Pituicytoma (pilocytic astrocytoma)

1987 ◽  
Vol 67 (5) ◽  
pp. 768-772 ◽  
Author(s):  
Marco L. Rossi ◽  
John S. Bevan ◽  
Margaret M. Esiri ◽  
John T. Hughes ◽  
Christopher B. T. Adams
Keyword(s):  
Pilocytic Astrocytoma ◽  
Serum Prolactin ◽  
Posterior Pituitary ◽  
Surgical Biopsy ◽  
Content Type ◽  
Cytoplasmic Filaments ◽  
Positive Immunostaining ◽  
Pituitary Lesion ◽  
Visual Failure ◽  
Fine Print

✓ Tumors of the posterior pituitary are rare and the previous nomenclature has been confusing. A 40-year-old man presented with visual failure and disconnection hyperprolactinemia (830 mU/liter) due to a large invasive pituitary tumor shown to be a pituicytoma (pilocytic astrocytoma). Its astrocytic nature was confirmed by positive immunostaining for glial fibrillary acidic protein and the finding of cytoplasmic filaments on electron microscopy. This case report contains the pathological description of a pituicytoma and illustrates that a non-adenomatous pituitary lesion may masquerade as a pituitary adenoma. Large pituitary lesions associated with serum prolactin concentrations of less than 3000 mU/liter require early surgical biopsy.

Distinctions between pituicytoma and ordinary pilocytic astrocytoma

2003 ◽  
Vol 98 (2) ◽  
pp. 404-406 ◽  
Author(s):  
Toshiro Katsuta ◽  
Tooru Inoue ◽  
Hiroyuki Nakagaki ◽  
Morishige Takeshita ◽  
Ken Morimoto ◽  
...  
Keyword(s):  
Pilocytic Astrocytoma ◽  
Rare Case ◽  
Sellar Region ◽  
Magnetic Resonance Study ◽  
Content Type ◽  
Spindle Cells ◽  
History Of ◽  
Pituitary Lesion ◽  
Fine Print ◽  
Transsphenoidal Resection

✓ The authors present a rare case of pituicytoma. A dynamic magnetic resonance study performed after Gd injection revealed a markedly, homogeneously enhanced, early-phase pituitary lesion in a 32-year-old woman with a 1-year history of amenorrhea. The tumor bled easily during transsphenoidal resection. The lesion consisted of plump spindle cells and lacked Rosenthal fibers and granular bodies, and thus was different from ordinary pilocytic astrocytoma or any other form of this tumor. Although pituicytoma is often confused with pilocytic astrocytoma when it appears in the sellar region, these two kinds of gliomas should be distinguished on the basis of histological differences.

Malignant transformation in benign cerebellar astrocytoma

1978 ◽  
Vol 49 (1) ◽  
pp. 111-118 ◽  
Author(s):  
George M. Kleinman ◽  
William C. Schoene ◽  
Thomas M. Walshe ◽  
Edward P. Richardson
Keyword(s):  
Malignant Transformation ◽  
Pilocytic Astrocytoma ◽  
Partial Removal ◽  
Content Type ◽  
Cerebellar Astrocytoma ◽  
Juvenile Pilocytic Astrocytoma ◽  
Pilocytic Astrocytomas ◽  
Infiltrative Growth Pattern ◽  
Fine Print

✓ The authors give follow-up information on Case 59 of Cushing's 1931 series of cerebellar astrocytomas. The patient died with a malignant cerebellar astrocytoma 48 years after partial removal of a previously benign astrocytoma at the same site. Including the present one, there have been only five reported cases in which this has occurred. Ordinarily, juvenile pilocytic astrocytomas are of extremely benign character, and it is well established that even with incomplete resections patients have survived for years without progression of the tumor. Not all of the cases so reported can be wholly accepted as representing malignant transformation of the tumor, but may instead be instances of recurrence of an inherently benign glioma since the presence of features such as endothelial hyperplasia or nuclear atypicality in a juvenile pilocytic astrocytoma does not warrant its being classified as malignant. Features truly suggestive of malignancy are hypercellularity, frequent mitoses, necrosis, and, in some instances, a diffusely infiltrative growth pattern; all of these features were found in the present case.

Predictive value of serum prolactin levels measured immediately after transsphenoidal surgery

2002 ◽  
Vol 97 (2) ◽  
pp. 307-314 ◽  
Author(s):  
Arun P. Amar ◽  
William T. Couldwell ◽  
Joseph C. T. Chen ◽  
Martin H. Weiss
Keyword(s):  
Prolactin Level ◽  
Serum Prolactin ◽  
Surgical Removal ◽  
Consecutive Series ◽  
Cure Rate ◽  
Content Type ◽  
Group 2 ◽  
Fine Print ◽  
Group 1

Object. Prolactin-secreting pituitary adenomas may be managed by surgery, medication, radiotherapy, or observation. The authors reviewed a consecutive series of patients who were followed for at least 5 years after surgery to assess the prognostic significance of preoperative factors (tumor size and prolactin level) and an immediate postoperative factor (prolactin level obtained the morning after surgery) on long-term hormonal outcome, thereby clarifying the indications for surgical removal of tumor, the definition of successful treatment outcomes, and the nature of “recurrent” tumors. Methods. Between 1979 and 1991, 241 patients with prolactinomas underwent transsphenoidal resection. Nineteen patients were lost to follow-up review, whereas the remaining 222 patients underwent measurement of their prolactin levels on postoperative Day 1 (POD 1), at 6 and 12 weeks, and every 6 months thereafter for a minimum of 5 years. On POD 1, prolactin levels in 133 patients (Group 1) were lower than 10 ng/ml, in 43 patients (Group 2) between 10 and 20 ng/ml, and in 46 patients (Group 3) higher than 20 ng/ml. At 6 and 12 weeks, normal prolactin levels (≤ 20 ng/ml) were measured in 132 (99%) of the 133 patients in Group 1 but only in 32 (74%) of the 43 patients in Group 2. By 5 years postoperatively, normal levels of prolactin were still measured in 130 patients (98%) in Group 1 compared with only five patients (12%) in Group 2. No patient with a prolactin level lower than 3 ng/ml on POD 1 was found to have an elevated hormone level at 5 years. The likelihood of a long-term chemical cure was greater for patients with microadenomas (91% cure rate) than for those with macroadenomas (33%). Preoperative prolactin levels also correlated with hormonal outcome. Conclusions. Prolactin levels lower than 10 ng/ml on POD 1 predict a long-term chemical cure in patients with microadenomas (100% cure rate) and those with macroadenomas (93% cure rate). In contrast, a cure is not likely to be obtained in patients with normal levels ranging between 10 and 20 ng/ml on POD 1 if they harbor macroadenomas (0% cure rate). A recurrence reported several years after surgery probably represents the presence of persistent tumor that was not originally removed. If the initial operation was performed by an experienced surgeon, however, reoperation is not likely to yield a chemical cure.

A population-based study of the incidence and survival rates in patients with pilocytic astrocytoma

2003 ◽  
Vol 98 (6) ◽  
pp. 1170-1174 ◽  
Author(s):  
Christoph Burkhard ◽  
Pier-Luigi Di Patre ◽  
Danielle Schüler ◽  
Georges Schüler ◽  
M. Gazi Yaşargil ◽  
...  
Keyword(s):  
Pilocytic Astrocytoma ◽  
Postoperative Radiotherapy ◽  
Survival Rates ◽  
Population Based ◽  
Biological Behavior ◽  
Population Based Study ◽  
Content Type ◽  
Pilocytic Astrocytomas ◽  
The Mean ◽  
Fine Print

Object. The incidence of pilocytic astrocytomas and the rate of patient survival were analyzed in a population-based study in the canton of Zürich, Switzerland. Methods. Between 1980 and 1994, 987 astrocytic and oligodendroglial tumors were diagnosed, of which 55 (5.5%) were pilocytic astrocytomas. The incidence rate, adjusted to the World Standard Population, was 4.8 per 1 million per year. The mean age at clinical diagnosis was 19.6 ± 12.7 years, and the male/female ratio was 1.12. The most frequent tumor sites were the cerebellum (40%), followed by supratentorial locations (35%), the optic pathway and hypothalamus (11%), and the brainstem (9%). The mean follow-up period was 12 years. Observed survival rates were 100% at 5 years and 95.8% at 10 years after diagnosis (relative survival rate at 10 years: 96.8%). Seven patients (13%) received postoperative radiotherapy, but this did not significantly affect survival. In all patients the tumors were histologically classified as WHO Grade I, except in two patients who had anaplastic pilocytic astrocytoma (Grade III), one of whom died after 7 years, whereas the other was still alive after 10 years. Conclusions. This population-based study shows that, because of the benign biological behavior of pilocytic astrocytomas and advances in microneurosurgery, the survival rates for patients with these tumors are excellent, regardless of postoperative radiotherapy.

Cystic schwannoma of the trochlear nerve mimicking a brain-stem tumor

1987 ◽  
Vol 67 (6) ◽  
pp. 928-930 ◽  
Author(s):  
Paul Douglas Garen ◽  
Clive Gordon Harper ◽  
Charles Teo ◽  
Ian Hugh Johnston
Keyword(s):  
Brain Stem ◽  
Cranial Nerve ◽  
Clinical Approach ◽  
Trochlear Nerve ◽  
Surgical Biopsy ◽  
Content Type ◽  
Brain Stem Tumors ◽  
Fourth Cranial Nerve ◽  
Cystic Schwannoma ◽  
Fine Print

✓ A case is reported of a rare cystic schwannoma of the fourth cranial nerve which was interpreted as a probable intrinsic brain-stem lesion. The clinical approach to brain-stem tumors in terms of empirical treatment or surgical biopsy is discussed.

Spinal cord astrocytoma: pathological and treatment considerations

1995 ◽  
Vol 83 (4) ◽  
pp. 590-595 ◽  
Author(s):  
Kern J. Minehan ◽  
Edward G. Shaw ◽  
Bernd W. Scheithauer ◽  
Dean L. Davis ◽  
Burton M. Onofrio
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Survival Rate ◽  
Pilocytic Astrocytoma ◽  
Histological Type ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Fibrillary Astrocytoma ◽  
Fine Print

✓ Seventy-nine patients underwent surgery, with or without radiation therapy, for astrocytoma of the spinal cord. There were 43 tumors (54%) classified as pilocytic astrocytoma and 25 (32%) as diffuse fibrillary astrocytoma. Eleven tumors (14%) could not be classified other than as astrocytoma, “type not otherwise specified.” The 10-year overall survival rate for all 79 patients was 50% but significantly differed by histological type: 81% for patients with pilocytic astrocytoma compared to 15% for those with diffuse fibrillary astrocytoma. Tumor grade by the Kernohan, et al., or St. Anne—Mayo methods was also a significant predictor of survival in patients with diffuse fibrillary astrocytoma. The extent of surgical resection (biopsy vs. subtotal resection vs. gross total resection) did not significantly impact survival among patients with pilocytic or nonpilocytic astrocytomas of the spinal cord, although there was a trend toward poorer survival in patients undergoing some degree of resection as opposed to biopsy. Postoperative radiation therapy improved survival but did so more for diffuse fibrillary astrocytoma than pilocytic astrocytoma. In this series, histological type was the most significant predictor of survival in patients with astrocytoma of the spinal cord. The survival rate was highest in patients who underwent biopsy followed by postoperative radiation therapy.

Presence and significance of CD-95 (Fas/APO1) expression after spinal cord injury

2001 ◽  
Vol 94 (2) ◽  
pp. 257-264 ◽  
Author(s):  
Mercedes Zurita ◽  
Jesús Vaquero ◽  
Isabel Zurita
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
White Matter ◽  
Gray Matter ◽  
Spinal Cord Tissue ◽  
Injured Spinal Cord ◽  
Content Type ◽  
Cord Injury ◽  
Positive Immunostaining ◽  
Fine Print

Object. A glycoprotein, CD95 (Fas/APO1) is widely considered to be implicated in the development of apoptosis in a number of tissues. Based on the hypothesis that apoptosis is related to cell death after spinal cord injury (SCI), the authors studied the presence and distribution of CD95 (Fas/APO1)-positive cells in injured spinal cord tissue for the purpose of determining the significance of this protein during the early phases of SCI. Methods. The presence and distribution of cells showing positive immunostaining for CD95 (Fas/APO1) were studied 1, 4, 8, 24, 48, and 72 hours and 1, 2, and 4 weeks after induction of experimental SCI in rats. Studies were conducted using a monoclonal antibody to the CD95 (Fas/APO1) protein. Positivity for CD95 (Fas/APO1) was observed in apoptotic cells, mainly in the gray matter, 1 hour after trauma, and the number of immunostained cells increased for the first 8 hours, at which time the protein was expressed in both gray and white matter. From 24 to 72 hours postinjury, the number of immunostained cells decreased in the gray matter, but increased in the white matter. From then on, there were fewer CD95 (Fas/APO1)-positive cells, but some cells in the white matter still exhibited positive immunostaining 1 and 2 weeks after injury. At 4 weeks, there remained no CD95 (Fas/APO1)-positive cells in injured spinal cord. Conclusions. These findings indicate that CD95 (Fas/APO1) is expressed after SCI, suggesting a role for this protein in the development of apoptosis after trauma and the possibility of a new therapeutic approach to SCI based on blocking the CD95 (Fas/APO1) system.

Serial plasma growth hormone concentration during selective removal of pituitary tumors in acromegaly

1974 ◽  
Vol 41 (1) ◽  
pp. 38-43 ◽  
Author(s):  
John P. Allen ◽  
David M. Cook ◽  
Monte A. Greer ◽  
Harold Paxton ◽  
Albert Castro
Keyword(s):  
Growth Hormone ◽  
Pituitary Tumors ◽  
Normal Function ◽  
Posterior Pituitary ◽  
Hormone Concentration ◽  
Plasma Growth Hormone ◽  
Tumor Removal ◽  
Content Type ◽  
Pituitary Dysfunction ◽  
Fine Print

✓ The pituitary function of two patients with acromegaly was monitored before, during, and after selective transnasal pituitary adenomectomy. The purpose of the study was to verify the efficacy of this technique, and to see if there was normal function in the residual pituitary tissue. Following surgery, both patients showed clinical improvement with no evidence of significant anterior or posterior pituitary dysfunction. Concentrations of plasma growth hormone obtained serially during surgery were elevated prior to tumor removal but fell precipitously after adenomectomy. The half-life for immunoreactive growth hormone in these patients was less than 35 minutes. We conclude that selective transnasal pituitary adenomectomy is an effective treatment for pituitary tumors. Furthermore, our data suggest that the pituitary tumor in these patients did not arise because of excessive stimulation by hypothalamic growth hormone-releasing factor.

The specificity of serum prolactin as a diagnostic indicator of pituitary adenoma

1979 ◽  
Vol 51 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Saul Balagura ◽  
Andrew G. Frantz ◽  
Edgar M. Housepian ◽  
Peter W. Carmel
Keyword(s):  
Pituitary Adenoma ◽  
Neurological Disease ◽  
Pituitary Tumors ◽  
Serum Prolactin ◽  
Content Type ◽  
Regular Work ◽  
Work Up ◽  
Diagnostic Indicator ◽  
Fine Print ◽  
Rule Out

✓ Serum prolactin levels were determined in 205 patients with a variety of intracranial diseases, including 70 cases with pituitary tumors. It is concluded that although the absence of elevated prolactin levels does not help to rule out pituitary pathology, the presence of hyperprolactinemia is highly specific for diseases of the pituitary and hypothalamus, and prolactin determination should be part of the regular work-up of pituitary tumor suspects. Excluding known causes of hyperprolactinemia, such as tranquilizing drug ingestion, the presence of neurological disease outside the hypothalamic-pituitary area was not associated with increased serum prolactin concentrations.

Serum prolactin in patients with hypothalamus and pituitary disorders

1981 ◽  
Vol 55 (2) ◽  
pp. 194-199 ◽  
Author(s):  
Per Olov Lundberg ◽  
Per Olof Osterman ◽  
Leif Wide
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Single Case ◽  
Geometric Mean ◽  
High Serum ◽  
Serum Prolactin ◽  
Content Type ◽  
Sellar Tumor ◽  
Very High ◽  
Fine Print

✓ Serum prolactin concentrations were studied in 115 patients with anatomically defined disorders in the hypothalamo-pituitary region. Fifty of the patients had expansively growing pituitary adenomas; in 17 of them (13 females and four males) the prolactin values were slightly raised (15 to 100 µg/liter), and in 13 (11 females and two males) they were over 100 µg/liter. The frequency of elevated prolactin values was higher for females than for males. Fifteen patients with invasively growing pituitary adenomas had very high serum prolactin levels (range 1230 to 31,500 µg/liter, geometric mean 3150 µg/liter). In a single case of malignant pituitary adenoma, the serum prolactin was at the lower level of detection. Of 49 further patients with suprasellar meningiomas, craniopharyngiomas, or other expansive or destructive lesions of the hypothalamus and sellar region, 15 had slightly raised prolactin values (maximum 114 µg/liter). Eight of these 49 patients had sellar destruction, with a roentgenological picture similar to that in patients with invasive pituitary adenomas. Among these eight patients, the maximum prolactin value was 67 µg/liter. It is concluded that moderately raised serum prolactin values (up to 100 µg/liter) in a patient with a sellar tumor does not prove that the tumor is a prolactinoma. A serum prolactin value of 100 to 1000 µg/liter strongly indicates a prolactin-producing tumor. In a patient with sellar destruction, a serum prolactin value of over 1000 µg/liter is proof that the destruction is caused by an invasive pituitary adenoma.

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