Difference between revisions of "Pituitary gland"

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Pituitary gland (view source)

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Divisions:<ref>[http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo.html http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo.html]</ref>
Divisions:<ref>[http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo.html http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo.html]</ref>
*Anterior pituitary ([[AKA]] adenohypophysis).
*Anterior pituitary ([[AKA]] adenohypophysis, pars distalis).
*Posterior pituitary (AKA neurohypophysis, neural pituitary).
*Posterior pituitary (AKA neurohypophysis, neural pituitary, pars nervosa).


==Function==
=Function=
===Anterior===  
===Anterior===  
Hormones:<ref name=rcn_com>[http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/Pituitary.html http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/Pituitary.html]</ref>
Hormones:<ref name=rcn_com>[http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/Pituitary.html http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/Pituitary.html]</ref>
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Mnemonic: "Go Look For The Adenoma Please" = GH, LH, FSH, TSH, ACTH, PRL.
Mnemonic: "Go Look For The Adenoma Please" = GH, LH, FSH, TSH, ACTH, PRL.
===Intermedia===
* Originates from the posterior wall of the Rathke’s pouch.
* Hormones: MSH, ACTH precursor.
* Contains colloid cysts.


===Posterior===
===Posterior===
Line 22: Line 27:
*Antidiuretic hormone (ADH).
*Antidiuretic hormone (ADH).


==Anatomy and histology==
=Anatomy and histology=
===Anatomy===
===Anatomy===
Basic anatomy (simplified):<ref name=bowen>URL: [http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo_pit.html http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo_pit.html]. Accessed on: 31 October 2010.</ref>
Basic anatomy (simplified):<ref name=bowen>URL: [http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo_pit.html http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo_pit.html]. Accessed on: 31 October 2010.</ref>
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**GH, PRL.
**GH, PRL.
*Basophils (10% of cells) = basophilic (light blue).
*Basophils (10% of cells) = basophilic (light blue).
**TSH, LH, FSH.
**TSH, LH, FSH, ACTH.
*Chromophobes (50% of cells) = amphophilic (purplish/grey).
*Chromophobes (50% of cells) = amphophilic (purplish/grey).


Notes:
Notes:
*The cellular product (i.e. hormone produced) is not strictly correlated with the cell type.<ref name=Ref_PSNP26>{{Ref PSNP|26}}</ref>
*The cellular product (i.e. hormone produced) is not strictly correlated with the cell type.<ref name=Ref_PSNP26>{{Ref PSNP|26}}</ref>
*The cells can be typed using [[IHC]]; somatotrophs (GH), lactotrophs (PRL), corticotrophs (ACTH), thyrotrophs (TSH), gonadotrophs (FSH, LH).<ref>{{Ref PBoD8|1098-9}}</ref>


====Posterior====
====Posterior====
Line 56: Line 62:
*Less cellular.
*Less cellular.
**Usually more cellular in perivascular location.
**Usually more cellular in perivascular location.
Image: [http://www.ouhsc.edu/histology/Glass%20slides/38_09.jpg Herring bodies (ouhsc.edu)].
<gallery>
File:Pituitary gland histology 2014.jpg | Pituitary gland, low magnification (WC/Athikhun.suw)
</gallery>
=DDx for sella turcica lesions=
*[[Pituitary adenoma|PitNET]].
*[[Rathke cleft cyst]].
*[[Craniopharyngioma]].
*[[Germ cell tumour]].
*[[Meningioma]].
=Pituitary necrosis=
*Rare.
===Causes of pituitary necrosis===
*Sheehan syndrome - secondary to blood loss in childbirth.<ref>URL: [http://www.mayoclinic.com/health/sheehans-syndrome/DS00889 http://www.mayoclinic.com/health/sheehans-syndrome/DS00889]. Accessed on: 16 November 2010.</ref>
*[[Syphilis]] (fetal-maternal transmission).<ref>URL: [http://pediatrics.aappublications.org/cgi/content/full/104/1/e4 http://pediatrics.aappublications.org/cgi/content/full/104/1/e4]. Accessed on: 16 November 2010.</ref>
*Mollaret's meningitis - very rare.<ref name=pmid18715308>{{cite journal |author=Dancer CM, Woods ML, Henderson RD, Robertson T, Mungomery M, Allworth A |title=Mollaret's meningitis and pituitary failure associated with a Rathke's cleft cyst |journal=Intern Med J |volume=38 |issue=7 |pages=609–11 |year=2008 |month=July |pmid=18715308 |doi=10.1111/j.1445-5994.2008.01709.x |url=}}</ref> (???)
*Spontaneous necrosis of pituitary tumours - case reports.<ref>{{cite journal |author=Sachdev Y, Evered DC, Hall R |title=Spontaneous pituitary necrosis |journal=Br Med J |volume=1 |issue=6015 |pages=942 |year=1976 |month=April |pmid=1268492 |pmc=1639254 |doi= |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1639254/pdf/brmedj00512-0028a.pdf}}</ref>
Images:
*[http://path.upmc.edu/cases/case288.html Pituitary necrosis - several images (upmc.edu)].
=Specific entities=
==Pituitary neuroendocrine tumor (PitNET)==
Old terminology '''Pituitary adenoma''' is depreceated.
The WHO 2022 Classification of tumours of endocrine organs recoginizes following tumours:<ref>{{cite journal |vauthors=Asa SL, Mete O, Perry A, Osamura RY |title=Overview of the 2022 WHO Classification of Pituitary Tumors |journal=Endocr Pathol |volume=33 |issue=1 |pages=6–26 |date=March 2022 |pmid=35291028 |doi=10.1007/s12022-022-09703-7 |url=}}</ref>


Image: [http://www.ouhsc.edu/histology/Glass%20slides/38_09.jpg Herring bodies (ouhsc.edu)].


==DDx for stellar lesions==
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
*Pituitary adenoma.
! PitNET lineage
*Rathke cleft cyst.
! PitNET type
*Craniopharyngioma.
! subtypes
*Germ cell tumour.
! Hormone IHC
*Meningioma.
! Transcription factor IHC
|-
| PIT1
| Somatotroph tumor
| Densely and sparsely granulated tumor
| GH, a-subunit+/-, CK+
| PIT1
|-
| PIT1
| Lactotroph tumor
| Densely and sparsely granulated tumor
| PRL, CK-ve or weak
| PIT1, [[Estrogen receptor|ER]]
|-
| PIT1
| Mammosomatotroph tumor
|
| GH, PRL (usu. less), CK perinuclear +ve
| PIT1, [[Estrogen receptor|ER]]
|-
| PIT1
| Thyrotroph tumor
|
| TSH, CK-ve or weak
| PIT1, GATA3
|-
| PIT1
| Mature plurihormonal PIT1 lineage tumor
|
| GH, PRL, TSH, a-subunit +/-ve, CK perinuclear
| PIT1, [[Estrogen receptor|ER]], GATA3
|-
| PIT1
| Immature PIT1 lineage tumor
|
| Only focal GH, PRL, TSH, a-subunit +/-ve, CK variable
| PIT1, [[Estrogen receptor|ER]] +/-ve, GATA3 +/-ve
|-
| PIT1
| Acidophilic stem cell tumor
|
| PRL, GH (focal/variable), CK fibrous bodies
| PIT1, [[Estrogen receptor|ER]]
|-
| PIT1
| Mixed somatotroph and lactotroph tumor
|
| PRL, GH (in separate cells)
| PIT1, [[Estrogen receptor|ER]] (only in lactotroph component) 
|-
| TPIT
| Corticotroph tumor
| Densely and sparsely granulated tumors, Crooke cell adenoma
| ACTH,CK+ve
| TPIT
|-
| SF1
| Gonadotroph tumor
|
| FSH, LH, a-Subunit or none
| SF1, ER, GATA3, CK+/-ve
|-
| None
| Plurihormonal tumor
|
| All combinations possible
| All combinations possible, CK+/-ve
|-
| None
| Null cell adenoma
|
| None (adenohypophyseal?)
| None
|}
 
Other tumours may be classified as plurhormonal or double adenomas or as adenomas with unusual IHC combination.


==Pituitary adenoma==
===General===
===General===
*Classically presents with visual field defects.
*Clinical:<ref>{{Ref PBoD8|1100}}</ref>
*May be part of [[multiple endocrine neoplasia]] I  
**Classically: visual field defects (bitemporal hemianopsia).
**3Ps: '''p'''ituitary adenoma, [[parathyroid|'''p'''arathyroid]] adenoma, [[pancreas|'''p'''ancreatic]] neuroendocrine tumours.
**Others (increased intracranial pressure): headache, nausea, vomiting.
**Tumor of adults.
 
Morphologic Classification:
#Microtumor <= 1 cm.
#Macrotumor 1-4 cm.
#Giant tumor > 4cm.
 
May be classified by what they secrete.
#Functional (endocrine hyperfunction).
#*Acromegaly/giantism.
#*Hyperprolactinemia.
#*Cushing disease.
#*Hyperthyroidism.
#*Significant elevation of FSH/LH.
#Clinically nonfunctioning.
 
Notes:
''Cushing disease'' is due to pituitary gland hypersecretion of ACTH (due to a pituitary adenoma ''or'' CRH hypersecretion from the hypothalamus).<ref name=Ref_PBoD8_1148>{{Ref PBoD8|1148}}</ref>  [[Cushing syndrome]] is hypercortisolism ''not'' due to pituitary gland pathology.
 
Imaging:
*Sellar enlargement.
*Bone erosion, invasive growth esp. cavernous sinus (35-45%).
*Inhomogenous signal in T1w MRI.
 
====Familial pituitary adenomas====
A pituitary adenoma may be part of a familial syndrome:<ref name=pmid19564887>{{Cite journal  | last1 = Elston | first1 = MS. | last2 = McDonald | first2 = KL. | last3 = Clifton-Bligh | first3 = RJ. | last4 = Robinson | first4 = BG. | title = Familial pituitary tumor syndromes. | journal = Nat Rev Endocrinol | volume = 5 | issue = 8 | pages = 453-61 | month = Aug | year = 2009 | doi = 10.1038/nrendo.2009.126 | PMID = 19564887 }}</ref><ref name=Ref_PCPBoD8|554>{{Ref PCPBoD8|554}}</ref>
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
! Syndrome
! Gene
! Notes
|-
| [[Multiple endocrine neoplasia]] I
| MEN1
| characterized by the 3 Ps: '''p'''ituitary adenoma, [[parathyroid adenoma|'''p'''arathyroid adenoma]], [[pancreatic neuroendocrine tumour|'''p'''ancreatic neuroendocrine tumour]]
|-
| MEN-1-like syndrome
| CDKN1B<ref name=omim600778>{{OMIM|600778}}</ref>
| also known as ''Multiple endocrine neoplasia IV'' <ref name=omim600778>{{OMIM|600778}}</ref>
|-
| [[Carney syndrome]]
| PRKAR1A
| other findings (mnemonic ''NAME''): nevi, [[atrial myxoma]], myxoid neurofibroma, ephelides (freckles)
|-
| Isolated pituitary adenoma<ref name=pmid22612670>{{Cite journal  | last1 = Korbonits | first1 = M. | last2 = Storr | first2 = H. | last3 = Kumar | first3 = AV. | title = Familial pituitary adenomas - Who should be tested for AIP mutations? | journal = Clin Endocrinol (Oxf) | volume =  | issue =  | pages =  | month = May | year = 2012 | doi = 10.1111/j.1365-2265.2012.04445.x | PMID = 22612670 }}</ref>
| AIP
| classically GH-producing adenoma - leads to acromegaly
|}


===Microscopic===
===Microscopic===
Features:<ref name=Ref_PSNP36>{{Ref PSNP|36}}</ref>
Features:<ref name=Ref_PSNP36>{{Ref PSNP|36}}</ref>
*Loss of fibrous stroma.
*Loss of fibrous stroma.
**The cells of a normal (anterior) pituitary are nested.
*Basophilic cells (corticotrophs).
*Eosinophilic cells(somatotrophs).
*Extensive fibrosis often seen in TSH-producing tumors.


Notes:
Notes:
*Smears very well.<ref>MUN. 24 November 2010.</ref>
*Smears very well.<ref>MUN. 24 November 2010.</ref>
====Images====
<gallery>
Image:Nonfunctioning_pituitary_adenoma_%281%29.jpg | Pituitary adenoma - non-functioning. (WC/KGH)
File:HE fibrosis pituitary adenoma.jpg | Extensive interstitial and perivascular fibrosis in a pituitary adenoma (WC/jensflorian)
File:PRL HE histology.jpg | Pituitary adenoma - PRL producing, HE. Note the basophilic appearance of the cells (WC/jensflorian)
File:PRL adenoma treatment HE.jpg | Pituitary adenoma - PRL producing, HE. Extensive regressive changes after after dopamine agonist treatment (WC/jensflorian)
File:PRL IHC pituitary adenoma.jpg | Pituitary adenoma - PRL producing, Prolactin IHC (WC/jensflorian)
File:Densely granulated HGH producing adenoma.jpg | Pituitary adenoma - HGH producing, HE. The cells have a slightly eosinophilic appearance (WC/jensflorian)
File:Sparsely granulated HGH adenoma.jpg | Sparsely granulated adenoma - HGH producing. Note the numerous fibrous bodies in HE stain (WC/jensflorian)
File:HGH adenoma CK8.jpg | Sparsely granulated adenoma - HGH producing. CK8 IHC highlighting fibrous bodies (WC/jensflorian)
File:TSHoma HE.jpg | Pituitary adenoma - TSH producing. HE stain showing pleomorphism (WC/jensflorian)
File:TSHoma IHC-TSH.jpg |  Pituitary adenoma - TSH producing. TSH IHC can be heterogeneous (WC/jensflorian)
Image:Pituitary_adenoma_%281%29_GH_production.jpg | Pituitary adenoma - GH producing. (WC/KGH)
File:HE-GHoma.jpg | Pituitary adenoma , HE. This gonadotropin producing adenoma has a papillary architecture (WC/jensflorian)
File:FSH-GHoma.jpg | Pituitary adenoma, IHC for FSH (WC/jensflorian)
File:LH-GHoma.jpg | Pituitary adenoma, IHC for LH (WC/jensflorian)
File:ACTHoma-PAS-O-G.jpg | Pituitary adenoma , ACTH producing. PAS-O-G stain showing basophilic adenoma cells (WC/jensflorian)
File:ACTHoma-IHC.jpg | Pituitary adenoma , ACTH producing. Strong ACTH IHC in this basophilic adenoma (WC/jensflorian)
File:Pituitary_adenoma-nonfunctioning.jpg |Pituitary adenoma with vascular pseudorosettes, nonfunctioning (WC/jensflorian)
Crooke_HE_40x.jpg | Crooke cell adenoma, HE (WC/Marvin101)
File:Crooke Cytokeratins.jpg | Crooke cell adenoma, panCK (WC/Marvin101)
HE_fibrosis_pituitary_adenoma.jpg | Fibrosis in pituitary adenoma.
</gallery>
===Stains===
*Reticulin - loss of reticulin between tumour cells.
===IHC===
*LH.
*FSH.
*TSH - [[Hyperthyroidism]]
*GH - [[Acromegaly]].
*Prolactin -Galactorrhea, Amenorrhea, Gynecomastia. Golgi staining pattern in sparsely granulated cases.
*ACTH - [[Cushing syndrome]].
*PIT-1: stains somatotrophs, lactotrophs and thyrothrops.
*TPIT: stains corticotrophs.
*SF1: stains gonadotrophs.
*Chromogranin A +ve
*Synaptophysin strongly +ve (except lactotrophs)
*CAM5.2: fibrous bodies in sparsely granulated somatotroph adenoma, Ring-like staining in Crooke cell adenoma.
*MIB-1: Usu less than 3%.
Note:
Null-cell adenoma must be hormone immunonegative and negative for transcription factors.
===Variants===
*Corticotroph adenomas exhibiting Crooke's hyaline change: agressive course.<ref>{{Cite journal  | last1 = George | first1 = DH. | last2 = Scheithauer | first2 = BW. | last3 = Kovacs | first3 = K. | last4 = Horvath | first4 = E. | last5 = Young | first5 = WF. | last6 = Lloyd | first6 = RV. | last7 = Meyer | first7 = FB. | title = Crooke's cell adenoma of the pituitary: an aggressive variant of corticotroph adenoma. | journal = Am J Surg Pathol | volume = 27 | issue = 10 | pages = 1330-6 | month = Oct | year = 2003 | doi =  | PMID = 14508394 }}</ref>
*Acidophilic stem cell adenomas: large, locally invasive adenoma with low GH activity. <ref>{{Cite journal  | last1 = Horvath | first1 = E. | last2 = Kovacs | first2 = K. | last3 = Singer | first3 = W. | last4 = Smyth | first4 = HS. | last5 = Killinger | first5 = DW. | last6 = Erzin | first6 = C. | last7 = Weiss | first7 = MH. | title = Acidophil stem cell adenoma of the human pituitary: clinicopathologic analysis of 15 cases. | journal = Cancer | volume = 47 | issue = 4 | pages = 761-71 | month = Feb | year = 1981 | doi =  | PMID = 6261917 }}</ref>
*Sparsely granulated somatotroph adenomas are more invasive than other variants and respond less to medical treatment. <ref>{{Cite journal  | last1 = Kato | first1 = M. | last2 = Inoshita | first2 = N. | last3 = Sugiyama | first3 = T. | last4 = Tani | first4 = Y. | last5 = Shichiri | first5 = M. | last6 = Sano | first6 = T. | last7 = Yamada | first7 = S. | last8 = Hirata | first8 = Y. | title = Differential expression of genes related to drug responsiveness between sparsely and densely granulated somatotroph adenomas. | journal = Endocr J | volume = 59 | issue = 3 | pages = 221-8 | month =  | year = 2012 | doi =  | PMID = 22200580 }}</ref>
* Lactotroph adenomas in men may show aggressive clinical behavior. <ref>{{Cite journal  | last1 = Delgrange | first1 = E. | last2 = Vasiljevic | first2 = A. | last3 = Wierinckx | first3 = A. | last4 = François | first4 = P. | last5 = Jouanneau | first5 = E. | last6 = Raverot | first6 = G. | last7 = Trouillas | first7 = J. | title = Expression of estrogen receptor alpha is associated with prolactin pituitary tumor prognosis and supports the sex-related difference in tumor growth. | journal = Eur J Endocrinol | volume = 172 | issue = 6 | pages = 791-801 | month = Jun | year = 2015 | doi = 10.1530/EJE-14-0990 | PMID = 25792376 }}</ref>
*Immature PIT-1 lineage tumors may show aggresive growth. <ref> {{Cite journal  | last1 = Mete | first1 = O. | last2 = Gomez-Hernandez | first2 = K. | last3 = Kucharczyk | first3 = W. | last4 = Ridout | first4 = R. | last5 = Zadeh | first5 = G. | last6 = Gentili | first6 = F. | last7 = Ezzat | first7 = S. | last8 = Asa | first8 = SL. | title = Silent subtype 3 pituitary adenomas are not always silent and represent poorly differentiated monomorphous plurihormonal Pit-1 lineage adenomas. | journal = Mod Pathol | volume = 29 | issue = 2 | pages = 131-42 | month = Feb | year = 2016 | doi = 10.1038/modpathol.2015.151 | PMID = 26743473 }}</ref>
===Molecular===
*GNAS mutations frequently in densely granulated somatotroph tumors.
==Pituitary blastoma==
* New entity introduced in 2017<ref>{{Cite journal  | last1 = Lopes | first1 = MBS. | title = The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. | journal = Acta Neuropathol | volume = 134 | issue = 4 | pages = 521-535 | month = Oct | year = 2017 | doi = 10.1007/s00401-017-1769-8 | PMID = 28821944 }}</ref>
* Epithelial glands with rosette-like formations resembling immature Rathke epithelium.
* Synaptophysin +ve, usu. ACTH+ve
* DICER1 mutations<ref>{{Cite journal  | last1 = de Kock | first1 = L. | last2 = Sabbaghian | first2 = N. | last3 = Plourde | first3 = F. | last4 = Srivastava | first4 = A. | last5 = Weber | first5 = E. | last6 = Bouron-Dal Soglio | first6 = D. | last7 = Hamel | first7 = N. | last8 = Choi | first8 = JH. | last9 = Park | first9 = SH. | title = Pituitary blastoma: a pathognomonic feature of germ-line DICER1 mutations. | journal = Acta Neuropathol | volume = 128 | issue = 1 | pages = 111-22 | month = Jul | year = 2014 | doi = 10.1007/s00401-014-1285-z | PMID = 24839956 }}</ref>
==Pituitary carcinoma==
* Depreceated in the WHO2022 classification.
* It is acknowledged that PitNETs can be invasive or spread to other sites.


==Rathke cleft cyst==
==Rathke cleft cyst==
Line 90: Line 314:
*Arachnoid cyst.
*Arachnoid cyst.
*[[Craniopharyngioma]].
*[[Craniopharyngioma]].
*Cysticercosis (see ''[[microorganisms]]'').
*[[Cysticercosis]].
*[[Pituitary adenoma]].
*[[Pituitary adenoma]].
*Epidermoid of brain.
*Epidermoid of brain.
Line 96: Line 320:
===Microscopic===
===Microscopic===
Features:
Features:
*Lined by cuboidal or columnar epithelial +occasional goblet cells.<ref>URL: [http://www.endotext.org/neuroendo/neuroendo3/neuroendo3.html http://www.endotext.org/neuroendo/neuroendo3/neuroendo3.html]. Accessed on: 27 May 2010.</ref>
*Lined by a layer of cuboidal ''or'' columnar epithelial with cilia.
*+/-Squamous metaplasia.
*+/-Goblet cells.<ref>URL: [http://www.endotext.org/neuroendo/neuroendo3/neuroendo3.html http://www.endotext.org/neuroendo/neuroendo3/neuroendo3.html]. Accessed on: 27 May 2010.</ref>
*+/-Squamous metaplasia ~ may be several layers thick.
**May be confused with ''[[papillary craniopharyngioma]]''.<ref name=Ref_PSNP408>{{Ref PSNP|408}}</ref>
*Cholesterol clefts may be seen in association with rupture.<ref>URL: [http://path.upmc.edu/cases/case177/dx.html http://path.upmc.edu/cases/case177/dx.html]. Accessed on: 8 January 2012.</ref>


Image: [http://www.endotext.org/neuroendo/neuroendo3/figures/figure11.jpg Rathke's cleft cyst (endotext.org)].
DDx:
*[[Papillary craniopharyngioma]].
 
Images:
*[http://www.endotext.org/neuroendo/neuroendo3/figures/figure11.jpg Rathke cleft cyst (endotext.org)].
*[http://path.upmc.edu/cases/case177/micro.html Rathke cleft cyst (upmc.edu)].


==Craniopharyngioma==
==Craniopharyngioma==
===General===
{{Main|Craniopharyngioma}}
*Develop from remains of Rathke's pouch or squamous epithelial cell rests.<ref name=pmid17425791>{{Cite journal  | last1 = Garnett | first1 = MR. | last2 = Puget | first2 = S. | last3 = Grill | first3 = J. | last4 = Sainte-Rose | first4 = C. | title = Craniopharyngioma. | journal = Orphanet J Rare Dis | volume = 2 | issue =  | pages = 18 | month =  | year = 2007 | doi = 10.1186/1750-1172-2-18 | PMID = 17425791 }}</ref>
 
==Gangliocytoma==
* Neuronal cells in abundant neuropil.
* S-100, Synaptophysin +ve.
* Isolated sellar cases are very rare.


Comes in two flavours:<ref name=pmid17425791/>
Image: [[https://twitter.com/sty_md/status/664676241111252992]]
*Adamantinomatous type. 
*Squamous papillary type.
**Usu. older individuals.


Radiology:<ref name=pmid17425791/>
==Mixed Gangliocytoma-adenoma==
*Calcified (adamantinomatous type).
AKA: ganglioneuroma, pituitary adenoma with neuronal choristoma (PANCH)
*Solid & cystic.
*Neuronal cells mixed with pituitary adenoma cells.
* Approx. 0.25% of all pituitary adenomas.
* Association with somatotroph adenomas (acromegaly).


===Microscopic===
==Pituicytoma==
====Adamantinomatous====
{{Main|Pituicytoma}}
Features (adamantinomatous):<ref name=Ref_DCHH184>{{Ref DCHH|184}}</ref>
*Well-circumscribed (or pseudoinvasive border).
*Multicystic.
*Small-to-medium sized cells with moderate amount of basophilic cytoplasm.
*Bland nuclei (with occ. small nucleoli).
*"Wet" keratin - nests of whorled keratin.
*Calcifications (non-psammomatous).


Images:
==Spindle cell oncocytoma==
*[http://commons.wikimedia.org/wiki/File:Adamantinomatous_craniopharyngioma_-_very_low_mag.jpg Adamantinomatous craniopharyngioma - very low mag. (WC)].
*Origin: Neurohypophysis or infundibulum.
*[http://commons.wikimedia.org/wiki/File:Adamantinomatous_craniopharyngioma_-_intermed_mag.jpg Adamantinomatous craniopharyngioma - intermed. mag. (WC)].
*Benign clinical course - WHO grade I.
*[http://commons.wikimedia.org/wiki/File:Adamantinomatous_craniopharyngioma_-_very_high_mag.jpg Adamantinomatous craniopharyngioma - very high mag. (WC)].
*Elongated bipolar, spindle cells.
*Fascicular or storiform growth patterns.
*EMA: patchy, S-100+/-ve, GFAP+/-ve, TTF1+ve.


====Papillary====
*It is thought that Spindle cell oncocytomas and Granular cell tumors of the neurohypophysis are variants of Pituicyoma.<ref>{{Cite journal  | last1 = Mete | first1 = O. | last2 = Lopes | first2 = MB. | last3 = Asa | first3 = SL. | title = Spindle cell oncocytomas and granular cell tumors of the pituitary are variants of pituicytoma. | journal = Am J Surg Pathol | volume = 37 | issue = 11 | pages = 1694-9 | month = Nov | year = 2013 | doi = 10.1097/PAS.0b013e31829723e7 | PMID = 23887161 }}</ref>
Features (papillary):<ref name=Ref_PSNP406>{{Ref PSNP|406}}</ref>
*Non-keratinized squamous epithelium (without nuclear atypia).
*Fibrovascular cores (required for ''papillary'').


Notes:
==Granular cell tumor of the sellar region==
*+/-Cilia (rare).
{{Main|Granular_cell_tumour}}
*+/-Goblet cell-like formations (rare).


==Necrosis==
*Origin: Neurohypophysis or infundibulum.
*Rare.
*Benign clinical course - WHO grade I.
*Well circumscribed.
*Polygonal cells with abundant granular cytoplasm.
*CD68+ve, S-100+/-ve, GFAP+/-ve, TTF1+ve.


===Causes===
<gallery>
*Sheehan syndrome - secondary to blood loss in childbirth.<ref>URL: [http://www.mayoclinic.com/health/sheehans-syndrome/DS00889 http://www.mayoclinic.com/health/sheehans-syndrome/DS00889]. Accessed on: 16 November 2010.</ref>
File:Granular_cell_tumor_pituitary.jpg | Granular cell tumor of the sellar region (HE).
*[[Syphilis]] (fetal-maternal transmission).<ref>URL: [http://pediatrics.aappublications.org/cgi/content/full/104/1/e4 http://pediatrics.aappublications.org/cgi/content/full/104/1/e4]. Accessed on: 16 November 2010.</ref>
</gallery>
*Mollaret's meningitis - very rare.<ref name=pmid18715308>{{cite journal |author=Dancer CM, Woods ML, Henderson RD, Robertson T, Mungomery M, Allworth A |title=Mollaret's meningitis and pituitary failure associated with a Rathke's cleft cyst |journal=Intern Med J |volume=38 |issue=7 |pages=609–11 |year=2008 |month=July |pmid=18715308 |doi=10.1111/j.1445-5994.2008.01709.x |url=}}</ref> (???)
*Spontaneous necrosis of pituitary tumours - case reports.<ref>{{cite journal |author=Sachdev Y, Evered DC, Hall R |title=Spontaneous pituitary necrosis |journal=Br Med J |volume=1 |issue=6015 |pages=942 |year=1976 |month=April |pmid=1268492 |pmc=1639254 |doi= |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1639254/pdf/brmedj00512-0028a.pdf}}</ref>


==Autoimmune hypophysitis==
==Autoimmune hypophysitis==
Line 152: Line 379:
*Rare.
*Rare.
*Autoantigens are unknown.
*Autoantigens are unknown.
*May occur in pregnancy.
*May be misdiagnosed as a nonsecreting adenoma.
*May be misdiagnosed as a nonsecreting adenoma.


Line 158: Line 386:
*Lymphocytic infiltration.
*Lymphocytic infiltration.


==See also==
<gallery>
File:Lymphocytic_hypophysitis_CD3.jpg | Lymphocytic hypophysitis, CD3 IHC. (WC/jensflorian)
</gallery>
 
=See also=
*[[CNS cytopathology]].
*[[CNS cytopathology]].
*[[Neuropathology]].
*[[Neuropathology]].
*[[Brain tumours]].
*[[Brain tumours]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


==External links==
=External links=
*[http://www.neuropathologyweb.org/ Neuropathology] - neuropathologyweb.org.
*[http://www.neuropathologyweb.org/ Neuropathology] - neuropathologyweb.org.
*[http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/endocrin.htm Endocrine histology (anhb.uwa.edu.au)].
*[http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/endocrin.htm Endocrine histology (anhb.uwa.edu.au)].


[[Category:Neuropathology]]
[[Category:Neuropathology]]
Jensflorian
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