Table of Contents
1
UI - 11771050
AU - Campis P; Frenkiel S; Glikstein R; Mohr G
TI -
Unilateral sixth cranial nerve palsy caused by skull base mass lesions:
case series.
SO - J Otolaryngol 2001 Jun;30(3):184-6
AD - Department of Otolaryngology, Sir Mortimer B. Davis-Jewish General
Hospital, McGill University, Montreal, Quebec.
2
UI - 11862525
AU - Fujisawa H; Hasegawa M; Tachibana O; Yamashita J
TI -
Spinal epidural lipomatosis associated with pituitary macroprolactinoma.
SO - Acta Neurochir (Wien) 2002 Feb;144(2):213-4
AD - Department of Neurosurgery, Division of Neuroscience, Graduate School of
Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa
920-8641, Japan.
3
UI - 11765049
AU - Asteria C; Anagni M; Persani L; Beck-Peccoz P
TI -
Loss of heterozygosity of the MEN1 gene in a large series of
TSH-secreting pituitary adenomas.
SO - J Endocrinol Invest 2001 Nov;24(10):796-801
AD - Institute of Endocrine Sciences, University of Milan, Italy.
Thyrotropin-secreting pituitary adenomas (TSH-omas) are rare tumors
(0.5% of all pituitary adenomas) showing an invasive behavior and
usually sporadic, although a few cases are associated with multiple
endocrine neoplasia type 1 (MEN1), an autosomal dominant inherited
syndrome. This disorder is linked to loss of heterozygosity (LOH) on
11q13 and inactivating mutations of MEN1 gene, which is located in the
same chromosomal region. As other types of anterior pituitary adenomas,
TSH-omas are the result of a monoclonal outgrowth where the intrinsic
genetic defects involving oncogenes or tumor suppressor genes occur in a
progenitor cell. However, so far no activating mutations of particular
oncogenes or inactivating mutations of tumor suppressor genes have been
identified. Starting from the observation that 3-30% of sporadic
pituitary adenomas show LOH on 11q13, and that allelic losses on the
long arms of chromosome 11, beside 10 and 13, are significantly
associated with the transition from the non-invasive to the invasive
phenotype, we decided to investigate LOH on 11q13 and mutations of menin
in a large series of TSH-omas. Thirteen tumors were evaluated. DNA was
extracted from tumors by standard methods and genomic DNA from
peripheral blood leukocytes was used as control. LOH was screened by
using 3 polymorphic markers on 11q13: D11S956, PYGM, INT-2. In 3 out of
15 cases we could demonstrate LOH on 11q13, but none of the tumors
showed menin mutation after sequence analysis. These data strongly
suggest that menin does not play a causative role in the development of
TSH-omas, and are in agreement with other studies demonstrating a
limited role of menin in pituitary sporadic tumorigenesis.
4
UI - 11937977
AU - Torremocha F; Hadjadj S; Menet E; Kas A; Bourgeois H; Levillain P;
TI -
Bataille B; Marechaud R
[Pituitary germinoma presenting as a pseudotumoral lymphocytic
hypophysitis in a man]
SO - Ann Endocrinol (Paris) 2002 Feb;63(1):13-7
AD - Services de Medecine Interne, Endocrinologie et Maladies Metaboliques,
France.
A 45-year-old man presented with headaches and extraocular muscle palsy
due to a sellar mass extending into the right cavernous sinus. Hormonal
determinations revealed a gonadotrophic insufficiency. A transsphenoidal
surgical removal revealed a lymphocytic hypophysitis with fibrosis and
necrosis. Rapid growth of the pseudotumor was noted despite a high dose
steroid therapy (1 mg/kg/d) for a month. Further biological and
histopathological investigations were performed. They showed a high
cerebrospinal fluid (CSF) B-human chorionic gonadotropin (ss-HCG) level
of 12 UI/L (normal<5 UI/L), normal plasma BHCG level, and undetectable
CSF and plasma alpha-fetoprotein levels. The tumors cells showed a
positive reactivity for placental alkaline phosphatase and for vimentin.
These findings were consistent with an inflammatory lymphocytic process
caused by an intrasellar germinoma. Chemotherapy was ill-tolerated and
external radiotherapy was ineffective.
5
UI - 11318794
AU - Hofle G; Gasser RW; Buchfelder M; Fahlbusch R; Waldenberger P;
TI -
Finkenstedt G
Elevated inferior petrosal sinus levels of PTHrP in a patient with
Cushing's disease.
SO - Clin Endocrinol (Oxf) 2001 Apr;54(4):555-7
AD - Department of Internal Medicine, Landeskrankenhaus Feldkirch, Austria.
guenter.hoefle@vol.at
PTHrP has been found in various tissues, including prolactinomas and
growth hormone producing adenomas. The function and clinical importance
of PTHrP are poorly understood. We report the case of a 25-year-old
female patient with hirsutism. Autonomous ACTH-dependent
hypercortisolism was documented by endocrine testing. Magnetic resonance
imaging (MRI) revealed a 3-mm intrasellar hypointense lesion in the left
side of the pituitary gland. The inferior petrosal sinus sampling
disclosed a gradient of ACTH left central/peripheral of 30.5 and right
central/peripheral of 2.0 and suggested the diagnosis of a left-sided
pituitary ACTH secreting microadenoma. Interestingly, we found elevated
PTHrP levels in the left inferior petrosal sinus with a gradient of 4.7
compared to peripheral venous blood and of 3.6 compared to the right
sinus. Our results fit very well to the concept of a para-/autocrine
secretion of PTHrP which has been proposed recently and suggest a role
in the regulation of cell growth of pituitary adenomas.
6
UI - 11770017
AU - Tateyama H; Tada T; Okabe M; Takahashi E; Eimoto T
TI -
Different keratin profiles in craniopharyngioma subtypes and
ameloblastomas.
SO - Pathol Res Pract 2001;197(11):735-42
AD - Department of Pathology, Nagoya City University Medical School, Nagoya,
Aichi, Japan. htate@med.nagoya-cu.ac.jp
Craniopharyngiomas are generally considered to arise from the remnants
of Rathke's pouch or a misplaced enamel organ. We tried to refine these
hypotheses, comparing the subtypes of craniopharyngioma with Rathke's
cleft cyst, a known Rathke's pouch derivative, and with ameloblastoma,
an enamel organ derivative. Nineteen craniopharyngiomas (14
adamantinomatous and 5 papillary type tumors) and 17 ameloblastomas were
immunostained for cytokeratin (CK) 7, CK 8, CK 14, and human hair
keratin (HHK). All cases of adamantinomatous craniopharyngioma were CK
7+/CK 8+/CK 14+. Two cases (40%) of papillary craniopharyngioma were CK
7+/CK 8+/CK 14+, whereas the remaining three cases (60%) were CK 7+/CK
8-/CK 14+. Fifteen cases (88%) of ameloblastoma were CK 7-/CK 8+/CK 14+.
Only the shadow cells present in adamantinomatous craniopharyngiomas
were positive for HHK, which may indicate their follicular
differentiation. In Rathke's cleft cyst, ciliated cuboidal cells were CK
7+/CK 8+/CK 14- and metaplastic squamous cells were CK 7+/CK 8/CK 14+.
These findings suggest that both subtypes of craniopharyngioma may
differ from ameloblastoma in histogenesis, although cytokeratin
expression patterns may change during tumor development.
Adamantinomatous craniopharyngioma may be related to a heterotopic
ectodermal tissue which can differentiate into hair follicles, while
papillary craniopharyngioma may arise from Rathke's cleft cyst.
7
UI - 11940053
AU - Leung B; Lismaa TP; Leung KC; Hort YJ; Turner J; Sheehy JP; Ho KK
TI -
Galanin in human pituitary adenomas: frequency and clinical
significance.
SO - Clin Endocrinol (Oxf) 2002 Mar;56(3):397-403
AD - Department of Anatomical Pathology, St Vincent's Hospital, Sydney,
Australia.
OBJECTIVES: Galanin (GAL) is a neuropeptide widely expressed in the
central and peripheral nervous system and in neuroendocrine tissue,
including the adenohypophysis where, in humans, it is expressed in
corticotrophs and in ACTH-producing adenomas. Previous analyses of human
tissue have used antiserum against porcine GAL for detection of GAL
immunoreactivity (GAL-IR) and no pathophysiological correlates have been
reported. Given significant differences between the sequence of porcine
and human GAL peptides, the aim of this study was to use antiserum
raised against synthetic human GAL to investigate GAL-IR in non tumorous
pituitaries and in pituitary adenomas, and to correlate GAL-IR with the
clinical and hormonal characteristics of patients with Cushing's
disease. PATIENTS: Six nontumorous pituitaries were obtained from
autopsy and 151 pituitary adenomas, comprising 62 functioning (16
corticotroph, 26 somatotroph, 19 lactotroph and one thyrotroph) and 89
nonfunctioning adenomas, were obtained by surgery. RESULTS: All non
tumorous pituitary glands showed GAL-IR in corticotrophs, in basophil
cells within the neurohypophysis and in nerve fibres of the
neurohypophysis. GAL-IR was found in a subset (10 of 16) of patients
with ACTH-secreting tumours causing Cushing's syndrome. GAL-IR was
rarely expressed in somatotroph adenomas and prolactinomas, but was
expressed in approximately one-third of nonfunctioning tumours. GAL-IR
was found in almost 90% of nonfunctioning tumours that were positive for
ACTH. There were no significant differences in sex ratio, age at
presentation or 24-h urinary free cortisol secretion in the subset of
patients with Cushing's disease positive (n = 10) or negative (n = 6)
for GAL-IR. However, Cushing's patients positive for GAL-IR tended to
have smaller tumours and achieved a higher cure rate than those without
(100 vs. 50%, P = 0.017). CONCLUSIONS: Galanin is present in normal and
tumorous human pituitaries. In addition, GAL colocalizes exclusively in
corticotrophs of normal pituitaries and is coexpressed almost
exclusively in corticotrophs from functioning and nonfunctioning
tumours. The finding that corticotroph adenomas can function
irrespective of the presence of GAL suggests that GAL may not play a
pathophysiological role in Cushing's disease. However, the better
surgical outcome observed in patients with Cushing's disease who had
tumours positive for GAL-IR suggests that the expression of GAL confers
a less aggressive tumour phenotype.
8
UI - 11950639
AU - Bonneville F; Narboux Y; Cattin F; Rodiere E; Jacquet G; Bonneville JF
TI -
Preoperative location of the pituitary bright spot in patients with
pituitary macroadenomas.
SO - AJNR Am J Neuroradiol 2002 Apr;23(4):528-32
AD - Department of Neuroradiology, Hopital Jean Minjoz, France.
BACKGROUND AND PURPOSE: The purpose of this study was to determine the
location of the pituitary bright spot in patients with pituitary
macroadenomas before surgery. METHODS: A total of 54 patients with
pituitary macroadenomas were retrospectively included in this study.
Nonenhanced spin-echo T1-weighted MR images were reviewed to identify
the location of the high-intensity-signal posterior pituitary lobe that
indicates antidiuretic hormone (ADH) storage. Images were acquired with
a 1.5-T machine by using 3-mm-thick contiguous sections in two or three
orthogonal planes and a 300 x 512 matrix. RESULTS: The bright spot
corresponding to ADH storage was identified in 44 (81%) patients. Two
groups of patients were defined by the height of the macroadenoma: Group
A patients (n = 27) had pituitary macroadenomas less than 20 mm in
height, and group B (n = 27) had macroadenomas 20 mm or larger. In group
A, the bright spot was identified in 25 patients (93%); it was located
in the sella in 24 of these cases (96%). In group B, the bright spot was
identified in 19 patients (70%); it was in an ectopic location in 14 of
these cases (74%). CONCLUSION: MR imaging can be used to depict the
pituitary bright spot in most patients with pituitary macroadenomas
before surgery. The bright spot is usually identified at its expected
location within the sella in patients with pituitary macroadenomas less
than 20 mm in height, whereas an ectopic location is common when
pituitary macroadenomas are larger more than 20 mm.
9
UI - 11422113
AU - Korbonits M; Chitnis MM; Gueorguiev M; Norman D; Rosenfelder N; Suliman
TI -
M; Jones TH; Noonan K; Fabbri A; Besser GM; Burrin JM; Grossman AB
The release of leptin and its effect on hormone release from human
pituitary adenomas.
SO - Clin Endocrinol (Oxf) 2001 Jun;54(6):781-9
AD - Department of Endocrinology, St Bartholomew's Hospital, London EC1A 7BE,
UK.
BACKGROUND: Leptin is the protein product of the obese gene, known to
play an important role in body energy balance. The leptin receptor
exists in numerous isoforms, the long isoform being the major form
involved in signal transduction. Leptin expression has recently been
demonstrated in the human pituitary, both in normal tissue and in
pituitary adenomas. The long isoform of the leptin receptor has also
been shown to be present in pituitary adenomas; however, contrasting
results have been obtained regarding its expression in the normal human
pituitary. AIM: The aim of this study was (i) to investigate the
presence and pattern of distribution of leptin mRNA and the long isoform
of its receptor mRNA in the normal pituitary and in different types of
pituitary adenomas with RT-PCR; (ii) to study leptin secretion from
human pituitary tumours in culture and (iii) to assess in vitro
pituitary hormone release following stimulation with human leptin.
RESULTS: Leptin receptor long isoform expression was detected in 2/4
GH-secreting adenomas, 12/17 non-functioning adenomas, 5/9
ACTH-secreting adenomas, 1/2 prolactinomas, 2/2 FSH-secreting adenomas
and 5/5 normal pituitaries. The receptor long isoform did not segregate
with any particular tumour type, and varying levels of expression were
detected between the tissues studied. Leptin mRNA was detected at a low
level of expression in 2/7 GH-secreting adenomas, 9/14 non-functioning
adenomas, 2/3 ACTH-secreting adenomas, 1/3 prolactinomas and 1/3
FSH-secreting adenomas. We were unable to detect leptin mRNA in any of
the five normal pituitaries removed at autopsy; however, immunostaining
of a non-tumorous pituitary adjacent to an adenoma removed at
transsphenoidal surgery showed scattered leptin positive cells. Culture
of pituitary adenomas showed that 16/47 released leptin into the
incubation media. Leptin release did not correlate with tumour type or
with any of the other pituitary hormones released. In vitro leptin
stimulation of pituitary tumours caused stimulation of FSH and
alpha-subunit secretion from a non-functioning adenoma and TSH secretion
from a somatotroph adenoma. CONCLUSION: We conclude that not only is
leptin stored within the pituitary, but it may also be released from
pituitary cells and modulate other pituitary hormone secretion.
Pituitary leptin may therefore be a novel paracrine regulator of
pituitary function.
10
UI - 11938361
AU - Elwatidy SM; Jamjoom ZA; Jamjoom AB; Yakoub AO
TI -
Craniopharyngioma. Analysis of factors that affect the outcome.
SO - Saudi Med J 2002 Jan;23(1):34-8
AD - Department of Surgery, King Khalid University Hospital, King Saud
University, Riyadh 11472, Kingdom of Saudi Arabia. smfwat@yahoo.com.
OBJECTIVE: The aim of this work is to find out factors that affect the
outcome of treatment of patients with craniopharyngioma treated at King
Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. METHODS:
This study was carried out retrospectively by reviewing the medical
records of all patients with craniopharyngiomas treated at King Khalid
University Hospital, Riyadh, Kingdom of Saudi Arabia in the last 10
radiological, surgical, and follow-up data and performing statistical
analysis to find out factors that affect the outcome of such cases.
RESULTS: There were 11 females (61%), and 7 males (39%), the median age
was 24 years. The main presenting symptoms were reduced vision in 66.7%,
symptoms of raised intracranial pressure in 50%, endocrinal problems in
33.3%, seizures in 16.7%, and hemiparesis in 5.6%. Radiologic studies
showed 72% of tumors had mixed solid and cystic components,
calcification in 83%, and ventricular dilatation in 50% of cases. The
tumor extended to the posterior fossa in 11%, and to both middle and
posterior fossae in 11% of cases. Eighty-nine percent of patients had
tumor excision through pterional craniotomy and 11% through subfrontal
approach. Gross total removal was achieved in 17% and subtotal resection
in 83%. Tumor recurred in 9 patients (50%), 4 of them (44%) had
postoperative radiotherapy. The outcome was good in 10 patients (56%),
poor in 6 patients (33%), and 2 patients died (11%). The patient age,
radiological appearance of tumors and their location were significantly
correlated with the outcome (p 0.02, 0.02, 0.04). CONCLUSION:
Ophthalmologists and Pediatricians should be aware of the clinical
presentation and refer patients to specialized centers for treatment.
Total resection of the tumor should be the goal of the Neurosurgeon as
it offers the best chance of cure.
11
UI - 11761433
AU - Losa M; Mortini P; Barzaghi R; Franzin A; Giovanelli M
TI -
Endocrine inactive and gonadotroph adenomas: diagnosis and management.
SO - J Neurooncol 2001 Sep;54(2):167-77
AD - Department of Neurosurgery, IRCCS San Raffaele, University of Milan,
Italy. losa.marco@hsr.it
Endocrine inactive pituitary adenomas represent about one quarter of all
pituitary tumors. By immunocytochemistry, most of these tumors are
positive for intact gonadotropins and/or their subunits. Clinical
presentation is usually secondary to mass effect symptoms, such as
visual disturbances, headache, and hypopituitarism. Differential
diagnosis is usually accomplished by neuroradiologic studies, even
though in selected cases positron emission tomography and/or single
photon emission tomography may aid to distinguish pituitary adenomas
from other endocrine inactive lesions, such as meningiomas and
craniopharyngiomas. Surgical management is usually considered the first
choice treatment for patients with endocrine inactive pituitary adenomas
because it is very effective in ameliorating symptoms of chiasmal
compression and headache. Radical removal of the tumor, however, is
difficult to obtain because of the frequent invasiveness into the
cavernous sinus. Radiation therapy diminishes the likelihood of tumor
recurrence, especially in patients with demonstrable tumor remnants
after surgery. Medical therapy with dopaminergic drugs, somatostatin
analogs, or gonadotropin-releasing hormone agonists or antagonists
causes mild reduction of tumor size in few patients and, therefore,
seems to be of limited value in the therapeutic management of patients
with endocrine inactive pituitary adenomas.
12
UI - 11761436
AU - Thoren M; Hoybye C; Grenback E; Degerblad M; Rahn T; Hulting A L
TI -
The role of gamma knife radiosurgery in the management of pituitary
adenomas.
SO - J Neurooncol 2001 Sep;54(2):197-203
AD - Department of Endocrinology and Diabetology, Karolinska Hospital and
Institute, Stockholm, Sweden.
No treatment modality has been entirely successful in the management of
pituitary adenomas. Although most patients with pituitary microadenomas
can be cured by transsphenoidal surgery, the results are less
satisfactory in macroadenomas in particular with suprasellar and/or
parasellar extension. Additional treatment is then called for.
Conventional fractional radiotherapy can often control tumour growth but
is limited to 45-50 Gy with a very slow reduction in elevated pituitary
hormones and a high incidence of pituitary insufficiency. Stereotactic
radiosurgery allows the delivery of radiation with high precision to the
target with low doses to the surrounding tissues permitting higher
radiation doses. Gamma knife radiosurgery using photon energy with gamma
beams from multiple cobalt 60 radiation sources is now used in many
centers. It can be carried out in an outpatient setting with one single
treatment. A more rapid normalization of pituitary hormone
hypersecretion than with conventional radiation can be achieved as well
as arrest of tumour growth and reduction of tumour mass. We therefore
consider gamma knife radiosurgery as a valuable compliment to pituitary
surgery. Long-term prospective studies are needed to evaluate the
frequency of pituitary insufficiency in patients where the target area
is determined with stereotactic magnetic resonance imaging (MRI).
13
UI - 11763422
AU - Salame K; Ouaknine GE; Yossipov J; Rochkind S
TI -
Paraganglioma of the pituitary fossa: diagnosis and management.
SO - J Neurooncol 2001 Aug;54(1):49-52
AD - Department of Neurosurgery, Tel Aviv Sourasky Medical Center the Sackler
Faculty of Medicine, Tel Aviv University, Israel.
salame@tasmc.health.gov.il
Paraganglioma of the sellar area is extremely rare with only six cases
having been reported in the literature. Surgical removal of these tumors
is difficult, and the transsphenoidal approach usually results in
limited resection. Most authors who published reports on this tumor
recommended radiation therapy after partial removal of the tumor.
However, considering the benign nature of these tumors, the risk of
radiation-induced endocrine insufficiency and optic neuropathy and the
lack of proven effectiveness of radiotherapy, its value remains
controversial. We describe a 48-year-old woman with parasellar
paraganglioma who presented with headaches, visual loss and
oligomenorrhea. Magnetic resonance imaging (MRI) showed an invasive
tumor in the sellar and parasellar areas which extended to both
cavernous sinuses and compressed the optic chiasm and the left internal
carotid artery. Surgery by the transsphenoidal approach enabled only
limited biopsy of the tumor. The patient was reoperated by an extended
pterional approach which resulted in a subtotal removal of the tumor and
adequate decompression of the adjacent structures. She received no
adjuvant treatment during the 8-year postsurgical follow-up and remained
in good health. A repeated MRI showed no change in the size of the
residual tumor. Contrary to the therapeutic recommendations described in
previous reports, we favor postoperative adjuvant therapy only if the
symptoms or signs of cranial nerve compression persist following maximal
tumor removal, or if there is evidence of subsequent growth of residual
tumor.
14
UI - 11989605
AU - Uza MC; Kocak Z; Doganay L; Tokatli F; Caloglu M; Kilincer C
TI -
Pituitary metastasis mimicking a macroadenoma from carcinoma of the
larynx: a case report.
SO - Tumori 2001 Nov-Dec;87(6):451-4
AD - Department of Radiation Oncology, Trakya University Medical Faculty,
Edirne, Turkey.
Metastatic tumors of the pituitary gland are not commonly diagnosed
during life in cancer patients. The occurrence of symptomatic lesions is
also very unusual and difficult to differentiate clinically and
radiologically from pituitary adenomas. Furthermore, a single
intrasellar metastasis from laryngeal carcinoma mimicking a pituitary
adenoma is an extremely rare pathological finding. We report on the
clinical, radiological, and pathological findings in a patient with
laryngeal carcinoma who had a symptomatic solitary pituitary gland
metastasis that was recognized antemortem.
15
UI - 11753242
AU - Colao A; Dorato M; Pulcrano M; Rossi FW; Auriemma RS; Lombardi G;
TI -
Lastoria S
[Somatostatin analogs in the clinical management of pituitary neoplasms]
SO - Minerva Endocrinol 2001 Sep;26(3):181-91
AD - Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica,
Universita degli Studi Federico II, Naples, Italy. calao@unina.it
The medical approach to patients with secreting or clinically
non-functioning pituitary adenoma as made considerable progress thanks
to the use of new somatostatin analogs. They were first used to treat
acromegaly in the mid 1980s and numerous studies have shown a reduction
in GH concentration in over 90% of acromegalic patients. Good results
were obtained using slow-release analog treatment also in TSH-secreting
adenomas, whereas the therapeutic efficacy of these peptides in
clinically non-functioning adenomas is still controversial. Treatment
with somatostatin analogs improves symptoms, normalises hormone
secretion and in some cases may induce a reduction in the volume of
pituitary adenomas. Scintigraphy with octreotide may help to select
patients who respond to this form of treatment.
16
UI - 11966584
AU - Connor SE; Deasy NP
TI -
MRI appearances of the sphenoid sinus at the late follow-up of
trans-sphenoidal surgery for pituitary macroadenoma.
SO - Australas Radiol 2002 Mar;46(1):33-40
AD - Department of Neuroradiology, King's College Hospital, London, UK.
s.connor@tiscali.co.uk
We aimed to demonstrate the appearances of the sphenoid sinus on MRI
performed later than 2 years post- transsphenoidal surgery (TSS). We
retrospectively reviewed 47 patients in whom follow-up MRI scans had
been performed at least 2 years post-TSS. We specifically reviewed the
clinical and imaging of those patients in whom the sphenoid sinus was
filled with signal abnormality or masses were present arising from the
sinus roof and classified them as tumour or indeterminate abnormalities
on imaging criteria. We documented other clinicoradiological details.
Twelve of 47 patients demonstrated sphenoid sinus filling or sinus roof
masses and in six of 12 patients it was possible to classify them as
tumourous using imaging and clinical criteria. The indeterminate and
non-tumourous sphenoid sinus abnormalities most frequently had a
T1-weighted signal similar to subsellar tumour and displayed rim
enhancement and thus could not be reliably distinguished from tumourous
abnormality on the basis of signal or enhancement characteristics. The
presence of a well-defined surgical defect in the sella floor was
associated with resolution of abnormality on MRI follow-up. We concluded
MRI findings of sphenoid sinus filling or sinus roof masses are present
in approximately 26% of scans performed longer than 2 years post-TSS.
Half of these are of indeterminate origin and follow-up is required to
discriminate tumour from non- tumour with certainty. A well-defined
surgical defect in the sella floor is, however, suggestive of a
non-tumourous abnormality.
17
UI - 11761722
AU - Rickert CH; Dockhorn-Dworniczak B; Busch G; Moskopp D; Albert FK; Rama
TI -
B; Paulus W
Increased chromosomal imbalances in recurrent pituitary adenomas.
SO - Acta Neuropathol (Berl) 2001 Dec;102(6):615-20
AD - Institute of Neuropathology, University Clinics Munster, Domagkstr. 19,
48129 Munster, Germany. rickchr@uni-muenster.de
Eight pituitary adenomas (four gonadotroph cell adenomas, three
prolactin cell adenomas, one null cell adenoma) and their respective
recurrences in the same patients were studied by comparative genomic
hybridization. Chromosomal imbalances were found in seven of eight
patients affecting two of eight primary and seven of eight recurrent
tumors. Overall, pituitary adenomas showed an average of 1.6 chromosomal
imbalances per primary and 3.4 per recurrent tumor (P < 0.01). Prolactin
cell adenomas showed an average of 4.3 chromosomal changes per primary
and 6.3 per recurrent tumor, which were significantly more common than
in gonadotroph cell adenomas (0 vs 1.7 changes; P < 0.05) and the null
cell adenoma (0 vs 1.0 changes; P < 0.05). The most common changes were
gains of 4q (in three of eight recurrences), 5q, and 13q (in two of
eight recurrences each) as well as losses of chromosome 2 (in both
primary and recurring tumors of two patients), 1p, 8q, 10, and 12q (in
two of eight recurrences). Minimal common regions associated with
recurrent adenomas were gains of 4q31.2-34 (three recurrences), 5q14-23
and 13q21-31 and losses of 12q24.3-qter (two recurrences each). The
average MIB-1 proliferation indices were 1.2% for primary and 1.9% for
recurrent adenomas (P < 0.005). Our findings suggest that acquisition of
certain chromosomal imbalances is related to and may underlie adenoma
recurrence.
18
UI - 11916504
AU - Elmaci L; Kurtkaya-Yapicier O; Ekinci G; Sav A; Pamir MN; Vidal S;
TI -
Kovacs K; Scheithauer BW
Metastatic papillary craniopharyngioma: case study and study of tumor
angiogenesis.
SO - Neuro-oncol 2002 Apr;4(2):123-8
AD - Department of Neurosurgery, Marmara University School of Medicine,
Istanbul, Turkey.
We report a case of suprasellar papillary craniopharyngioma metastatic
to the temporoparietal region 2 years after its initial resection. The
literature documents examples of craniopharyngioma recurrences along the
surgical tract, as well as remote ipsi- and contralateral metastases via
cerebrospinal fluid seeding. Ours is the second report of a
craniopharyngioma of papillary type to exhibit metastatic behavior. The
tumor spread opposite the side of craniotomy. Although a rare
occurrence, it confirms the limited capacity of histologically benign
craniopharyngiomas to undergo meningeal seeding, likely the result of
surgical manipulation. Immunohistochemical demonstration of increased
microvascular density and vascular endothelial growth factor expression,
as well as a high vascular endothelial growth receptor (VEGFR2) signal
by in situ hybridization, suggests that tumor vascularity facilitated
angiogenesis and may have been involved in the establishment and growth
of the metastatic deposit.
19
UI - 11965418
AU - Tella OI Jr; Herculano MA; Delcello R; Aguiar PH
TI -
[Prolactinomas: neurosurgical aspects]
SO - Arq Neuropsiquiatr 2002 Mar;60(1):106-12
AD - Disciplina de Neurocirurgia, Universidade Federal de Sao Paulo, Brasil.
detella.ncir@epm.br
We report our experience with 38 cases of prolactin secreting pituitary
adenomas. The adenomas were divided in three different groups. The
adenomas producing only prolactin tend to be microadenoma and they show
the typical alterations of this type of tumor. The GH-PRL, GH-alpha
subunit, the other combinations, and the pluri hormonal adenomas tend to
present with visual symptoms. The treatment of the prolactinomas is
initially clinical and the surgical indication for this type of adenomas
is related to intolerance to the medication or to visual alterations.
Surgical result with total resection of the tumor was possible in 50% of
the cases.
20
UI - 11965419
AU - Tella OI Jr; Herculano MA; Delcello R; Aguiar PH
TI -
[ACTH pituitary adenomas: neurosurgical aspects]
SO - Arq Neuropsiquiatr 2002 Mar;60(1):113-8
AD - Disciplina de Neurocirurgia, Universidade Federal de Sao Paulo, Brasil.
detella.ncir@epm.br
We report our experience with 19 cases of ACTH secreting pituitary
adenomas. They were microadenomas in 50% of the cases, coming with the
typical picture of the Cushing syndrome. The ACTH adenoma associated
with other types of hormones tend to show visual alterations. The
treatment is often surgical using the transsphenoidal approach. The
results were satisfactory in most of the cases. For those in which
surgical cure was not reached, radiotherapy was indicated.
21
UI - 11965420
AU - Tella OI Jr; Herculano MA; Delcello R; Aguiar PH
TI -
[Nonfuntional pituitary adenomas: evaluation of 36 patients]
SO - Arq Neuropsiquiatr 2002 Mar;60(1):119-22
AD - Disciplina de Neurocirurgia, Universidade Federal de Sao Paulo, Brasil.
detela.ncir@epm.br
We present our experience with 36 cases of nonfunctional pituitary
adenomas. These tumors were divided into non reactive and inactive in
agreement with the immunohistochemical study. They present with visual
symptoms, mainly bitemporal hemianopsia; they were macroadenomas, either
invasive or non invasive, in both groups. The treatment is surgical
using the transsphenoidal approach. Total resection was possible in
about 40% of the cases. Visual improvement occurred in 90% of the
patients.
22
UI - 11965421
AU - Tella OI Jr; Herculano MA; Delcello R; Aguiar PH
TI -
[Growth pituitary adenomas: evaluation of 20 patients]
SO - Arq Neuropsiquiatr 2002 Mar;60(1):123-8
AD - Disciplina de Neurocirurgia, Universidade Federal de Sao Paulo, Brasil.
The growth hormone secreting pituitary adenomas can be mono, bi or
pluri-hormonals. The most frequent association of GH is with the sub
unit alpha or with the prolactin. This type of adenoma comes with the
classic alterations of acromegaly, but when they produce more than one
hormone, visual symptoms can be present. The adenoma producing just GH
hormone is generally microadenoma and the other two groups tend to be
macroadenoma. We analyze 20 cases of these adenomas and we have found
quite satisfactory surgical result for the mono-hormonal type group.
Radiotherapy should be considered in cases of partial resection.
23
UI - 11965422
AU - Tella OI Jr; Herculano MA; Delcello R; Prandini MN
TI -
[TSH pituitary adenoma: case report]
SO - Arq Neuropsiquiatr 2002 Mar;60(1):129-32
AD - Disciplina de Neurocirurgia, Universidade Federal de Sao Paulo, Brasil.
detella.ncir@epm.br
We describe a rare case of thyroid-stimulating hormone-secreting
pituitary adenoma in a patient with a clinical picture of
hyperthyroidism, that developed bitemporal hemianopsia after four years
of a known thyroid dysfunction. CT scan showed a pituitary tumor
considered grade 2 and stage C according to Hardy-Vezina and Wilson.
Treatment was surgical, initially by a transsphenoidal approach, in
which only a biopsy was possible. The patient was then submitted to an
orbital-pterional craniotomy with sub-total resection of the tumor.
Complementary treatment was indicated with radiotherapy.
24
UI - 11964016
AU - Lakka-Papadodima E
TI -
Non-secreting pituitary tumors in adolescents--consequences in
adulthood.
SO - J Pediatr Endocrinol Metab 2001;14 Suppl 5():1217-26; discussion 1261-2
AD - Department of Endocrinology and Metabolism, Henry Dunant Hospital,
Athens, Greece. fuga@otenet.gr
This article reviews non-secreting pituitary tumors in children and
adolescents. These tumors include a wide range of pathological
situations. They differ from those in adults regarding incidence,
pathology, clinical presentation, size and consequences. Pituitary
tumors are uncommon in this age group (2.7% of intracranial tumors)
whilst in adults they represent 22.5-27%. Pituitary adenomas are the
most frequent in adults (30%) while craniopharyngiomas are more common
in children and adolescents (80-90%). Of pituitary adenomas in children
and adolescents, non-secreting pituitary adenomas are very rare (3-6%)
and are usually macroadenomas. These are usually benign, not life
threatening, but can profoundly affect the quality and length of life
because of serious secondary complications. In spite of the difficulties
presented, surgery is the treatment of choice for most of these tumors.
Even following the best of treatment, however, there is a great
possibility of permanent pituitary insufficiency. In a large percentage
of patients, these adverse effects of the tumors can be prevented by
early and rapid intervention and treatment.
25
UI - 11964017
AU - Duntas LH
TI -
Prolactinomas in children and adolescents--consequences in adult life.
SO - J Pediatr Endocrinol Metab 2001;14 Suppl 5():1227-32; discussion 1261-2
AD - Endocrine Unit, Evgenidion Hospital, University of Athens and Medical
School, Greece. ledunt@otenet.gr
Prolactinomas in children and adolescents are rare. However, they
represent, together with corticotropinomas, the most frequent types of
pituitary tumors in adolescence. Most prolactin-secreting pituitary
tumors are microprolactinomas but many, and particularly those in men,
are macroadenomas. The clinical findings that would usually project into
the adult life of patients, in other words the issue of transitory
endocrinology from childhood to adulthood, are menstrual irregularities,
infertility, short stature, osteopenia and/or osteoporosis, and
sometimes psychometric abnormalities. The therapy of choice for both
macro- and microprolactinomas is one of the new dopamine agonists, such
as quinagolide or cabergoline. Recent evidence-based data have clearly
promoted cabergoline as the first-line treatment. Cabergoline may
normalize prolactin secretion, restore fertility in women and men. and
induce tumor shrinkage. Today, transsphenoidal surgery should be
considered only in patients with a large extrasellar extension.
26
UI - 11990811
AU - Shirane R; Ching-Chan S; Kusaka Y; Jokura H; Yoshimoto T
TI -
Surgical outcomes in 31 patients with craniopharyngiomas extending
outside the suprasellar cistern: an evaluation of the frontobasal
interhemispheric approach.
SO - J Neurosurg 2002 Apr;96(4):704-12
AD - Department of Neurosurgery, Tohoku University Graduate School of
Medicine, Sendai, Japan. reizo@nsg.med.tohoku.ac.jp
OBJECT: Craniopharyngiomas frequently grow from remnants of the Rathke
pouch, which is located on the cisternal surface of the hypothalamic
region. These lesions can also extend elsewhere in the
infundibulohypophyseal axis. The aim of this study was to establish the
usefulness of the frontobasal approach made through a relatively small
craniotomy window for the removal of tumors protruding from the
sellar-suprasellar region into the third and basal cistern. METHODS:
Thirty-one patients who were surgically treated for craniopharyngiomas
extending outside the sellar-suprasellar region were evaluated. The
diagnoses were established in all cases by using magnetic resonance and
computerized tomography imaging. The initial symptoms and signs were
increased intracranial pressure in eight, vision impairment or visual
field defect in 16, hypopituitarism in 17, and psychological
disturbances in three cases. All patients underwent surgery via the
frontobasal interhemispheric approach, and the average follow-up period
was 30 months. Total removal of the lesion was achieved in 22 cases, six
patients underwent subtotal resection, and three underwent partial
removal due to tumor recurrence after previous surgeries performed with
or without adjunctive radiotherapy. Major complications, including
impairment of the cranial nerves, were not observed in the immediate
postoperative period. One patient exhibited transient memory disturbance
due to infarction of the perforating vessels; after 3 months this
symptom was ameliorated. None of the patients died during long-term
follow up; however, four of the 22 who underwent total removal and six
of the nine patients who underwent subtotal or partial removal suffered
recurrence. Of the 10 patients with recurrence, six experienced a small
recurrence of the lesion (average 3 months postsurgery); after gamma
knife surgery (GKS), the size of two of the lesions was unchanged and in
four reoperation was performed due to tumor enlargement during the
follow-up period. Ultimately, a total of eight patients (four with
recurrence and four who had been treated with GKS) underwent
reoperation, with gross-total removal via the same approach or combined
with the orbitozygomatic approach in patients with very short optic
nerves. In no patient was deterioration of visual acuity and visual
field observed after surgery. Although all patients except four children
and one adult were receiving some form of hormone replacement therapy,
their endocrine status was stably controllable. CONCLUSIONS: In the
authors' experience, the frontobasal interhemispheric approach, even
made through a small craniotomy window, is a valid choice for the
removal of craniopharyngiomas extending outside the sellar-suprasellar
region. Via this approach, tumors can be removed without significant
sequelae related to the surgical method, due to ease of preservation of
the pituitary stalk, hypothalamic structures, and perforating vessels.
This approach offers a safe and minimally invasive means of treating
craniopharyngiomas.
27
UI - 11936054
AU - Abe T; Kawamura N; Ozawa H; Shimazu M; Izumiyama H; Matsumoto K
TI -
Male prolactinoma with pituitary apoplexy concomitant with intracerebral
hemorrhage--case report.
SO - Neurol Med Chir (Tokyo) 2002 Mar;42(3):125-7
AD - Department of Neurosurgery, Showa University School of Medicine, Tokyo.
takumi@med.showa-u.ac.jp
A 56-year-old male presented with a prolactin-secreting pituitary
adenoma who suffered pituitary apoplexy associated with intracerebral
hemorrhage of the caudate head and putamen. The centers of both the
intratumoral hematoma and intracerebral hemorrhage appeared as
hyperintense on T1-weighted and T2-weighted magnetic resonance imaging,
indicating the subacute stage and probably similar timing of onset. The
tumor was treated surgically 6 weeks after the onset. The causative
factor for the apoplexy remains unclear.
28
UI - 11758781
AU - Fuller CE; Frankel B; Smith M; Rodziewitz G; Landas SK; Caruso R;
TI -
Schelper R
Suprasellar monomorphous pilomyxoid neoplasm: an ultastructural
analysis.
SO - Clin Neuropathol 2001 Nov-Dec;20(6):256-62
AD - Department of Anatomic Pathology, SUNY Upstate Medical University,
Syracuse, New York, USA. fullercny@hotmail.com
The authors report 3 patients, 2 children and 1 adult, each of whom
presented with an unusual myxoid lesion reminiscent of pilocytic
astrocytoma but with other features of myxopapillary ependymoma. The
magnetic resonance imaging findings in all cases showed a diffusely
contrast-enhancing suprasellar mass focally extending into the third
ventricle. Involvement of adjacent structures was more extensive in both
infants. By light microscopy, all were composed of a monotonous
population of cells with delicate piloid-like processes, loosely
arranged within a prominent myxoid background. Focally, the neoplastic
cells converged upon small blood vessels in pseudorosette-like
formations. These histomorphologic features are identical to those of
the recently described astrocytoma with monomorphous pilomyxoid
features. In addition, the individual tumor cells showed strong
cytoplasmic immunoreactivity with antibodies to glial fibrillary acidic
protein (GFAP) and vimentin, as well as nuclear and cytoplasmic staining
with S-100. All stained positive for synaptophysin and negative for
chromogranin. By electron microscopy, the tumor cells were bipolar with
elongated processes and apical surfaces displaying microvilli,
cytoplasmic blebs and rare cilia. Vesicles and coated pits were seen, as
were occasional synaptoid complexes. The current study serves to expand
our clincopathologic experience with this rare and enigmatic lesion,
with particular attention given to the ultrastructural characteristics.
29
UI - 11770897
AU - Vogelgesang S; Junge MH; Pahnke J; Gaab MR; Warzok RW
TI -
SO - Brain Pathol 2002 Jan;12(1):135-6, 139
AD - Department of Neuropathology, University of Greifswald, Germany.
neurohypophysis are rare lesions. They are generally regarded as benign
neoplasms, although detailed descriptions of the natural course of the
tumors are limited to a few cases. We report on a 59-year-old woman with
a large GCT of the neurohypophysis and rapid onset of symptoms. Although
lacking definitive signs of malignancy, the tumor showed nuclear
polymorphism, proliferative activity, evidence of a mutation of the
tumor suppressor gene p53 as well as expression of the
apoptosis-inhibiting protein bcl-2. These indices may be useful in
defining more precisely the clinicopathological prognosis for
neurohypophyseal GCTs.
30
UI - 11893889
AU - Zhang YQ; Wang CC; Ma ZY
TI -
Pediatric craniopharyngiomas: clinicomorphological study of 189 cases.
SO - Pediatr Neurosurg 2002 Feb;36(2):80-4
AD - Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China.
yuqi@public.fhnet.cn.net
OBJECTIVE: To understand the pathological changes in pediatric
craniopharyngiomas in order to determine the diagnosis and operative
strategy and to prevent damage to the hypothalamus. METHODS: A total of
189 cases of pediatric craniopharyngiomas from 1990 to 1998 were
reviewed and analyzed based on computerized tomography scans, magnetic
resonance imaging and operations. RESULTS: Of the 189 cases, 187 (98.9%)
were cystic tumors and calcification could be seen in 176 cases (93.1%).
Two cases were solid tumors (1.1%), and calcification occurred in only 1
of these. There was a gliosis layer between the wall of the tumor and
the hypothalamus. CONCLUSION: Cystic changes and calcification are the
pathological features of pediatric craniopharyngiomas. There are some
special relationships between the tumors and stalk. This is the basis
for the total removal of pediatric craniopharyngiomas. Copyright 2002 S.
Karger AG, Basel
31
UI - 11956103
AU - Finelli P; Pierantoni GM; Giardino D; Losa M; Rodeschini O; Fedele M;
TI -
Valtorta E; Mortini P; Croce CM; Larizza L; Fusco A
The High Mobility Group A2 gene is amplified and overexpressed in human
prolactinomas.
SO - Cancer Res 2002 Apr 15;62(8):2398-405
AD - Laboratory of Medical Cytogenetics and Molecular Genetics, Istituto
Auxologico Italiano, Via Viotti 3/4, 20123 Milan, Italy.
Trisomy of chromosome 12 is a nonrandom chromosomal change in pituitary
adenomas, particularly prolactinomas. This and the finding that
prolactin-secreting pituitary adenomas develop in transgenic mice
overexpressing the wild-type HMGA2 gene (which maps to 12q14-15)
prompted us to investigate HMGA2 rearrangements and expression in human
prolactinomas. By dual-color interphase fluorescence in situ
hybridization analysis using HMGA2-specific PACs and BACs, we found that
the HMGA2 locus was amplified in seven of the eight prolactinoma samples
examined. The cytogenetic manifestations of elevated HMGA2
concentrations ranged from simple trisomy to tetrasomy 12 and der(12)
chromosomes to marker chromosomes bearing 12q14-15-derived regions.
Reverse transcription-PCR, Western blot and immunohistochemical analysis
showed HMGA2 overexpression in a number of prolactinomas bearing
rearrangement of regions 12q14-15. These data suggest a critical role of
the HMGA2 overexpression in the generation of prolactin-secreting
pituitary adenomas in humans.
32
UI - 12005408
AU - Gnanalingham KK; Chakraborty A; Galloway M; Revesz T; Powell M
TI -
Osteosarcoma and fibrosarcoma caused by postoperative radiotherapy for a
pituitary adenoma. Case report.
SO - J Neurosurg 2002 May;96(5):960-3
AD - Department of Neurosurgery, National Hospital for Neurology and
Neurosurgery, London, United Kingdom. kannagnana@hotmail.com
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.
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