Two Cases of Double Adenomas in a Surgical Series over 16 Years in a Single Centre

Background: Double pituitary adenomas (DA) are two morphologically and immunohystochemically different tumours in the same gland. They are rare, generally small adenomas and divided in: separated, when clearly recognizable before or during surgery, and contiguous, when diagnosed only in the following histopathological examination. Acromegaly and Cushing’s disease are the main prevalent clinical presentation. Objective: We described two cases of DA in a surgical series over 16 years in a single center. Methods: In September 2018 we diagnosed a DA in a man with acromegaly (case 1). In order to assess the presence of other cases of DA, we performed a retrospective analysis of the endonasal endoscopically operated sellar adenomas from January 2004 to December 2019. Results : 468 pituitary adenomas were found. A DA with a Pit-1 positive small macroadenoma (GH-TSH- PRL positive) and an ACTH microadenoma clinically silent in an acromegalic woman was retrospectively found (case 2). Conclusion : Our analysis confirms that DA are rare (0.4 % of the pituitary adenomas) and often associated with acromegaly. Their pre-operatively diagnosis is difficult but clinician’s awareness of DA can improve the diagnosis. The use of pituitary transcription factors could be useful in detecting DA.

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Double Adenomas of the Pituitary: Transcription Factors Pit-1, T-pit, and SF-1 Identify Cytogenesis and Differentiation

Endocrine Pathology ◽

10.1385/ep:16:3:187 ◽

2005 ◽

Vol 16 (3) ◽

pp. 187-194 ◽

Cited By ~ 23

Author(s):

R. A. Jastania ◽

K. O. Alsaad ◽

M. Al-Shraim ◽

K. Kovacs ◽

S. L. Asa

Keyword(s):

Transcription Factors ◽

Pituitary Transcription Factors ◽

Double Adenomas

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O-Methylguanine-DNA Methyltransferase Immunoexpression in a Double Pituitary Adenoma

Neurosurgery ◽

10.1227/01.neu.0000363852.77126.ad ◽

2010 ◽

Vol 66 (2) ◽

pp. E421-E422 ◽

Cited By ~ 8

Author(s):

Safraz Mohammed ◽

Michael D. Cusimano ◽

Bernd W. Scheithauer ◽

Fabio Rotondo ◽

Eva Horvath ◽

...

Keyword(s):

Pituitary Adenoma ◽

Dna Methyltransferase ◽

Clinical Presentation ◽

Blood Levels ◽

Cell Adenoma ◽

Ki 67 ◽

Methylguanine Dna Methyltransferase ◽

Double Pituitary Adenomas ◽

Double Adenomas ◽

Transsphenoidal Resection

Abstract OBJECTIVE Double pituitary adenomas in surgical cases are rarely reported. The incidence in published surgical specimens ranges from 0.4% to 1.3%. We present a treatment dilemma of a double adenoma that had differential O-methylguanine-DNA methyltransferase (MGMT) reactivity. CLINICAL PRESENTATION A 48-year-old man presented with acromegaly and a recurrent pituitary adenoma. He had elevated growth hormone (GH) and elevated insulin-like growth factor blood levels and hyperprolactinemia. INTERVENTION Subtotal transsphenoidal resection was performed. Morphologic examination disclosed 2 histologically distinct tumors, including a GH adenoma and a prolactin adenoma. Immunohistochemistry revealed Ki-67 labeling indices of 1% and 2%, respectively. Of significant note was MGMT immunopositivity in the GH adenoma and lack of staining in the prolactin adenoma. CONCLUSION This is the first clinical instance in which MGMT was assessed in double adenomas of the pituitary. The 2 tumors showed significant differences in reactivity that could impact chemotherapeutic management. The adenomas underwent recurrence, a feature that reflects their invasive nature and the possibility that chemotherapeutic intervention may be required in the future. Response to temozolomide use is anticipated with respect to the prolactin adenoma but would likely not benefit the GH cell adenoma of our patient.

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Double pituitary adenomas in a large surgical series

Pituitary ◽

10.1007/s11102-019-00996-2 ◽

2019 ◽

Vol 22 (6) ◽

pp. 620-632

Author(s):

Grzegorz Zieliński ◽

Emir Ahmed Sajjad ◽

Maria Maksymowicz ◽

Monika Pękul ◽

Andrzej Koziarski

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Pituitary Adenomas ◽

Clinical Laboratory ◽

Histopathological Examination ◽

Cushing's Disease ◽

Imaging Data ◽

Tertiary Center ◽

Double Pituitary Adenomas ◽

Double Pituitary Adenoma

Abstract Purpose To explore the incidence of double pituitary adenomas in a tertiary center for pituitary surgery and asses their clinical, imaging and histopathological features. Methods The medical records of the patients operated on for pituitary tumors at the Department of Neurosurgery of Military Institute of Medicine in Warsaw, Poland between the years 2003 and 2018 were retrospectively analyzed. Among the 3270 treated patients, the diagnosis of double pituitary adenoma was established in 22 patients. Clinical, laboratory, detailed histopathological and diagnostics imaging data were collected and analyzed. Results There were 21 cases of synchronous and one case of asynchronous double pituitary adenoma. The main clinical finding was acromegaly (12/22) followed by Cushing’s disease (3/22). The diagnosis of synchronous double pituitary adenoma was suspected in the preoperative MRI in 11 patients. In the remaining patients the diagnosis of contiguous double pituitary adenoma was confirmed in the histopathological examination. There was no predilection for gender and the mean observation time was 74.2 months. In one case of Cushing’s disease the occurrence of double pituitary adenoma led to the initial failure of achieving hormonal remission. One patient presented with double pituitary adenomas as a manifestation of Carney complex. Conclusions Double pituitary adenoma is a rare entity that can pose a significant challenge especially in the setting of Cushing’s disease. Careful inspection of preoperative MRI and diagnostic work-up before transsphenoidal surgery and thorough histopathological microscopic examinations with immunohistochemical staining for all pituitary hormones is essential for establishing the diagnosis of double pituitary adenoma.

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Double Pituitary Adenomas with Synchronous Somatotroph and Corticotroph Clinical Presentation of Acromegaly and Cushing's Disease

World Neurosurgery ◽

10.1016/j.wneu.2019.08.224 ◽

2019 ◽

Vol 132 ◽

pp. 161-164

Author(s):

Naomi Collazo-Gutiérrez ◽

Orlando de Jesús ◽

Maria Villamil-Jarauta ◽

Milliette Alvarado ◽

Loida González ◽

...

Keyword(s):

Cushing’S Disease ◽

Pituitary Adenomas ◽

Clinical Presentation ◽

Cushing's Disease ◽

Double Pituitary Adenomas

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A Retrospective Analysis of Colorectal Serrated Lesions from 2005 to 2014 in a Single Center: Importance of the Establishment of Diagnostic Patterns

Gastroenterology Research and Practice ◽

10.1155/2018/5946057 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

Priscilla S. P. Oliveira ◽

Rita B. Carvalho ◽

Daniela O. Magro ◽

Michel G. Camargo ◽

Carlos A. R. Martinez ◽

...

Keyword(s):

Colorectal Cancer ◽

Retrospective Analysis ◽

Histopathological Examination ◽

Morphological Characterization ◽

Histological Diagnosis ◽

Single Center ◽

Serrated Adenoma ◽

Serrated Lesions ◽

Patient’S History ◽

Serrated Adenomas

Background. Serrated colorectal lesions are increasingly recognized as an important process in the development of colorectal cancer. Endoscopic and histological diagnosis may be difficult, and knowledge of the serrated lesions is important for the establishment of strategies for treating colorectal lesions. We aimed to analyze serrated lesions diagnosed at a single center and evaluate if there was an increase in their identification over the years. Design and Setting. A retrospective analysis of colonoscopy reports was performed at a specialized center from 2005 to 2014. Methods. Colonoscopy reports about any resected endoscopic lesions were reviewed and subjected to histological diagnosis from 2005 to 2014. Then, serrated lesions were evaluated based on morphological characterization, location, size, occurrence of synchronous lesions, and the patient’s history of colorectal cancer and polyps. Results. A total of 2126 colonoscopy examination reports were reviewed, and 3494 lesions were analyzed. On histopathological examination, 1089 (31.2%) were classified as hyperplastic polyps, 22 (0.6%) as sessile serrated adenomas, and 21 (0.6%) as traditional serrated adenomas. There was an increase in the number of cases of sessile and traditional serrated adenomas diagnosed after 2010. Before 2010, two cases of sessile serrated adenomas and seven cases of traditional serrated adenomas were diagnosed; after 2010, 20 cases of sessile serrated adenoma and 14 cases of traditional serrated adenomas were diagnosed. Conclusion. There was an increase in the diagnosis of sessile serrated adenomas over the years, which can be attributed to better accuracy in colonoscopy and histological classification.

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