Development of a histological pseudocapsule and its use as a surgical capsule in the excision of pituitary tumors

2006 ◽  
Vol 104 (1) ◽  
pp. 7-19 ◽  
Author(s):  
Edward H. Oldfield ◽  
Alexander O. Vortmeyer
Keyword(s):  
Pituitary Gland ◽  
Surgical Techniques ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Surrounding Tissue ◽  
Maximum Diameter ◽  
Preoperative Imaging ◽  
Tumor Diameter ◽  
Cushing Disease ◽  
Pituitary Glands

Object The presence of a histological pseudocapsule around pituitary tumors was noted in the early 1900s. Since that time there has been no emphasis on the sequence of the stages of its development or on the relationship between these stages and the capacity to identify very small pituitary tumors at surgery in patients in whom preoperative imaging has been nondiagnostic. In addition, limited emphasis has been given to the pseudocapsule’s use for selective and complete resection of pituitary adenomas. Methods The development of the pseudocapsule was examined by performing histological analysis of portions of pituitary glands removed during 805 operations for Cushing disease. Twenty-five adenomas, each measuring between 0.25 and 4 mm in maximum diameter, were detected in the excised specimens; 17 were adenocorticotropic hormone–positive adenomas and eight were incidental tumors (four prolactin-secreting and four nonsecreting lesions). In 16 tumors the size of the adenoma could be established. The distribution of tumor size in relation to the presence of a histological pseudocapsule indicates a transition from the absence of a reticulin capsule (tumor diameter ≤ 1 mm) through the initial compression of surrounding tissue (tumor diameter 1–2 mm) to the presence of a multilayered reticulin capsule observed when adenomas become larger (tumor diameter 2–3 mm). Conclusions The absence of a reticulin capsule in cases of very small tumors may contribute to limited localization of these lesions during surgical exploration of the pituitary gland. In this article the authors describe surgical techniques in which the histological pseudocapsule is used as a surgical capsule during pituitary surgery. In their experience, recognition of this surgical capsule and its use at surgery has contributed to the identification of microadenomas buried in the pituitary gland, aided the recognition of subtle invasion of the pituitary capsule and contiguous dura mater, and enhanced the consistency of complete tumor excision with small and large tumors.

Sir Victor Horsley: pioneer craniopharyngioma surgeon

2015 ◽  
Vol 123 (1) ◽  
pp. 39-51 ◽  
Author(s):  
José M. Pascual ◽  
Ruth Prieto ◽  
Paolo Mazzarello
Keyword(s):  
Pituitary Gland ◽  
Clinical Symptoms ◽  
Surgical Techniques ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Assistant Professor ◽  
Hospital Staff ◽  
Surgical Removal ◽  
Giovanni Verga ◽  
Papillary Type

Sir Victor Horsley (1857–1916) is considered to be the pioneer of pituitary surgery. He is known to have performed the first surgical operation on the pituitary gland in 1889, and in 1906 he stated that he had operated on 10 patients with pituitary tumors. He did not publish the details of these procedures nor did he provide evidence of the pathology of the pituitary lesions operated on. Four of the patients underwent surgery at the National Hospital for Neurology and Neurosurgery (Queen Square, London), and the records of those cases were recently retrieved and analyzed by members of the hospital staff. The remaining cases corresponded to private operations whose records were presumably kept in Horsley's personal notebooks, most of which have been lost. In this paper, the authors have investigated the only scientific monograph providing a complete account of the pituitary surgeries that Horsley performed in his private practice, La Patologia Chirurgica dell'Ipofisi (Surgical Pathology of the Hypophysis), written in 1911 by Giovanni Verga, Italian assistant professor of anatomy at the University of Pavia. They have traced the life and work of this little-known physician who contributed to the preservation of Horsley's legacy in pituitary surgery. Within Verga's pituitary treatise, a full transcription of Horsley's notes is provided for 10 pituitary cases, including the patients' clinical symptoms, surgical techniques employed, intraoperative findings, and the outcome of surgery. The descriptions of the topographical and macroscopic features of two of the lesions correspond unmistakably to the features of craniopharyngiomas, one of the squamous-papillary type and one of the adamantinomatous type. The former lesion was found on necropsy after the patient's sudden death following a temporal osteoplastic craniectomy. Surgical removal of the lesion in the latter case, with the assumed nature of an adamantinomatous craniopharyngioma, was successful. According to the evidence provided in Giovanni Verga's monograph, it can be claimed that Sir Victor Horsley was not only the pioneer of pituitary gland surgery but also the pioneer of craniopharyngioma surgery.

The Nasal Gateway for Pituitary Surgery

1988 ◽  
Vol 2 (4) ◽  
pp. 193-200 ◽  
Author(s):  
Mary D. Lekas
Keyword(s):  
Pituitary Gland ◽  
Sella Turcica ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
External Rhinoplasty

There has been an evolution in the transseptal transsphenoidal approach for pituitary surgery. The nasal approach to the pituitary gland can be from the sublabial transseptal transsphenoidal; the transseptal transsphenoidal; the alotomy transseptal transsphenoidal; the external rhinoplasty transsphenoidal; the transnasal by mobilizing the whole nose on a pedicle; the transseptal infranasal; the midline columellar incision; all types of nasofacial incisions; and transethmoidal approach with nasal instrumentation. The transsphenoidal hypophysectomy surgery has become a safe and effective approach for pituitary tumors. We are mainly concerned with the transnasal and not the transethmoidal approach to the sella turcica at this time.

scholarly journals Desmopressin Test in Silent Corticothoph Pituitary Adenomas, a Preliminary Study - a Comparison With Cushing Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A642-A642
Author(s):  
Martha Katherine Huayllas ◽  
Marilena Nakaguma ◽  
Mirela Costa de Miranda ◽  
Priscila Rosada Montebello Mitsuyama Cardoso
Keyword(s):  
Pituitary Adenomas ◽  
Preoperative Evaluation ◽  
Pituitary Tumors ◽  
Immunohistochemical Analysis ◽  
Pituitary Surgery ◽  
High Recurrence Rate ◽  
Cushing Disease ◽  
Basal Cortisol ◽  
Free Cortisol ◽  
Cortisol Increase

Abstract Introduction: Silent corticothop adenomas (SCAs) account for 9 to 19% of nonfunctioning pituitary adenomas and behave as the most agressive pituitary tumors with more invasiveness and high recurrence rate. The identification of these patients during the preoperative stage could predict better surgery results. Some authors refer to high basal ACTH level in the preoperative evaluation as the only marker but until this date, there are no clinical and hormonal markers that could predict its occurrence. The aim of this study is to evaluate the response to desmopressin test and the presence of silent corticothoph tumors. Patients and Methods: Among 496 patients underwent pituitary surgery, 425 were pituitary adenomas, (106 were acromegaly, 46 Cushing disease, 10 prolactinomas, 263 nonfunctioning adenomas). Twenty-three patients, 17 with Cushing disease, (CD), mean age: 31 y, 13 female and 4 male) and 6 patients with SCA (mean age: 47 y, 5 female and 1 male) had positive ACTH confirmed by immunohistochemical analysis. Clinical characteristics: in the CD group, 53% had hypertension (9/17), 42% diabetes (7/17), 100% dyslipidemia, BMI was 30.7 kg/m2. Among SCA group, 67% hypertension, 50% diabetes, 50% dyslipidemia, BMI was 28 kg/m2. All patients were evaluated with basal ACTH and DHEAS before surgery. Patients with SCA underwent desmopressin test and were compared to CD. Dexamethasone suppression test (DST 1 mg) and 24-hour free urinary test was performed in patients with CD and in two patients with SCA. Response to desmopressin test was considered positive when increase in cortisol was above 20% and in ACTH of 35% using chemiluminescence assay (Immulite 2000). Results: Among CD group, the median (med) basal ACTH was 75.9 pg/mL (30.9 to 211), the med basal cortisol was 22.5 µg/dL (14.5 to 43.5), the med DHEAS was 170 µg/dL (33 to 465), the med 24h urinary free cortisol of 454.5 µg/24 h (149 to 1673) and med basal cortisol after DST 1mg of 15.4 µg/dL (4.7 to 31.5). Among SCA, med basal ACTH was 19.4 pg/mL (9.5 to 65.5), the med basal cortisol was 9.5 µg/dL (7.8 to 16.4) and the med DHEAS was 104.5 µg/dL (82 to 127). Only 4 patients with CD had macroadenomas. All of them responded with ACTH increase (med increase of 98%, 31.6 to 377%), and only 4 did not respond to cortisol increase (med increase of 54.4%, 0 to 167%). All patients with SCA had macroadenomas. Only one patient did not respond to ACTH increase (med increase of 123.5%, 9.5 to 1522%, 9.5 to 1522%), and 3 patients did not respond to cortisol increase (med increase of 17.9%, 0 to 234%). Discussion: SCA are invasive tumors, with high recurrence and tests predicting their occurrence are missing. We hypothesized that as ACTH is present in the adenoma a response to desmopressin test could exist (like CRH). Conclusion:The desmopressin test can be a useful tool in the evaluation of SCA and can predict pathological phenotype in preoperative tumors.

Preoperative imaging study in assessment of hazard to Internal Carotid Arteries injury during endoscopic endonasal transsphenoidal surgery

2019 ◽  
Vol 92 (1) ◽  
pp. 1-5
Author(s):  
Greta Berger ◽  
Adam Łukaszewicz ◽  
Vitalii Grinevych ◽  
Edward Tarasów ◽  
Anna Justyna Milewska
Keyword(s):  
Pituitary Gland ◽  
Rank Correlation ◽  
Correlation Coefficients ◽  
Imaging Study ◽  
Preoperative Imaging ◽  
Endoscopic Endonasal ◽  
Spearman’S Rank Correlation ◽  
Pituitary Glands ◽  
Preoperative Imaging Study ◽  
Convex Point

In endoscopic endonasal transsphenoidal procedures, ICA injury occurs up to 3.8%[8]. The highest hazard of injury is in case of contact between the ICA and pituitary gland, during opening of the dura. Preoperative imaging ie. CTA, MRA supports objectively intraoperative techniques of imaging. CTA as well as MRA are essential to access anatomic details in variability of cavernous segment of ICA (C4 ICA). The aim of the study was to measure the space between the pituitary gland and ICA on both sides. Anatomic relations between left and right ICAs were accessed on CTA ( coronal scans) at levels:A- the most concave point of the C4-C5 bend;B- at the most convex point of the C4 bend;C- at the C4 posterior ascending portion. Distances between pituitary gland and ICAs were measured on both sides on MRA (axial scans):A'- at the most concave point of C4-C5 bend;B'- the most convex point of the C4 bend.The Statistica 13 (StatSoft) software was used for the statistical analysis. The Mann Whitney U test was applied to determine differences between the quantitative variables, Spearman's rank correlation coefficients were calculated. The results were considered statistically significant at the level of p<0,05. Distance reduction was shown between pituitary glands and cavernous segment (C4) of ICAs on both sides, which is related to age. This has impact on surgical planning and highlights the risk of ICAs intraoperative injury.

Accumulation of 11C-methionine in the normal pituitary gland on 11C-methionine PET

2016 ◽  
Vol 58 (3) ◽  
pp. 362-366 ◽  
Author(s):  
Noriaki Tomura ◽  
Toshiyuiki Saginoya ◽  
Yasuaki Mizuno ◽  
Hiromi Goto
Keyword(s):  
Pituitary Gland ◽  
Linear Regression Analysis ◽  
Standardized Uptake Value ◽  
Pituitary Tumors ◽  
Emission Tomography ◽  
The Past ◽  
Normal Pituitary Gland ◽  
Positron Emission ◽  
Pet Ct ◽  
Pituitary Glands

Background For pituitary tumors, positron emission tomography (PET) with 11C-methonine (MET) has been reported as feasible to facilitate diagnosis. MET is well-known to accumulate in the normal pituitary glands, but almost no studies have examined the degree of MET accumulation in the normal pituitary gland. Purpose To investigate accumulation of MET in normal pituitary gland on PET/CT. Material and Methods Among patients who underwent PET/CT using MET over the past 7 years, 77 patients who fulfilled our criteria for normal pituitary glands were retrospectively selected. Maximum standardized uptake value (SUVmax) for the pituitary gland was measured. Results SUVmax of MET in the pituitary gland was in the range of 0.9–6.6 (mean ± standard deviation = 2.60 ± 1.04). A negative correlation between SUVmax and patient age (y = −0.032 × + 4.29, n = 77, r = 0.55) was found by linear regression analysis. SUVmax of the pituitary gland did not differ significantly between women and men. Conclusion MET shows strong accumulation in normal pituitary gland. PET/CT would thus be feasible to differentiate between normal and abnormal pituitary glands.

Granular Cell Tumor and Spindle Cell Oncocytoma of the Pituitary Gland: Imaging and Intraoperative Cytology Diagnostic Dilemmas and Management Challenges

2021 ◽  
Author(s):  
Sandeep Kandregula ◽  
Abhinith Shashidhar ◽  
Shilpa Rao ◽  
Manish Beniwal ◽  
Dhaval Shukla ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Vision Loss ◽  
Spindle Cell ◽  
Pituitary Tumors ◽  
Granular Cell ◽  
Preoperative Imaging ◽  
Posterior Pituitary ◽  
Intraoperative Cytology ◽  
Transcranial Approach

Abstract Background Tumors arising from the posterior pituitary gland are rare and closely resemble pituitary adenoma in presentation and imaging. Most of them come as a histopathologic surprise. We have analyzed the posterior pituitary tumors managed in our institute and have discussed the dilemmas in imaging, challenges in intraoperative squash cytology, and surgical management. Methods We retrospectively reviewed our operative database of pituitary tumors over the past 10 years, which included five posterior pituitary tumors (three granular cell tumors [GCTs] and two spindle cell oncocytomas [SCOs]). Clinical, imaging, and endocrine characteristics; intraoperative details; histopathologic features; and postoperative outcomes were collected and analyzed. Results The mean age of the patients was 47 years. All patients presented with varying degrees of vision loss. Radiology revealed a sellar / suprasellar lesion with the pituitary gland seen separately in two of three GCTs, whereas a separate pituitary gland could not be identified in both the SCOs. Pituitary adenoma was a radiologic diagnosis in only two of five cases. Three patients underwent a transsphenoidal surgery, whereas two underwent surgery by the transcranial approach. Intraoperative cytology was challenging, though a possibility of posterior pituitary tumor was considered in three of four cases, whereas one was considered meningioma. All the tumors were very vascular and influenced the extent of resection. Conclusions GCTs and SCOs are relatively uncommon tumors that are difficult to diagnose on preoperative imaging. Intraoperative squash cytology too can pose challenges. A preoperative suspicion can prepare the surgeon for surgery of these hypervascular tumors. The transcranial approach may be necessary in cases of uncertainty in imaging.

scholarly journals Pituitary spindle cell oncocytoma: illustrative case

2021 ◽  
Vol 2 (14) ◽  
Author(s):  
Taha M. Taka ◽  
Chen Yi Yang ◽  
Joshua N. Limbo ◽  
Alvin Y. Chan ◽  
Jordan Davies ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Spindle Cell ◽  
Pituitary Tumors ◽  
World Health ◽  
Preoperative Imaging ◽  
Illustrative Case ◽  
Structure Damage ◽  
Secondary Hypothyroidism ◽  
Increased Risk ◽  
Spindle Cell Oncocytoma

BACKGROUND Spindle cell oncocytoma (SCO) of the pituitary gland is an extremely rare nonfunctional World Health Organization grade I tumor. SCOs are often misdiagnosed as nonfunctional pituitary adenomas on the basis of preoperative imaging. They are often hypervascular and locally adherent, which increases hemorrhage risk and limits resection, leading to increased risk of recurrence. The authors report a case of SCO treated at their institution and provide a review of the current literature. OBSERVATIONS SCO of the pituitary gland can be a rare cause of progressively growing pituitary tumors that presents similarly to nonfunctional pituitary adenoma. Endoscopic transsphenoidal resection of the tumor by a multidisciplinary team allowed total resection despite local adherence of the tumor. Postoperatively, the patient’s visual symptoms improved with persistence of secondary adrenal insufficiency and secondary hypothyroidism. LESSONS Careful resection is needed due to SCO’s characteristic hypervascularity and strong adherence to minimize local structure damage. Long-term follow-up is recommended due to the tendency for recurrence.

Transcranial Surgery for Pituitary Adenomas

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. 168-175 ◽  
Author(s):  
A. Samy Youssef ◽  
Siviero Agazzi ◽  
Harry R. van Loveren
Keyword(s):  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Surgical Techniques ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Default Mode ◽  
Orbitozygomatic Approach ◽  
Transcranial Approach ◽  
Planum Sphenoidale ◽  
Prolactin Inhibition

Abstract Although The Transsphenoidal approach is the preferred approach to the vast majority of pituitary tumors with or without suprasellar extension, the transcranial approach remains a vital part of the neurosurgical armamentarium for 1 to 4% of these tumors. The transcranial approach is effective when resection becomes necessary for a portion of a pituitary macroadenoma that is judged to be inaccessible from the transsphenoidal route because of isolation by a narrow waist at the diaphragma sellae, containment within the cavernous sinus lateral to the carotid artery, projection anteriorly onto the planum sphenoidale, or projection laterally into the middle fossa. The application of a transcranial approach in these circumstances may still be mitigated by response to prolactin inhibition of prolactinomas, the frequent lack of necessity to remove asymptomatic nonsecretory adenomas from the cavernous sinus, and the lack of evidence that sustained chemical cures can be reliably achieved by removal of secretory adenomas (adrenocorticotropic hormone, growth hormone) from the cavernous sinus. Cranial base surgical techniques have refined the surgical approach to pituitary adenomas but have had less effect on actual surgical indications than anticipated. Because application of the transcranial approach to pituitary adenomas is and should be rare in clinical practice, it is useful to standardize the technique to a default mode with which the surgical team is most experienced and, therefore, most comfortable. Our default mode for transcranial pituitary surgery is the frontotemporal-orbitozygomatic approach.

Two Distinct Types of Microfilaments in the Cytoplasm of Human Adenohypophysial Cells

1973 ◽  
Vol 31 ◽  
pp. 668-669
Author(s):  
E. Horvath ◽  
K. Kovacs ◽  
I. E. Stratmann ◽  
C. Ezrin
Keyword(s):  
Pituitary Tumors ◽  
Average Diameter ◽  
Anterior Lobe ◽  
Uranyl Acetate ◽  
Type I ◽  
Breast Cancer Patients ◽  
Human Pituitary ◽  
Severe Diabetes ◽  
Pituitary Glands ◽  
Membrane Bound

Surgically removed human pituitary glands as well as pituitary tumors fixed in glutaraldehyde, postfixed in osmium tetroxide, embedded in epon resin, stained with uranyl acetate and lead citrate have been investigated by electron microscopy in order to correlate ultrastructure with functional activity. In the course of this study two distinct types of microfilaments have been identified in the cytoplasm of adenohypophysiocytes.Type I microfilaments (Fig. 1) were found in the cytoplasm of anterior lobe cells of five female subjects with disseminated mammary cancer and two patients with severe diabetes mellitus. The breast cancer patients were treated pre-operatively for various periods of time with different doses of oxysteroids. The microfilaments had an average diameter of JO A, formed parallel bundles, were scattered irregularly in the cytoplasm and were frequently located in the perikaryon. They were not membrane-bound and failed to show any periodicity.

METABOLIC STUDIES WITH 131I-LABELED THYROXINE. II.

1963 ◽  
Vol 44 (3) ◽  
pp. 475-480 ◽  
Author(s):  
R. Grinberg
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Optic Nerve ◽  
Pituitary Gland ◽  
Time Interval ◽  
Time Intervals ◽  
Pituitary Glands ◽  
The Central Nervous System ◽  
Tentative Explanation

ABSTRACT Radiologically thyroidectomized female Swiss mice were injected intraperitoneally with 131I-labeled thyroxine (T4*), and were studied at time intervals of 30 minutes and 4, 28, 48 and 72 hours after injection, 10 mice for each time interval. The organs of the central nervous system and the pituitary glands were chromatographed, and likewise serum from the same animal. The chromatographic studies revealed a compound with the same mobility as 131I-labeled triiodothyronine in the organs of the CNS and in the pituitary gland, but this compound was not present in the serum. In most of the chromatographic studies, the peaks for I, T4 and T3 coincided with those for the standards. In several instances, however, such an exact coincidence was lacking. A tentative explanation for the presence of T3* in the pituitary gland following the injection of T4* is a deiodinating system in the pituitary gland or else the capacity of the pituitary gland to concentrate T3* formed in other organs. The presence of T3* is apparently a characteristic of most of the CNS (brain, midbrain, medulla and spinal cord); but in the case of the optic nerve, the compound is not present under the conditions of this study.

Sign in / Sign up

Export Citation Format

Share Document