scholarly journals A Silent Corticotroph Pituitary Carcinoma: Lessons From an Exceptional Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Pablo Remón-Ruiz ◽  
Eva Venegas-Moreno ◽  
Elena Dios-Fuentes ◽  
Juan Manuel Canelo Moreno ◽  
Ignacio Fernandez Peña ◽  
...  
Keyword(s):  
Case Report ◽  
Primary Tumor ◽  
Pituitary Tumor ◽  
Pituitary Tumors ◽  
Treatment Resistance ◽  
Exceptional Case ◽  
Ki 67 ◽  
Fractionated Radiotherapy ◽  
Mitotic Figures

Nowadays, neither imaging nor pathology evaluation can accurately predict the aggressiveness or treatment resistance of pituitary tumors at diagnosis. However, histological examination can provide useful information that might alert clinicians about the nature of pituitary tumors. Here, we describe our experience with a silent corticothoph tumor with unusual pathology, aggressive local invasion and metastatic dissemination during follow-up. We present a 61-year-old man with third cranial nerve palsy at presentation due to invasive pituitary tumor. Subtotal surgical approach was performed with a diagnosis of silent corticotroph tumor but with unusual histological features (nuclear atypia, frequent multinucleation and mitotic figures, and Ki-67 labeling index up to 70%). After a rapid regrowth, a second surgical intervention achieved successful debulking. Temozolomide treatment followed by stereotactic fractionated radiotherapy associated with temozolomide successfully managed the primary tumor. However, sacral metastasis showed up 6 months after radiotherapy treatment. Due to aggressive distant behavior, a carboplatine-etoposide scheme was decided but the patient died of urinary sepsis 31 months after the first symptoms. Our case report shows how the presentation of a pituitary tumor with aggressive features should raise a suspicion of malignancy and the need of follow up by multidisciplinary team with experience in its management. Metastases may occur even if the primary tumor is well controlled.

scholarly journals Phyllodes tumor presented as fungating mass on right breast and fibroadenoma on contralateral breast: a case report

2020 ◽  
Vol 7 (2) ◽  
pp. 596
Author(s):  
Sribatsa Kumar Mahapatra ◽  
Pramit Ballav Panigrahi ◽  
Abinash Mahapatra ◽  
Srimanta Mahapatra
Keyword(s):  
Case Report ◽  
Wide Local Excision ◽  
Phyllodes Tumor ◽  
Left Breast ◽  
Contralateral Breast ◽  
Histopathological Diagnosis ◽  
Ki 67 ◽  
Tumor Margin ◽  
Proliferative Markers

This is an article reporting a large phyllodes tumor with fibroadenoma. A 25 years female presented with a fungating mass of size 20×15 cms in right breast since last 1 year and amass of size 3×3 cms in left breast since 6 month. Biopsy from right side and left side breast mass proven to be Cystosarcomaphyllodes and fibroadenoma respectively. Wide local excision with 1cm normal tumor margin on right side and   excision of mass on left side done. Proliferative markers like Ki-67 and P53 were in range of 1-2% and 3-4% respectively. Histopathological diagnosis of tumor was borderline phyllodes tumor (right side) and fibroadenoma (left side). Patient had an uneventful post-operative course and is presently on three monthly follow up since 1 year.

scholarly journals Prognostic Value of Invasion, Markers of Proliferation, and Classification of Giant Pituitary Tumors, in a Georeferred Cohort in Brazil of 50 Patients, with a Long-Term Postoperative Follow-Up

2016 ◽  
Vol 2016 ◽  
pp. 1-14 ◽  
Author(s):  
Juliano Coelho de Oliveira Zakir ◽  
Luiz Augusto Casulari ◽  
José Wilson Corrêa Rosa ◽  
João Willy Corrêa Rosa ◽  
Paulo Andrade de Mello ◽  
...  
Keyword(s):  
Pituitary Tumors ◽  
Biological Behavior ◽  
Significant Relation ◽  
Ki 67 ◽  
Radiological Features ◽  
Current Classification ◽  
Geographical Cluster

Although some pituitary adenomas may have an aggressive behavior, the vast majority are benign. There are still controversies about predictive factors regarding the biological behavior of these particular tumors. This study evaluated potential markers of invasion and proliferation compared to current classification patterns and epidemiogeographical parameters. The study included 50 patients, operated on for tumors greater than 30 mm, with a mean postoperative follow-up of 15.2 ± 4.8 years. Pituitary magnetic resonance was used to evaluate regrowth, invasion, and extension to adjacent tissue. Three tissue biomarkers were analyzed: p53, Ki-67, and c-erbB2. Tumors were classified according to a combination of histological and radiological features, ranging from noninvasive and nonproliferative (grade 1A) to invasive-proliferative (grade 2B). Tumors grades 2A and 2B represented 42% and 52%, respectively. Ki-67 (p=0.23) and c-erbB2 (p=0.71) had no significant relation to tumor progression status. P53 (p=0.003), parasellar invasion (p=0.03), and classification, grade 2B (p=0.01), were associated with worse clinical outcome. Parasellar invasion prevails as strong predictive factor of tumor recurrence. Severe suprasellar extension should be considered as invasion parameter and could impact prognosis. No environmental factors or geographical cluster were associated with tumor behavior.

scholarly journals SAT-265 An Asynchronous Double Growth Hormone Secreting Pituitary Adenoma as a Cause of Rapid Tumor Regrowth After Initially Successful Surgery

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Malgorzata Trofimiuk-Muldner ◽  
Kluczynski Lukasz ◽  
Grzegorz Zielinski ◽  
Grzegorz Sokolowski ◽  
Maria Maksymowicz ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Pituitary Tumor ◽  
Tumor Regression ◽  
Somatostatin Receptors ◽  
Ki 67 ◽  
Gh Secretion ◽  
Repeated Surgery ◽  
Double Pituitary Adenomas ◽  
Mitotic Figures

Abstract Background. Double pituitary adenomas are a rare entity, which requires clinical attention and a careful follow-up. Case report. A 37-year-old man presented with left-sided painful gynecomastia. He denied typical symptoms of excessive growth hormone (GH) secretion and did not show any acromegalic features. Due to low testosterone and LH levels with mild hyperprolactinaemia, the patient was referred to pituitary MR, which revealed an 11x13 mm right-sided sellar tumor. An increased IGF-1 was noted subsequently (1482 ng/mL; N 109-284 ng/mL), together with the lack of GH suppression in OGTT. Transphenoidal resection of pituitary tumor performed in 2012 led to biochemical (IGF-1 260 ng/mL, GH 0.08 ng/mL) and radiological remission of the disease. A histopathology report revealed a densely granulated somatotropic pituitary adenoma with mild nuclear atypia, expressing somatostatin receptors [sstr2A (+), sstr5 (+/-)]. Due to gradually increasing IGF-1 levels (with low, although rising, GH values ranging from 0.07 to 0.92 ng/mL) in subsequent years, OGTT was repeated in 2015, showing appropriate GH suppression. In 2016, however, acromegaly recurrence was confirmed both biochemically (increasingly high IGF-1 - 664 ng/mL - and unsuppressed post-OGTT growth hormone) and in MR imaging. The patient was reoperated in June 2017. The second histopathology reported an oncocytic somatotropic acidophil stem cell pituitary adenoma with Ki-67 >3% and mitotic figures. Subsequent anterior pituitary lobe insufficiency (adrenal, thyroid and gonadal axis) was found and adequately treated. Complete tumor removal was confirmed by MR performed three months after repeated surgery, as well as a low GH level (0.97 ng/mL), although accompanied by borderline IGF-1 values (277 ng/mL). Eighteen months after surgery, the recurrence of acromegaly was again confirmed, with adenoma regrowth and increased GH (2.31 ng/mL) and IGF-1 (474 ng/mL) levels. Octreotide LAR was started (despite retina wrinkling which was observed when lanreotide was administered before the first surgery), which led to a normalization of GH (0.96 ng/mL) and IGF-1 levels (152 ng/mL), as well as partial pituitary tumor regression after six months therapy. Conclusion. In a case of GH-secreting pituitary adenoma recurrence after apparent successful surgery, a double pituitary tumor with more aggressive histology should be considered.

scholarly journals Conjunctival Melanocytic Nevi With Granular Cell Change

2019 ◽  
Vol 144 (4) ◽  
pp. 457-465
Author(s):  
Maya Eiger-Moscovich ◽  
Ralph C. Eagle ◽  
Sara E. Lally ◽  
Carol L. Shields ◽  
Jerry A. Shields ◽  
...  
Keyword(s):  
Case Series ◽  
Granular Cell ◽  
Surgical Excision ◽  
Melanocytic Nevus ◽  
Proliferative Index ◽  
Ki 67 ◽  
Melanocytic Nevi ◽  
Pathologic Features ◽  
Mitotic Figures

Context.— Granular cell change in melanocytic nevus is underrepresented in the literature with only 4 well-documented cases, 1 described in the conjunctiva. Unfamiliarity with the clinical and pathologic features of these lesions contributes to the diagnostic difficulty. Objective.— To delineate the clinical and histopathologic features of conjunctival nevi with granular cell change. Design.— In a retrospective observational case series, the medical records of all patients with conjunctival nevi and granular cell change diagnosed between December 2016 and October 2018 were reviewed. Data collected included age, sex, clinical presentation, pathologic findings, and follow-up. Results.— Twelve patients, 6 males and 6 females, with a median age of 14 years (range, 8–82 years) were identified. The nevus manifested as a pigmented, well-circumscribed nodule (7 of 9; 78%) or patch (2 of 9; 22%) in the bulbar and limbal conjunctiva (7 of 9; 78%) or in the plica semilunaris/caruncle (2 of 9; 22%). Cysts were noted in 7 of 9 lesions (78%). Features prompting surgical excision included atypical pigmentation (8 of 9; 89%), growth (7 of 9; 78%), and atypical vascularity (4 of 9; 44%). Microscopically, all lesions comprised a conventional melanocytic nevus with focal granular cell change and immunoreactivity for Melan-A, SOX10, and HMB-45, with Ki-67 proliferative index of less than 2%. Of the 9 lesions with follow-up information, there were no recurrences over mean follow-up of 11.2 months (range, 1–23 months). Conclusions.— Granular cell change in melanocytic nevi is an underrecognized finding that can simulate melanoma clinically and histopathologically. Young age at diagnosis, lack of associated conjunctival melanosis, bulbar location, cysts, and the absence of mitotic figures with a low Ki-67 proliferative index are helpful clinical and pathologic diagnostic clues.

scholarly journals Ameloblastic Fibrosarcoma: A Case Report and Literature Review

2017 ◽  
Vol 28 (2) ◽  
pp. 262-272 ◽  
Author(s):  
João Paulo Silva Servato ◽  
Paulo Rogério de Faria ◽  
Cássio Vinhadelli Ribeiro ◽  
Sergio Vitorino Cardoso ◽  
Paulo Rogério de Faria ◽  
...  
Keyword(s):  
Case Report ◽  
Current Knowledge ◽  
Immunohistochemical Analysis ◽  
Cytokeratin 19 ◽  
High Power Field ◽  
Ki 67 ◽  
Prognostic Features ◽  
Regional Metastasis ◽  
Ameloblastic Fibrosarcoma

Here is described a case of ameloblastic fibrosarcoma (AFS) affecting the posterior mandible of a woman who was treated surgically and recovered without signs of recurrence or metastasis after 12 years of follow-up. Tumor sections were immunostained for cell cycle, epithelial and mesenchymal markers. Immunohistochemical analysis evidenced high Ki-67 positivity in stromal cells (mean of 20.9 cells/High power field). Epithelial cells displayed strong positivity for p53, p63 and cytokeratin 19. In addition to the case report, a systematic review of current knowledge is presented on the AFS’s clinical-demographic features and prognostic factors. Based on the review, 88/99 cases were diagnosed as AFS, 9/99 as ameloblastic fibro-odontosarcoma and 2/99 as ameloblastic fibrodentinosarcoma. All these lesions displayed very similar clinical-demographic and prognostic features. Moreover, the review provided evidence that first treatment, regional metastasis, distant metastasis and local recurrence were significant prognostic values for malignant odontogenic mesenchymal lesions. Based on the findings, segregation among ameloblastic fibrosarcoma, ameloblastic fibrodentinosarcoma and ameloblastic fibro-odontosarcoma seems illogical, considering all these lesions have similar predilections and outcomes.

scholarly journals “Double hit” B-lymphoblastic lymphoma with concurrent IGH/BCL2 and 8q24/MYC translocations: a case report

2020 ◽  
Author(s):  
Lu He ◽  
Zhiwen Li ◽  
Xiangshan Fan ◽  
Jieyu Chen ◽  
Hongyan Wu ◽  
...  
Keyword(s):  
De Novo ◽  
Abdominal Mass ◽  
Initial Response ◽  
Proliferation Index ◽  
Ki 67 ◽  
Double Hit ◽  
Mitotic Figures ◽  
B Lymphoblastic Lymphoma

Abstract BackgroundB-lymphoblastic lymphomas (B-LBLs) with a documented “double-hit” (DH) (IGH/BCL2 and 8q24/MYC rearrangement) are rare and their clinical, cytogenetic and immunophenotypic features have not been well elucidated. Here we describe an unusual case of de novo DH B-LBL.Case presentationA 39-year-old man presented with abdominal distention at admission. Radiological findings revealed a retroperitoneal lump and multiple lymphadenopathy. Histologic examination of the abdominal mass showed a predominant population of neoplastic lymphoblasts with round nuclei, which focally formed single files surrounded by fibrotic septa. These cells have high nuclear to cytoplasmic ratio, fine chromatin, and no inconspicuous nucleoli. Necrosis, apoptotic bodies and mitotic figures were common. Prominent starry-sky appearance was not observed. The typical immunophenotype of malignant cells was positive for TdT, CD99, CD10, PAX-5, Bcl2 (70%), MYC (70%), and negative for CD34,Cyclin-D1, SOX11, CD56, and CD123. The proliferation index was high with Ki-67 of 80%. Fluorescence in situ hybridization (FISH) studies demonstrated 8q24/MYC rearrangement and IGH/BCL2 gene fusion. Subsequent bone marrow biopsy showed no involvement. Normal chromosome karyotype was observed. Finally, the diagnosis of “double-hit” B-LBL was clinically rendered. The patient showed an initial response to six cycles of hyper-CVAD chemotherapy (hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) and was alive at the last follow-up (2020.4.10, six months after the diagnosis).ConclusionsFew guidelines regarding DH B-LBL are available in the literature or in the WHO scheme. The optimal clinical management of such patients has not been fully established attributed to the small number of reported cases. Multicenter data is warranted to better make clinical strategies on patients with DH B-LBL.

scholarly journals Pituitary carcinoma: The University of Texas MD Anderson Cancer Center experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 2068-2068
Author(s):  
Fernando Santos Pinheiro ◽  
Marta Penas-Prado ◽  
Ian E. McCutcheon ◽  
Anita Mahajan ◽  
Paul D. Brown ◽  
...  
Keyword(s):  
Single Agent ◽  
Survival Rates ◽  
Pituitary Tumors ◽  
Progression Free Survival ◽  
Pituitary Carcinoma ◽  
Cancer Center ◽  
Ki 67 ◽  
University Of Texas ◽  
Md Anderson

2068 Background: Pituitary carcinoma (PC) is a rare and aggressive neuroendocrine tumor diagnosed once a pituitary adenoma (PA) becomes metastatic. Although no standard treatment currently exists, surgery, radiation (XRT) and/or chemotherapy are most commonly used. Recently, treatment with temozolomide (TMZ) has shown promising results, although the lack of prospective trials limits accurate outcome assessment. Methods: We describe a single-center multidisciplinary team experience in managing PC patients over a 13-year period (Oct, 2003 to Jan, 2017). Results: A total of 17 patients (9 males) were seen. Median age at diagnosis of PC was 44 years (range 16-82 years) and the median time from PA to PC conversion was 6 years (range 1-29 years). Median follow-up time: 28 months (range 8-158 months) with 7 reported deaths. The majority of PC was hormone-secreting (HS) subtype (n = 12): ACTH (n = 5), PRL (n = 4), FSH/LH (n = 2), GH (n = 1). After PC diagnosis, all pituitary tumors were locally invasive, all underwent at least one resection (mean 2.3) and all received at least one course of XRT alone (IMRT = 76%, SRS = 29%, IMPT = 12%) or concurrent with chemotherapy (18%). Immunohistochemistry showed high Ki-67 labeling index ( > 3%) in 9 (53%) cases. Most cases (n = 14) had metastases to the CNS, 35% of those had combined CNS and systemic foci. Ten (59%) cases underwent focal treatment of metastases, 90% of which underwent XRT. The most common chemotherapy used was TMZ [n = 14 (82%): single agent (n = 10); TMZ+capecitabine (n = 5); concurrent TMZ+XRT (n = 3); concurrent TMZ+XRT with adjuvant TMZ (n = 1)]. The median longest progression-free survival (LPFS) was 18 months (range 4-45 months). TMZ was associated with the chemotherapy-related LPFS in 9 (75%) cases. The 2, 3 and 5 year survival rate was 65%, 53% and 35%, respectively. All patients surviving > 5 years were treated with TMZ (n = 5, 2 survived > 10 years). Two refractory cases are currently on PD-1 inhibitor agent. Eighty percent of non-functioning PC were alive at last follow-up (HS-PC, 58%). Recurrence occurred in 11 (65%) cases. Conclusions: Treatment of PC requires a multidisciplinary approach. Multimodality therapy with surgery, radiation and TMZ was associated with higher survival rates and longer PFS.

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