Osteosarcoma and fibrosarcoma caused by postoperative radiotherapy for a pituitary adenoma

2002 ◽  
Vol 96 (5) ◽  
pp. 960-963 ◽  
Author(s):  
Kanna K. Gnanalingham ◽  
Aabir Chakraborty ◽  
Malcolm Galloway ◽  
Tamas Revesz ◽  
Michael Powell
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Rare Complication ◽  
Postoperative Radiotherapy ◽  
Pituitary Macroadenoma ◽  
Content Type ◽  
Sarcomatous Change ◽  
First Case ◽  
Fine Print

✓ Sarcomatous change is a rare complication of postoperative radiotherapy for pituitary adenomas. The authors report on what they believe to be the first case in which fibrosarcoma and, later, osteosarcoma developed during a 14-year period following surgery and radiotherapy for a nonsecreting pituitary macroadenoma.

Intrasellar persistent trigeminal artery associated with a pituitary adenoma

1989 ◽  
Vol 70 (2) ◽  
pp. 271-273 ◽  
Author(s):  
K. Stuart Lee ◽  
David L. Kelly
Keyword(s):  
Pituitary Adenoma ◽  
Sella Turcica ◽  
Preoperative Imaging ◽  
Persistent Trigeminal Artery ◽  
Pituitary Macroadenoma ◽  
Trigeminal Artery ◽  
Imaging Studies ◽  
Content Type ◽  
Fine Print ◽  
Transsphenoidal Resection

✓ The case of a patient with Cushing's disease and a pituitary macroadenoma, who also had a persistent trigeminal artery coursing through the sella turcica on preoperative imaging studies, is presented. The patient was treated by transsphenoidal resection of the tumor.

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.

Anemia, testosterone, and pituitary adenoma in men

2003 ◽  
Vol 98 (5) ◽  
pp. 974-977 ◽  
Author(s):  
Dilantha B. Ellegala ◽  
Tord D. Alden ◽  
Daniel E. Couture ◽  
Mary L. Vance ◽  
Nicholas F. Maartens ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Tumor Size ◽  
Pituitary Adenomas ◽  
Clinical Laboratory ◽  
Serum Testosterone ◽  
Testosterone Replacement Therapy ◽  
Content Type ◽  
Testosterone Levels ◽  
Fine Print ◽  
Low Serum

Object. Older men with clinically nonfunctioning pituitary tumors have been noted to be anemic, to have hypopituitarism, and to have low serum levels of testosterone. The authors hypothesized that men with pituitary adenomas and hypogonadism have a physiologically related decrease in hematocrit. Methods. A retrospective analysis was conducted of 216 patients older than 50 years of age who harbored pituitary adenomas. In 100 men serum testosterone levels and a complete blood (cell) count (CBC) were obtained before treatment; a CBC was also acquired in a series of women with pituitary adenomas. Using clinical laboratory standards, anemia was defined as a hematocrit less than 40% in men and less than 35% in women. Thirty-one (46.3%) of 67 men with low serum concentrations of testosterone were anemic. In men with low levels of testosterone, the average hematocrit was 39.9%, compared with 45.6% for men with normal testosterone levels (p < 0.001). Men with macroadenomas were most likely to have both anemia and a low serum concentration of testosterone. Anemia was associated with a low level of testosterone, adjusting for tumor size (odds ratio 19, 95% confidence interval 4.86–77.03). Of patients with anemia, 84% were men and 16% were women (p < 0.001). The prevalence of anemia in women was low and was not correlated with tumor size. Men receiving testosterone replacement therapy had a significantly higher hematocrit value than men with low or normal testosterone levels. Conclusions. These findings support a direct relationship between serum testosterone levels and hematopoiesis in men, and demonstrate that hematopoiesis is compromised in men who have low concentrations of testosterone due to a pituitary adenoma.

Pituitary apoplexy: its incidence and clinical significance

1981 ◽  
Vol 55 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Susumu Wakai ◽  
Takanori Fukushima ◽  
Akira Teramoto ◽  
Keiji Sano
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Consecutive Series ◽  
Content Type ◽  
Histological Types ◽  
Hormonal Function ◽  
A Minor ◽  
Fine Print

✓ The occurrence of hemorrhage from pituitary adenoma (so-called “pituitary apoplexy”) was investigated in a consecutive series of 560 cases operated on during the past 30 years. There were 93 cases (16.6%) in which hemorrhage from pituitary adenomas was confirmed either clinically or surgically. These patients were analyzed in terms of age, sex, symptoms and signs, size of tumor, hormonal function, and histological types of adenomas, and computerized tomography findings. In 90 cases (16.1%), hematoma or old bloody fluid was verified within the tumor tissue at surgery. Three other patients presented with subarachnoid hemorrhage, but there was no detectable intratumor hematoma in any of them. Among these 93 patients, 42 (7.5%) showed no evidence of clinical symptoms related to hemorrhage (asymptomatic hemorrhage). Fifty-one patients (9.1%) had definite histories of an acute episode that suggested sudden bleeding (symptomatic hemorrhage: pituitary apoplexy). Thirty-eight patients (6.8%) had a major attack manifested by disturbances of consciousness, hemiparesis, loss of vision, or ocular palsy. In two acromegalic patients, pituitary apoplexy developed during bromocriptine treatment. There was one case of sudden death due to massive hemorrhage from the tumor 14 months after the completion of postoperative radiation therapy. The other 13 symptomatic patients (2.3%) developed a minor attack which included headache, nausea, vomiting, and vertigo. Bleeding from pituitary adenomas was not statistically correlated with any of the following factors: sex, hormonal function of adenomas, and histological types, but it was correlated with age. The number of asymptomatic cases in the third decade was significantly greater than that of the whole group of pituitary adenoma patients in the same decade. The present investigation revealed that the incidence of pituitary apoplexy was unexpectedly high: a major attack in 6.8% of pituitary adenoma patients, a minor attack in 2.3%, and asymptomatic hemorrhage in 7.5% of the cases. This risk of pituitary apoplexy should be kept in mind in treating pituitary adenomas.

Prolactinoma of pituitary with associated amyloid-like substances

1983 ◽  
Vol 59 (6) ◽  
pp. 1067-1070 ◽  
Author(s):  
Jun-ichi Kuratsu ◽  
Yasuhiko Matsukado ◽  
Masaki Miura
Keyword(s):  
Electron Microscopy ◽  
Pituitary Adenoma ◽  
Tumor Cells ◽  
Pituitary Adenomas ◽  
Light And Electron Microscopy ◽  
Rare Entity ◽  
Short History ◽  
Content Type ◽  
History Of ◽  
Fine Print

✓ A prolactin-secreting pituitary adenoma containing amyloid substance was studied by light and electron microscopy. The tumor was found in a 32-year-old woman who presented with a short history of amenorrhea and galactorrhea. Pituitary adenoma containing amyloid substance is a very rare entity, and the implications of this association are discussed. Previous reports, suggesting that mesenchymal cells or hormone-secreting tumor cells in pituitary adenomas produce amyloid substances, are reviewed.

Gamma knife radiosurgery for pituitary adenomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 19-22 ◽  
Author(s):  
Masahiro Izawa ◽  
Motohiro Hayashi ◽  
Kohtarou Nakaya ◽  
Hiroyuki Satoh ◽  
Taku Ochiai ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Single Institution ◽  
Hormone Production ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. The purpose of this study was the analysis of a large series of patients treated with gamma knife radiosurgery for pituitary adenoma in a single institution. Methods. One hundred eight patients with pituitary adenomas were treated over the last 7 years. Seventy-four patients have been followed for more than 6 months and form the basis of this report. Conclusions. Twenty-three patients harbored nonfunctioning adenomas, and 56 harbored functioning adenomas. The mean margin dose was 22.5 Gy (nonfunctioning adenomas, 19.5 Gy; functioning adenomas, 23.8 Gy). Control of tumor growth was achieved in 91%. A significant decrease of excessive hormone production was seen in 80% of patients, and the endocrinological normalization rate was 30.3%. Postradiosurgical complications were seen in 2.5%.

Ectopic pituitary adenoma of the third ventricle

1990 ◽  
Vol 72 (1) ◽  
pp. 139-142 ◽  
Author(s):  
B. K. Kleinschmidt-DeMasters ◽  
Ken R. Winston ◽  
David Rubinstein ◽  
Mary H. Samuels
Keyword(s):  
Pituitary Adenoma ◽  
Neurological Examination ◽  
Pituitary Adenomas ◽  
Sphenoid Sinus ◽  
Third Ventricle ◽  
Electron Microscopic ◽  
Content Type ◽  
The Third ◽  
Ectopic Pituitary Adenoma ◽  
Fine Print

✓ Ectopic pituitary adenomas without associated intrasellar adenomas are rare and are usually located in the sphenoid sinus. Most have been reported without modern radiological, endocrinological, or electron microscopic (EM) documentation. The case of a 47-year-old man with a third ventricular, ectopic, clinically non-secretory pituitary adenoma, which was shown to be a gonadotrophic adenoma by immunohistochemical and EM study, is reported. Neurological examination, extensive neurodiagnostic imaging, surgical anatomical observation, and endocrinological evaluation showed no evidence of neoplasia outside the third ventricle.

A rare case of primary sellar melanoma

2004 ◽  
Vol 100 (5) ◽  
pp. 931-934 ◽  
Author(s):  
Jochen Tüttenberg ◽  
Wolfram Fink ◽  
Walter Back ◽  
Frederik Wenz ◽  
Dirk Schadendorf ◽  
...  
Keyword(s):  
Mr Imaging ◽  
S100 Protein ◽  
Sella Turcica ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Optic Chiasm ◽  
Pituitary Macroadenoma ◽  
Content Type ◽  
First Case ◽  
Fine Print

✓ The authors report on the case of a 37-year-old woman in whom a primary sellar malignant melanoma mimicking a hemorrhagic pituitary macroadenoma was treated. This entity is exceedingly rare; only five cases are described in the literature. The patient presented with rapid deterioration of vision within a 2-week period. After an ophthalmological diagnosis of chiasmal syndrome was made, magnetic resonance (MR) imaging of the head revealed an intra- and suprasellar mass that was elevating and compressing the optic chiasm. Because of the signal heterogeneity of the lesion a hemorrhagic pituitary macroadenoma was assumed; the lesion was transsphenoidally resected. Histological examination of the specimen showed a malignant melanocytic tumor with immunopositivity for S100 protein and HMB-45. Despite extensive staging no other primary melanotic tumor was found. Thus, a primary sellar melanoma was diagnosed. Postoperative MR images demonstrated no residual tumor. For adjuvant therapy the region around the sella turcica received 40.4 Gy stereotactically guided radiation. A 24-month follow-up examination revealed no tumor recurrence. This represents the sixth case of such a lesion reported in the literature, the third case evaluated using MR imaging, and the first case with a progression-free survival of 24 months. Thus, the authors advocate that management of primary sellar melanoma should include gross-total removal and postoperative stereotactic radiotherapy.

The long-term significance of microscopic dural invasion in 354 patients with pituitary adenomas treated with transsphenoidal surgery

2002 ◽  
Vol 96 (2) ◽  
pp. 195-208 ◽  
Author(s):  
Björn P. Meij ◽  
Maria-Beatriz S. Lopes ◽  
Dilantha B. Ellegala ◽  
Tord D. Alden ◽  
Edward R. Laws
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Tumor Tissue ◽  
Pituitary Surgery ◽  
Mr Images ◽  
Content Type ◽  
Pituitary Disease ◽  
The Mean ◽  
Fine Print

Object. Pituitary adenomas are considered benign tumors; however, they may infiltrate surrounding tissues including the dura mater. In this paper the authors analyze the clinical significance of microscopically confirmed dural invasion by comparing a range of variables (age and sex of patients, adenoma type, adenoma size on magnetic resonance [MR] images, remission, residual pituitary disease, recurrence, survival, and disease-free interval after surgery) between patients with noninvasive adenomas and those with invasive ones. Methods. Between 1992 and 1997 dural specimens were obtained in 354 patients with pituitary adenomas who underwent transsphenoidal surgery performed by the senior author (E.R.L.). Dural specimens were examined using routine histological methods and assessed for invasion by pituitary adenoma tissue. The dura was invaded by the pituitary adenoma in 161 patients (45.5%), and in 192 patients (54.5%) no evidence of dural invasion was found. Dural invasion was present significantly more frequently in the repeated surgery group (69%, 55 patients) than in the primary transsphenoidal surgery group (41%, 291 patients). The mean age of patients undergoing primary transsphenoidal surgery was significantly older in cases of invasive adenomas (50 years) compared with cases of noninvasive adenomas (43 years), and these age differences also correlated with adenoma size. Women tend to develop clinically evident, smaller adenomas at a younger age than men. Of the patients with pituitary adenomas that were 20 mm or smaller, 117 (76%) of 154 were women, whereas of the patients with adenomas that were larger than 20 mm, 74 (54%) of 137 were men. The frequency of dural invasion increased with increasing size of the pituitary adenoma as measured on MR images. In 291 patients who underwent primary pituitary surgery, the frequency of dural invasion according to adenoma size was 24% (≤ 10 mm), 35% (> 10 to ≤ 20 mm), 55% (> 20 to ≤ 40 mm), and 70% (> 40 mm). In patients who underwent primary transsphenoidal surgery, dural invasion was present in more than 50% of those with nonfunctioning adenomas and in 30 to 35% of patients with endocrinologically active adenomas. The mean diameter of the gonadotrophic adenomas and null-cell adenomas was significantly larger than that of each of the endocrinologically active adenomas. In 58 (20%) of 291 patients who underwent primary pituitary surgery there was residual pituitary disease postsurgery, and 20% of this subset of patients showed clinical improvement to such an extent that no further management was recommended. After pituitary surgery, residual tumor tissue was demonstrable significantly more frequently in patients with invasive adenomas than in those with noninvasive adenomas. Recurrences after initial remission (cure) of pituitary disease occurred in 18 (8.8%) of 205 patients between 2 and 79 months after primary pituitary surgery (median 25 months). The recurrence rate was not related to dural invasion in a consistent or significant fashion. Seven patients died between 14 and 79 months after pituitary surgery and all had invasive adenomas identified on gross observation at surgery and on microscopy. The survival rate was slightly but significantly decreased for patients with invasive adenomas (91%) compared with patients with noninvasive adenomas (100%) at 6 years postsurgery. Conclusions. The principal significance of dural invasion by pituitary adenoma is the persistence of tumor tissue after transsphenoidal surgery (incomplete adenomectomy; 20% in primary pituitary tumor resections). The increase in adenoma size with time and the concurrent development of dural invasion are the major factors that determine an incomplete adenomectomy. When the adenoma remains restricted to the sellar compartment or shows only moderate suprasellar extension, dural invasion may not yet have developed and conditions for complete selective adenomectomy are improved.

Familial acromegaly with pituitary adenoma

1986 ◽  
Vol 64 (3) ◽  
pp. 510-512 ◽  
Author(s):  
Kazem Abbassioun ◽  
Vahab Fatourehchi ◽  
Abbass Amirjamshidi ◽  
Nemotallah Aghai Meibodi
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Autosomal Recessive ◽  
Empty Sella ◽  
Review Of Literature ◽  
Familial Incidence ◽  
Content Type ◽  
The Third ◽  
Fine Print

✓ The authors report the cases of three brothers with pituitary adenomas who had classical findings of acromegaly and gigantism. Two had irreducibly elevated growth hormone (GH) values and underwent transsphenoidal microsurgical extirpation of their tumors. The third acromegalic brother had a normal GH value and evidence of panhypopituitarism; he had a small intrasellar tumor and a partially empty sella. The pattern of inheritance was probably autosomal recessive. A review of literature indicated that familial incidence of isolated acromegaly with pituitary adenomas is rare.

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