Nonfunctioning Ectopic Pituitary Adenoma Presenting as Epistaxis: A Report of Two Cases

ABSTRACT Ectopic pituitary adenomas are uncommon lesions and are found along the migratory pathway of the Rathke's pouch. Sites reported include suprasellar region, clivus, sphenoid sinus, nasopharynx, third ventricle, petrous temporal bone, hypo thalamus, etc. Compared to intrasellar adenomas, a higher proportion of the ectopic examples are functional and most commonly produce adenocorticotropic hormone (ACTH). The authors report two cases of ectopic pituitary adenoma in the sphenoid sinus in two male patients 36 and 40 years old, presenting with epistaxis. Both the patients did not have any endocrine abnor malities. The clinical and imaging findings were suggestive of sinonasal malignancy. The final diagnosis was made after histopathological examination and immunohistochemistry for cytokeratin, chromogranin and pituitary hormones. The diagnosis of ectopic pituitary adenomas is difficult especially in those tumors that are nonfunctioning. After extensive literature search, we could find only six cases of nonfunctioning adenomas reported in the sphenoid sinus and in all these cases the correct diagnosis could be made only by histopathology. How to cite this article Govindan A, Sasi P, Radhakrishnan S, Alapatt JP, Aravindan KP. Nonfunctioning Ectopic Pituitary Adenoma Presenting as Epistaxis: A Report of Two Cases. Int J Otorhinolaryngol Clin 2014;6(3):130133.

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Ectopic pituitary adenoma of the third ventricle

Journal of Neurosurgery ◽

10.3171/jns.1990.72.1.0139 ◽

1990 ◽

Vol 72 (1) ◽

pp. 139-142 ◽

Cited By ~ 40

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.

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“An Unexpected Pit” - Ectopic Pituitary Adenoma

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1137 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A557-A558

Author(s):

Hassaan B Aftab ◽

Canan Gunay ◽

Racha Dermesropian ◽

Vitaly Kantorovich

Keyword(s):

Pituitary Adenoma ◽

Pituitary Gland ◽

Pituitary Adenomas ◽

Sphenoid Sinus ◽

Fungal Infections ◽

Correct Diagnosis ◽

Pathology Report ◽

Pituitary Hormone ◽

Mri Brain ◽

Ectopic Pituitary Adenoma

Abstract Background: Ectopic pituitary adenomas (EPAs) are exceedingly rare neoplasms, comprising about 0.5% of all pituitary adenomas. These are often misdiagnosed radiologically, while the correct diagnosis requires high index of suspicion on pathology and immunohistochemistry analysis. Clinical Case: 62-year-old female presented to the ED with transient unilateral visual loss. She denied orbital pain, headache, or motor or sensory deficit. Following unremarkable ophthalmology evaluation, initial MRI brain was suggestive of pituitary adenoma. MRI of the pituitary with gadolinium contrast showed nonenhancing focus of about 1.5 cm within the posterior sphenoid sinus adjacent to a normal-appearing pituitary gland. Lab assessment showed no pituitary hormone excess or insufficiency. ENT evaluation with repeat MRI brain with contrast showed a T2 heterogeneously enhancing hyperintense lesion in the clivus measuring 2.1 x 1.9 x 1.3 cm (transverse, AP and CC, respectively) with bony thinning/erosion of the sellar floor, the posterior wall of sphenoid sinus and dorsal clivus. Patient underwent transnasal transsphenoidal resection of the tumor with sample submitted as clival chordoma. Pathology report showed a 3.3 x 2.7 x 0.9 cm tumor with immunohistochemistry positive for ACTH, FSH, synaptophysin, chromogranin, S100 and cytokeratin while staining negative for GH, LH, TSH, prolactin and epithelial membrane antigen (EMA). Reticulin stain showed loss of reticulin network and Ki-67 labeling index was 1%. Neurosurgery and ENT teams confirmed no gross manipulation of the pituitary gland had been performed and findings supported a diagnosis of ectopic pituitary adenoma. On 6-month follow-up patient continued to do well clinically and MRI showed normal-appearing pituitary gland with no residual or recurrent tumor. Conclusion: EPA is a rare entity with about 133 cases described in literature. EPAs are generally benign, however up to 79% are functionally active and more likely than their sellar counterparts to secrete multiple pituitary hormones. EPAs arise from remnants of embryonic pituitary tissue in the migratory part of the Rathke’s pouch during early fetal development. The most common locations for EPA are in the sphenoid sinus, clivus, nasopharynx, cavernous sinus and suprasellar space and these are often misdiagnosed on initial radiology as neuroendocrine tumors, sino-nasal carcinomas, clival chordomas or even fungal infections. It is vital to consider EPA in the differential diagnosis of tumors removed from the mentioned anatomic locations as establishing the correct diagnosis helps to avoid the significant morbidity associated with treatments employed for other tumors. Reference: Riccio, L., Donofrio, C.A., Tomacelli, G. et al. Ectopic GH-secreting pituitary adenoma of the clivus: systematic literature review of a challenging tumour. Pituitary 23, 457-466 (2020)

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Ectopic Pituitary Adenoma: Case Report with Review of Literature

Indian Journal of Neurosurgery ◽

10.1055/s-0036-1584598 ◽

2017 ◽

Vol 06 (02) ◽

pp. 117-121

Author(s):

Satish Nair ◽

W. Ramalingam ◽

Reena Bharadwaj ◽

Akshat Malik ◽

Rachana Prasad

Keyword(s):

Case Report ◽

Pituitary Adenoma ◽

Literature Review ◽

Sphenoid Sinus ◽

Review Of Literature ◽

Rare Presentation ◽

Nasal Mass ◽

Ectopic Pituitary Adenoma ◽

Suprasellar Region

AbstractEctopic pituitary adenoma (EPA) is a rare presentation first described by Erdheim. Most of the EPAs described in literature occur in the sphenoid sinus or suprasellar region. We describe a case of an EPA originating from the choana presenting as a case of nasal mass along with detailed literature review.

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MICROSURGICAL ANATOMY OF THE DIAPHRAGMA SELLAE AND ITS ROLE IN DIRECTING THE PATTERN OF GROWTH OF PITUITARY ADENOMAS

Neurosurgery ◽

10.1227/01.neu.0000317321.79106.37 ◽

2008 ◽

Vol 62 (3) ◽

pp. 717-723 ◽

Cited By ~ 39

Author(s):

Alvaro Campero ◽

Carolina Martins ◽

Alexandre Yasuda ◽

Albert L. Rhoton

Keyword(s):

Pituitary Adenoma ◽

Cavernous Sinus ◽

Dura Mater ◽

Pituitary Adenomas ◽

Potential Role ◽

Pituitary Tumors ◽

Microsurgical Anatomy ◽

Suprasellar Region ◽

Lateral Distance ◽

Diaphragma Sellae

Abstract OBJECTIVE To evaluate the anatomic aspects of the diaphragma sellae and its potential role in directing the growth of a pituitary adenoma. METHODS Twenty cadaveric heads were dissected and measurements were taken at the level of the diaphragma sellae. RESULTS The diaphragma sellae is composed of two layers of dura mater. There is a remarkable variation in the morphology of the diaphragm opening. The average anteroposterior distance of the opening was 7.26 mm (range, 3.4–10.7 mm) and the average lateral-to-lateral distance was 7.33 mm (range, 2.8–14.1 mm). CONCLUSION The variability in the diameter of the opening of the diaphragma sellae could explain the growth of pituitary tumors toward the cavernous sinus or toward the suprasellar region.

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Tuberculosis: A Common Infection with Rare Presentation, Isolated Sellar Tuberculoma with Panhypopituitarism

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_332_18 ◽

2019 ◽

Vol 10 (02) ◽

pp. 327-330 ◽

Cited By ~ 2

Author(s):

Vivek Mahesh Agrawal ◽

Pramod Janardhan Giri

Keyword(s):

Pituitary Adenoma ◽

Transsphenoidal Surgery ◽

Rare Case ◽

Nerve Palsy ◽

Histopathological Examination ◽

Rare Condition ◽

Final Diagnosis ◽

Endoscopic Transsphenoidal Surgery ◽

Rare Presentation ◽

Common Infection

ABSTRACTIsolated sellar tuberculoma is a very rare condition and usually presents with headache and decreased vision. It can present with panhypopituitarism with 3rd nerve palsy. Tuberculoma mimics pituitary adenoma clinically as well as radiologically and requires endoscopic transsphenoidal surgery and histopathological examination for the final diagnosis. We present a rare case of a 40-year-old female presented with headache, decreased vision, and unilateral 3rd nerve palsy with panhypopituitarism.

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Acromegaly due to an ectopic pituitary adenoma in the sphenoid sinus

Acta Radiologica ◽

10.1080/02841850410008405 ◽

2004 ◽

Vol 45 (6) ◽

pp. 689-691 ◽

Cited By ~ 17

Author(s):

J. A. Gondim ◽

M. Schops ◽

E. Ferreira ◽

T. Bulcão ◽

J. I. Mota ◽

...

Keyword(s):

Pituitary Adenoma ◽

Sphenoid Sinus ◽

Ectopic Pituitary Adenoma

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Rapidly-Growing Ectopic Pituitary Adenoma Within the Sphenoid Sinus —Case Report—

Neurologia medico-chirurgica ◽

10.2176/nmc.37.399 ◽

1997 ◽

Vol 37 (5) ◽

pp. 399-402 ◽

Cited By ~ 15

Author(s):

Tetsuyoshi HORIUCHI ◽

Yuichiro TANAKA ◽

Shigeaki KOBAYASHI ◽

Takashi UNOKI ◽

Akira YOKOH

Keyword(s):

Case Report ◽

Pituitary Adenoma ◽

Sphenoid Sinus ◽

Ectopic Pituitary Adenoma

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Collision Tumor in the Pituitary, Concurrent Pituitary Adenoma, and Craniopharyngioma

Case Reports in Otolaryngology ◽

10.1155/2020/9584090 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Zaid Shareef ◽

Connor Kerndt ◽

Trevor Nessel ◽

Devin Mistry ◽

Bryan Figueroa

Keyword(s):

Pituitary Adenoma ◽

Histopathological Examination ◽

Past History ◽

Third Ventricle ◽

Tumor Resection ◽

Optic Chiasm ◽

Collision Tumor ◽

Fat Graft ◽

Csf Leak ◽

Graft Harvest

Collision tumors are two independent, distinct tumors occupying the same anatomical space. This case presents a pituitary adenoma-craniopharyngioma collision tumor presenting with hemianopsia. A 60-year-old with a past history of a nonsecretory pituitary adenoma presented with progressive headaches, bitemporal hemianopsia, and nausea. Previously, in 2008, his adenoma was effectively treated with nasal septal flap and transsphenoidal pituitary resection. A magnetic resonance imaging (MRI) was ordered for concern of recurrence, given his history and neurologic complaints. The MRI revealed a suprasellar mass extending into the third ventricle with displacement of the hypothalamus and optic chiasm. Laboratory testing revealed no indicators of endocrinopathy. The neurosurgical and otolaryngologic teams were elected to perform tumor resection given the ongoing symptoms. An image-guided transsphenoidal tumor resection with abdominal fat graft harvest and septal mucosal flap CSF leak repair was performed. Histopathological examination revealed two tumor components within the resection including an adamantinomatous craniopharyngioma and recurrent pituitary adenoma.

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