ◽  
Composite Tumor ◽  
Malignant Lesions

Abstract Background: Nonfunctioning pituitary adenomas (NFPAs) are most common pituitary tumors, and primary pituitary gland malignancies are extremely rare. Most malignant pituitary gland lesions metastasize from other sites. Primary malignant lesions, such as sarcomas, usually develop after radiotherapy or chemotherapy for other diseases. We report a rare case of primary sellar leiomyosarcoma (LMS) without prior therapy that arose concurrently with a pituitary adenoma. Clinical Case: A 56-year-old woman with ptosis of the right eye, headache, and progressive visual deficits visited our neurosurgery department. She had no medical history besides hypertension. Twelve months ago, she was referred to us because of decreased visual acuity and a 3.5×3.6-cm-sized pituitary mass detected on brain MRI. Normal pituitary functions with mild hyperprolactinemia suggested a nonfunctioning pituitary mass with stalk compression. After transsphenoidal surgery, histopathology revealed a pituitary adenoma; MRI immediately post-surgery revealed no grossly remnant lesion. However, during the current visit, sellar MRI revealed a re-growing mass in the pituitary fossa extending to the sphenoid sinus and compressing the optic chiasm with a suprasellar extension. Functional endoscopic sinus surgery was performed, and histopathology revealed a composite tumor, i.e., a mesenchymal tumor with a pituitary adenoma. On immunohistochemical staining, smooth muscle actin, synaptophysin, and chromagranin were positive; tumor cell mitosis was observed at 7/10 high-power fields. Finally, a composite tumor of myxoid leiomyosarcoma and pituitary adenoma was diagnosed. Hence, systemic chemotherapy with radiotherapy was planned for the remnant lesion. Hormonal replacement therapy with hydrocortisone and thyroxine was also started for subsequent hypopituitarism. Conclusion: NFPA is benign and has good prognosis if it is not grow in size or is completely resected. Conversely, primary sarcomas, such as LMS, show rapid extension and aggressive local invasion. Although their incidence is extremely rare, few primary pituitary sarcoma cases with or without pituitary adenoma have been reported. In the former case, initial diagnosis of pituitary adenoma may lead to delayed diagnosis of combined malignant lesions. Thus, clinicians should consider this possibility and high index of suspicion is required when diagnosing a pituitary mass.

scholarly journals SAT-252 A Rare Case of Crooke’s Adenoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Adeyinka Taiwo ◽  
Marcelo Correia ◽  
Nicole Peyton
Keyword(s):  
Rare Case ◽  
Hormone Replacement ◽  
Brain Mri ◽  
Cranial Nerves ◽  
Pituitary Function ◽  
Csf Leak ◽  
Cell Adenoma ◽  
Post Surgery ◽  
Function Tests ◽  
The Right

Abstract BACKGROUND: Crooke’s cell adenoma is a rare variant of ACTH-secreting corticotroph adenomas (<1%). These are aggressive macroadenomas and usually invade the cavernous sinus producing visual symptoms. Clinical Case: A 48-year old male presented with acute right eye and right temple pain, and diplopia that started 6 days prior. Past medical history included hypertension, type 2 diabetes, hyperlipidemia, traumatic brain injury, CSF leak with bacterial meningitis s/p sphenoid repair and palsy of the right III, V and VI cranial nerves. Head CT showed a 1.9 x 2.1 x 1.5 cm soft tissue-density mass medial to the right cavernous carotid artery extending into the sphenoid sinus. There was expansile bony change to the floor and right dorsum of the sella. The mass showed mild contrast enhancement and abutted the superior orbital fissure. A brain MRI was not obtained due to history of a left cochlear implant. He did not have any cushingoid features on exam. Neuro-ophthalmology exam revealed, severe sixth cranial nerve palsy, bilateral optic disc pallor and a mild right superotemporal visual field defect. Pre-operative pituitary function tests revealed ACTH 103 pg/ml (7–63), cortisol 14 ug/dl (6.0–18.4), FSH 2.7 mIU/ml (1.5–12.4), LH 3.8 mIU/ml (1.7–8.6), prolactin 17.6 ng/ml (4–15.2), total testosterone 175 ng/dl (249–836), TSH 1.10 uIU/ml (0.27–4.20), free T4 0.67ng/dl (0.8–1.8) and IGF-1 208 ng/ml (69–224). He underwent successful endoscopic trans-sphenoidal resection of a 4.2 x 2.5 x 0.5 cm mass. Pathology revealed hyaline deposits in the cytoplasm and perinuclear cytokeratin in more than 50% of the adrenocorticotroph cells consistent with Crooke’s cell adenoma. Post-operatively, his right eye pain and abduction deficit improved, and diplopia returned to baseline. He was placed on a short hydrocortisone taper. Due to high risk of recurrence, he received 54Gy in 30 fractions to the sella. Six and 12-month follow-up head CTs revealed stable residual enhancing tissue. Pituitary function tests done 9 months post-surgery were normal and no hormone replacement was needed. He was clinically stable 12 months after surgery. Conclusion: We described a rare case of invasive Crooke’s cell pituitary adenoma with visual disturbances that was managed with resection and radiotherapy. The patient remained free of recurrence 1 year later. However, lifetime surveillance is necessary due to high incidence of recurrence. Reference: 1. Crooke’s Cell Tumors of the Pituitary. Neurosurgery, Volume 76, Issue 5, May 2015, Pages 616–22

Pituitary gland involvement by a gamma delta hepatosplenic lymphoma, a mimicker of pituitary adenoma: report of a rare case

2008 ◽  
Vol 88 (2) ◽  
pp. 237-241 ◽  
Author(s):  
D. Jain ◽  
M. C. Sharma ◽  
C. Sarkar ◽  
V. Suri ◽  
A. Garg ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Rare Case ◽  
Gamma Delta ◽  
Hepatosplenic Lymphoma

scholarly journals Giant Pituitary Adenoma Presenting with Foster-Kennedy Syndrome in a 21-Year Old Ethiopian Patient: A Rarely Reported Phenomenon: A Case Report

2020 ◽  
Vol 30 (2) ◽  
Author(s):  
Biniyam Ayele ◽  
Abenet Mengesha ◽  
Abdi Wotiye ◽  
Yodit Alemayehu
Keyword(s):  
Pituitary Adenoma ◽  
Visual Field ◽  
Pituitary Gland ◽  
Wide Spectrum ◽  
Brain Mri ◽  
Visual Disturbance ◽  
Serum Prolactin ◽  
Sellar Region ◽  
Giant Pituitary Adenoma ◽  
Foster Kennedy Syndrome

BACKGROUND: Disorders of the pituitary gland and the sellar region present a wide spectrum of clinical problems. A variety of lesions in this area tend to present with similar problems; namely, headache, hormonal disorders, and loss of vision. Benign adenomas of the pituitary gland are by far the most common disorders of sellar region. Rarely, patients with pituitary adenoma may present with blindness in one eye and visual field cut (temporal hemianopia) in the contralateral eye. This rare clinical entity is called Foster-Kennedy Syndrome (FKS).CASE PRESENTATION: We present a 21-year-old male patient, presented with progressive visual disturbance of the left eye, associated with global headache. The headache was refractory to over-counter medications. In addition, he had history of sleep disturbance and loss of appetite. Neurological examination was pertinent for left side visual loss with optic atrophy and right eye temporal visual field cut with disc edema. Brain MRI showed 4 cm X 3.5 cm sized lobulated intra and supra sellar mass with heterogeneous contrast enhancement and minimal surrounding edema. Serum prolactin level was 6,705 ng/mL. Otherwise, the other pituitary hormones were in normal range.CONCLUSION: This case highlighted that pituitary adenoma may present with the full picture of Foster Kennedy syndrome. Therefore, we recommend considering pituitary adenoma as a possible differential diagnosis of intracranial lesions presenting as Foster Kennedy syndrome, as early detection and management could potentially salvage patients’ vision and quality of life.

Primary Intrasellar Coccidioidomycosis Simulating a Pituitary Adenoma

Neurosurgery ◽  
1991 ◽  
Vol 28 (5) ◽  
pp. 748-751 ◽  
Author(s):  
M. Scanarini ◽  
A. Rotilio ◽  
L. Rigobello ◽  
A. Pomes ◽  
A. Parenti ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Cavernous Sinus ◽  
Transsphenoidal Approach ◽  
Mass Lesion ◽  
Pituitary Mass ◽  
Radiological Studies

Abstract The case of a 68-year-old woman who had relatively acute, unilateral ophthalmoplegia is reported. Radiological studies indicated a mass lesion involving the pituitary gland and left cavernous sinus. Pathological tissue obtained by the transsphenoidal approach revealed the presence of a Coccidioides granuloma. This pathological entity should be considered when evaluating patients with a pituitary mass and ophthalmoplegia.

A rare case of spontaneously cured acromegaly by the apoplexy of the pituitary adenoma

2019 ◽  
Author(s):  
Carla L Scanteie ◽  
Silviu Crainic ◽  
Cristina Ghervan
Keyword(s):  
Pituitary Adenoma ◽  
Rare Case

scholarly journals Post-Surgery Subcutaneous Seeding of Laryngeal Squamous Cell Carcinoma: A Rare Case

2021 ◽  
pp. 568-572
Author(s):  
Yongquan Jiang ◽  
Wanxin Cao ◽  
Yuanbo Luo ◽  
Ji Xu ◽  
Ying Li ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Head And Neck Cancer ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Locoregional Recurrence ◽  
Rare Case ◽  
Laryngeal Squamous Cell Carcinoma ◽  
Primary Lesion ◽  
Lymphogenous Metastasis ◽  
Post Surgery

Laryngeal squamous cell carcinoma (LSCC) is the most common malignant head and neck cancer, with a 40% recurrence rate in the first 3 years after radical treatment. Recurrence of LSCC mostly comprises lymphogenous metastasis, hematogenic metastasis, and locoregional recurrence, while LSCC seeding is rarest: there are only 4 cases reported in PubMed, and none of them is one of subcutaneous seeding. We report a case with post-surgery subcutaneous seeding of LSCC. The final biopsy demonstrated that the subcutaneous seeding of the LSCC was 2 cm away from the primary lesion, with no recurrent foci observed in the larynx and tracheostoma and little relation to the primary lesion. Thus, we drew the conclusion that LSCC surgeries should stick to the principle of the non-tumor technique to prevent subcutaneous seeding.

scholarly journals The combination of 13N-ammonia and 11C-methionine in differentiation of residual/recurrent pituitary adenoma from the pituitary gland remnant after trans-sphenoidal Adenomectomy

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fangling Zhang ◽  
Qiao He ◽  
Ganhua Luo ◽  
Yali Long ◽  
Ruocheng Li ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Gray Matter ◽  
Standard Uptake Value ◽  
Visual Evaluation ◽  
Additional Surgery ◽  
Pet Ct ◽  
Histological Confirmation ◽  
G Ratio

Abstract Background This study aimed to assess the clinical usefulness of 13N-ammonia and 11C- Methionine (MET) positron emission tomography (PET)/ computed tomography (CT) in the differentiation of residual/recurrent pituitary adenoma (RPA) from the pituitary gland remnant (PGR) after trans-sphenoidal adenomectomy. Methods Between June 2012 and December 2019, a total of 19 patients with a history of trans-sphenoidal adenomectomy before PET/CT scans and histological confirmation of RPA after additional surgery in our hospital were enrolled in this study. Images were interpreted by visual evaluation and semi-quantitative analysis. In semi-quantitative analysis, the maximum standard uptake value (SUVmax) of the target and gray matter was measured and the target uptake/gray matter uptake (T/G) ratio was calculated. Results The T/G ratios of 13N-ammonia were significantly higher in PGR than RPA (1.58 ± 0.69 vs 0.63 ± 1.37, P < 0.001), whereas the T/G ratios of 11C-MET were obviously lower in PGR than RPA (0.78 ± 0.35 vs 2.17 ± 0.54, P < 0.001). Using the canonical discriminant analysis, we calculated the predicted accuracy of RPA (100%), PGR (92.9%), and the overall predicted accuracy (96.43%). Conclusions The combination of 13N-ammonia and 11C-MET PET/CT is valuable in the differentiation of RPA from PGR after trans-sphenoidal adenomectomy.

U mỡ trong xương bướm: một trường hợp hiếm gặp

2021 ◽  
Author(s):  
Thu Hien Trinh Thi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Rare Case ◽  
Imaging Techniques ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Sphenoid Bone ◽  
Resonance Imaging ◽  
Large Tumor ◽  
Intraosseous Lipoma

TÓM TẮT U mỡ trong xương là khối u lành tính hiếm gặp, thường gặp ở các xương dẹt, hiếm gặp ở xương nền sọ, đặc biệt là xương bướm. Trong đa số các trường hợp, u mỡ trong xương bướm thường được phát hiện tình cờ qua chụp cắt lớp vi tinh (CLVT) hoặc cộng hưởng từ (CHT) sọ não. Đây là một khối u phát triển chậm, ít gây ra triệu chứng, một số trường hợp gây triệu chứng khi khối u to chèn ép vào cấu trúc lân cận như tuyến yên hoặc dây thần kinh thị. Trong bài này, chúng tôi báo cáo một trường hợp u mỡ trong xương bướm không triệu chứng được phát hiện tình cờ và được chẩn đoán dựa vào phim chụp cộng hưởng từ sọ não. Bệnh nhân được khuyến nghị theo dõi định kỳ bằng cộng hưởng từ mà không phải tiến hành bất kỳ phương pháp điều trị nào. Từ khóa: U mỡ, xương bướm, MRI, cộng hưởng từ sọ não, chẩn đoán hình ảnh. ABSTRACT INTRAOSSEOUS LIPOMA OF SPHENOID BONE: A RARE CASE REVIEW Intraosseous lipoma is very rare, usually benign tumor of flat bones. The incidence of an intraosseous lipomalocated basal skull bones is extremely rare, especially in sphenoid bone. Radiological imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) are used to detect the intraosseous lipoma by accident. These tumors are slow growing and usually asymptomatic, in some cases causing symptoms when the large tumor presses on nearby structures such as pituitary gland or the optic nerve. We present a rare case of lipomaof the sphenoid bone discovered incidentally with brain magnetic resonance imaging. The patient has been followed-up by magnetic resonance imaging without the need for surgery. Keywords: Intraosseous lipoma, sphenoid bone, MRI, brain MRI, diagnostic radiology

Metastases to the Pituitary Gland: Histological Patterns of Spread and Review of the Literature

2021 ◽  
Author(s):  
B K Kleinschmidt-DeMasters
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Surgical Excision ◽  
Disease Course ◽  
Review Of The Literature ◽  
Metastatic Cells ◽  
Filling Pattern ◽  
Pituitary Metastases ◽  
Atypical Pituitary Adenoma ◽  
Disease Stages

Abstract Few studies have focused on histological patterns of metastatic spread to the pituitary gland. We review our experience and that in the literature, 1970–present. Departmental cases, 1998–2021, were assessed for anterior versus posterior gland and/or capsular involvement and cohesive tumor obliterating underlying pituitary architecture versus metastatic cells filling pituitary acini with relative acinar preservation. Eleven autopsy/15 surgical cases, including 2 metastases to pituitary adenomas, were identified. Cohesive/obliterative patterns predominated histologically in both surgical and autopsy cases, but acinar filling by metastatic cells was extensive in 3/26 cases, focal in 5/26, and had resulted in initial erroneous impressions of atypical pituitary adenoma/pituitary carcinoma in 1 case and pituitary adenoma with apoplexy in another, likely due to focusing on necrotic areas in the specimen where the acinar pattern had been broken down and not appreciating nearby areas with acinar filling by metastatic cells. Although most pituitary metastases produce readily identifiable cohesive/obliterative patterns, diagnostic challenges remain with the less frequently seen “acinar filling” pattern. A dichotomy exists between patients with symptomatic pituitary metastases occurring early in the disease course and requiring surgical excision versus patients in whom asymptomatic small pituitary metastases are found incidentally at autopsy, the latter almost invariably in late disease stages, with widely disseminated metastatic disease.

EP.FRI.543 A rare case of acute jejuno-jenual intussusception in a patient with Roux-en-Y bypass secondary to a benign polyp

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Armin Fardanesh ◽  
Jamie Powell ◽  
Maitham Al-Whouhayb
Keyword(s):  
Small Bowel ◽  
Rare Case ◽  
Exploratory Laparotomy ◽  
Lead Point ◽  
Benign Polyp ◽  
Small Bowel Intussusception ◽  
Pathological Lead Point ◽  
Malignant Lesions ◽  
Ectopic Pacemaker ◽  
Upper Abdominal

Abstract Introduction Roux-en-Y Gastric bypass (REYGB) amounts for a third of surgical bariatric interventions. Small bowel obstruction (SBO) is a long-term complication in REYGB and can be caused by intussusception of bowel, in approximately 0.5% of procedures.  Intussusception in REYBG is mostly attributed to dysmotility. This report demonstrates a rare case of intussusception in REYGB secondary to a benign polyp.  Case description A 45 year old female, three years post REYGB, presented to A&E with acute, extreme upper abdominal pain, with three days absolute constipation. She was tender on examination with normal blood tests. CT scan demonstrated small bowel intussusception. Initial concerns were of intussusception of the jejuno-jejunostomy anastomosis causing SBO.  She had an exploratory laparotomy, which confirmed intussusception, however this was 20cm distal to the jejuno-jejunostomy. Bowel was gently reduced, and deemed viable. On thorough run-through, a small segment at the transition point, was considered abnormal on palpation. This region was resected and a 1x1cm intraluminal polyp was identified as the causative lead point. The patient did well postoperatively.  Discussion Small bowel intussusception in adults is typically attributed to pathological lead point, such as benign or malignant lesions. Intussusception in REYBG is a rare but well-documented cause of intestinal obstruction, usually attributed to dysmotility, secondary to ectopic pacemaker cells particularly around anastomoses. In this case, the intussusception was caused by an unusual pathology separate from the jejuno-jejunal anastomosis. We recommend thorough examination of all adjacent bowel to exclude lesions, in this case a polyp, which could result in recurrence. 

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