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Abramson Cancer CenterNCI CANCERLIT® Search: Pituitary Tumor - March 2002
National Cancer Institute®
Last Modified: March 1, 2002
Table of Contents
1
UI - 11733226
AU - Arafah BM; Nasrallah MP
TI -
Pituitary tumors: pathophysiology, clinical manifestations and
management.
SO - Endocr Relat Cancer 2001 Dec;8(4):287-305
AD - Division of Clinical and Molecular Endocrinology, Case Western Reserve
University and University Hospital of Cleveland, Cleveland, Ohio 44106,
USA.
Pituitary tumors are frequently encountered intracranial neoplasms. They
present with a variety of clinical manifestations that include symptoms
and signs of excessive hormone secretion by the tumor, signs of hormone
deficits by the normal pituitary gland and others related to expansion
of the tumor mass and the resulting compression of surrounding
structures such as the optic chiasm and cranial nerves. Advances in
molecular biology, immunocytochemical staining and imaging, and the
introduction of new treatment options have improved our understanding of
the natural history of these adenomas and their management. Available
treatments include surgical, medical and radiation therapy. Although the
primary treatment for each tumor type may vary, it is important to
consider all available options and select the most applicable for that
patient. The interaction of all members of management team, including
the primary care provider, the endocrinologist and the neurosurgeon in
selecting the treatment course can only improve therapeutic outcome.
Regardless of the initial choice of treatment,follow-up of all patients
should be maintained indefinitely. The managing physician should be
familiar with the natural history and long-term complications of
pituitary adenomas, and with the side effects of treatments given over
the years.
2
UI - 11811613
AU - Kon YC; Loh KC; Tambyah JA; Lim LH; Marshall JC
TI -
Thyrotrophin (TSH)-secreting pituitary macroadenoma with cavernous sinus
invasion.
SO - Singapore Med J 2001 Sep;42(9):433-7
AD - Endocrine Unit, Department of General Medicine, Tan Tock Seng Hospital,
Singapore.
Thyrotrophin (TSH)-secreting pituitary adenomas, although rare, should
be recognised as a possible cause of normal or elevated serum TSH in the
presence of elevated serum free thyroid hormone levels. Clinical
hyperthyroidism may be mild or absent. Early recognition provides the
best chance for surgical cure. We report a patient with a TSH-secreting
pituitary tumour with cavernous sinus invasion. This case illustrates
that multiple modalities of treatment are often necessary and
complementary in achieving control of tumour growth and hormonal
hypersecretion when these tumours are diagnosed late.
3
UI - 11741115
AU - Vitaz TW; Hushek S; Shields CB; Moriarty T
TI -
Changes in cyst volume following intraoperative MRI-guided Ommaya
reservoir placement for cystic craniopharyngioma.
SO - Pediatr Neurosurg 2001 Nov;35(5):230-4
AD - Department of Neurological Surgery, University of Louisville School of
Medicine and Norton Healthcare Intraoperative MRI Center, Louisville,
Ky., USA.
INTRODUCTION: Intracavitary treatment of solitary cystic
craniopharyngiomas with (32)P is an emerging treatment option,
especially for pediatric patients. We have treated two patients with
solitary cystic craniopharyngiomas using intraoperative MRI
(iMRI)-guided catheter placement. METHODS: The optical tracking system
of the General Electric Signa SP iMRI system was utilized for
preoperative planning and intraoperative catheter tracking during
insertion. Intraoperative volumetric imaging was then used to confirm
final catheter position. Patients were brought back to the iMRI suite
approximately 8 weeks later and diluted gadolinium was injected with
further MRI to confirm the absence of communication between the cyst
lumen and surrounding CSF spaces and for volumetric analysis. RESULTS:
Intraoperative imaging illustrated deformation and changes in the cyst
wall during catheter placement and cyst aspiration and confirmed final
catheter placement. Images acquired 8 weeks following catheter placement
prior to the instillation of (32)P showed decreases in cyst volume of 40
and 85%. CONCLUSION: iMRI-guided catheter placement for cystic
craniopharyngiomas helps to assure successful catheter placement.
Significant decreases in cyst volume occur in the interval between
catheter placement and (32)P administration and must be accounted for to
prevent overdosing of the radioisotope. Copyright 2001 S. Karger AG,
Basel
4
UI - 11751041
AU - Horner KC; Guieu R; Magnan J; Chays A; Cazals Y
TI -
Prolactinoma in some Meniere's patients--is stress involved?
SO - Neuropsychopharmacology 2002 Jan;26(1):135-8
AD - Laboratoire d'Otologie, Hopital Nord, Marseille, France
Dizziness is a common complaint in primary care clinics and can enter
the diagnostic profile of different pathologies spanning from
psychiatric problems to vestibular dysfunction. Episodes of vertigo in
Meniere's patients are often reported to be triggered by stress but no
physiological data are available to account for the subjective link. The
study involved 42 Meniere's patients hospitalized for neurectomy of the
vestibular nerve for relief of incapacitating vertigo. In addition 18
patients with neurinoma of the vestibular nerve and 12 patients with
facial spasm, who underwent surgery, served as controls. A blood sample
was taken on the day of surgery in order to determine the level of
battery of different stress hormones. The most striking observation was
the presence of hyperprolactinemia (above 20 microg/l) in 14 Meniere's
patients. The presence of prolactinoma was confirmed by MRI in six cases
out of six investigated and the others have not yet been followed up in
this retrospective study. These observations are clearly indicative for
systematic determination of prolactin levels before opting for surgery
in Meniere's patients.
5
UI - 11803197
AU - Abe T; Yamamoto M; Taniyama M; Tanioka D; Izumiyama H; Matsumoto K
TI -
Early palliation of oculomotor nerve palsy following gamma knife
radiosurgery for pituitary adenoma.
SO - Eur Neurol 2002;47(1):61-3
AD - Department of Neurosurgery, Showa University School of Medicine, Tokyo,
Japan. takumi@med.showa-u.ac.jp
6
UI - 11838791
AU - Meij BP; Lopes MB; Ellegala DB; Alden TD; Laws ER Jr
TI -
The long-term significance of microscopic dural invasion in 354 patients
with pituitary adenomas treated with transsphenoidal surgery.
SO - J Neurosurg 2002 Feb;96(2):195-208
AD - Department of Neurological Surgery, Health Sciences Center, University
of Virginia, Charlottesville 22908-0214, USA.
OBJECT: Pituitary adenomas are considered benign tumors; however, they
may infiltrate surrounding tissues including the dura mater. In this
paper the authors analyze the clinical significance of microscopically
confirmed dural invasion by comparing a range of variables (age and sex
of patients, adenoma type, adenoma size on magnetic resonance [MR]
images, remission, residual pituitary disease, recurrence, survival, and
disease-free interval after surgery) between patients with noninvasive
adenomas and those with invasive ones. METHODS: Between 1992 and 1997
dural specimens were obtained in 354 patients with pituitary adenomas
who underwent transsphenoidal surgery performed by the senior author
(E.R.L.). Dural specimens were examined using routine histological
methods and assessed for invasion by pituitary adenoma tissue. The dura
was invaded by the pituitary adenoma in 161 patients (45.5%), and in 192
patients (54.5%) no evidence of dural invasion was found. Dural invasion
was present significantly more frequently in the repeated surgery group
(69%, 55 patients) than in the primary transsphenoidal surgery group
(41%, 291 patients). The mean age of patients undergoing primary
transsphenoidal surgery was significantly older in cases of invasive
adenomas (50 years) compared with cases of noninvasive adenomas (43
years), and these age differences also correlated with adenoma size.
Women tend to develop clinically evident, smaller adenomas at a younger
age than men. Of the patients with pituitary adenomas that were 20 mm or
smaller, 117 (76%) of 154 were women, whereas of the patients with
adenomas that were larger than 20 mm, 74 (54%) of 137 were men. The
frequency of dural invasion increased with increasing size of the
pituitary adenoma as measured on MR images. In 291 patients who
underwent primary pituitary surgery, the frequency of dural invasion
according to adenoma size was 24% (< or = 10 mm), 35% (> 10 to < or = 20
mm), 55% (> 20 to < or = 40 mm), and 70% (> 40 mm). In patients who
underwent primary transsphenoidal surgery, dural invasion was present in
more than 50% of those with nonfunctioning adenomas and in 30 to 35% of
patients with endocrinologically active adenomas. The mean diameter of
the gonadotrophic adenomas and null-cell adenomas was significantly
larger than that of each of the endocrinologically active adenomas. In
58 (20%) of 291 patients who underwent primary pituitary surgery there
was residual pituitary disease postsurgery, and 20% of this subset of
patients showed clinical improvement to such an extent that no further
management was recommended. After pituitary surgery, residual tumor
tissue was demonstrable significantly more frequently in patients with
invasive adenomas than in those with noninvasive adenomas. Recurrences
after initial remission (cure) of pituitary disease occurred in 18
(8.8%) of 205 patients between 2 and 79 months after primary pituitary
surgery (median 25 months). The recurrence rate was not related to dural
invasion in a consistent or significant fashion. Seven patients died
between 14 and 79 months after pituitary surgery and all had invasive
adenomas identified on gross observation at surgery and on microscopy.
The survival rate was slightly but significantly decreased for patients
with invasive adenomas (91%) compared with patients with noninvasive
adenomas (100%) at 6 years postsurgery. CONCLUSIONS: The principal
significance of dural invasion by pituitary adenoma is the persistence
of tumor tissue after transsphenoidal surgery (incomplete adenomectomy;
20% in primary pituitary tumor resections). The increase in adenoma size
with time and the concurrent development of dural invasion are the major
factors that determine an incomplete adenomectomy. When the adenoma
remains restricted to the sellar compartment or shows only moderate
suprasellar extension, dural invasion may not yet have developed and
conditions for complete selective adenomectomy are improved.
7
UI - 11838792
AU - Hama S; Arita K; Nishisaka T; Fukuhara T; Tominaga A; Sugiyama K;
TI -
Yoshioka H; Eguchi K; Sumida M; Heike Y; Kurisu K
Changes in the epithelium of Rathke cleft cyst associated with
inflammation.
SO - J Neurosurg 2002 Feb;96(2):209-16
AD - Department of Neurosurgery, Hiroshima University School of Medicine,
Japan. ml-hns@hiroshima-u.ac.jp
OBJECT: Rathke cleft cysts (RCCs) are composed of tall,
well-differentiated, ciliated columnar epithelia. Their structures are
altered by hyperplasia or squamous metaplasia, but their cause remains
unknown. METHODS: The authors studied pathological findings and anterior
pituitary function in 20 patients harboring RCCs. They classified RCC
epithelium as either single (a single ciliated columnar cell lining or a
flattened cuboidal cell lining) or stratified (a stratified ciliated
columnar cell lining, basal cell hyperplasia, columnar cell hyperplasia,
or squamous metaplasia). Inflammation was classified as acute, subacute,
chronic, or end stage. The epithelial cell lining was observed in 13
specimens obtained during surgery (six specimens contained single and
seven contained stratified epithelia). Inflammation had penetrated the
cyst epithelium or subjacent stroma in 10 patients, and the stage of
inflammation correlated well with the type of epithelia group: early
stages of inflammation in the single epithelium group and chronic or
end-stage inflammation in the stratified epithelia (p = 0.0027). The
adenohypophysis was identified in 21 surgical specimens.
Postoperatively, growth hormone (p = 0.019), cortisol (p = 0.027), and
thyroid-stimulating hormone (p = 0.039) responses significantly worsened
as the inflammation progressed. The presence of diabetes insipidus
correlated well with advanced stages of neurohypophysitis (p = 0.025).
CONCLUSIONS: Epithelial stratification in the RCC is caused by
inflammation that may extend into the adjacent adenohypophysis or
neurohypophysis and overwhelm the hypophysis, resulting in
panhypopituitarism. Transsphenoidal excision may represent the best
choice for treatment, at least for cases of RCC in which there is
partial impairment of hypophysial function.
8
UI - 11838811
AU - Gaffey TA; Scheithauer BW; Lloyd RV; Burger PC; Robbins P; Fereidooni F;
TI -
Horvath E; Kovacs K; Kuroki T; Young WF Jr; Sebo TJ; Riehle DL; Belzberg
AJ
Corticotroph carcinoma of the pituitary: a clinicopathological study.
Report of four cases.
SO - J Neurosurg 2002 Feb;96(2):352-60
AD - Mayo Clinic, Rochester, Minnesota 55902, USA.
To understand the relationship between pituitary adenoma and carcinoma,
four adrenocorticotropic hormone-producing pituitary adenomas and
corresponding metastatic carcinomas were studied. All were functional
macroadenomas (three cases of Nelson syndrome and one of Cushing
disease) that initially invaded the sella turcica and occurred in women
ranging in age from 17 to 66 years (mean 45 years). Metastases (two
craniospinal and two systemic) occurred after latency periods of 6 to 13
years. Histological specimens were immunostained for pituitary hormones,
Ki-67 antigen (MIB-1), p53 and p27 proteins, D-type cyclins, and
glucocorticoid receptor messenger (m)RNA. The DNA content of the
specimens was assessed using Feulgen stain. Reactivities were quantified
by digital image analysis. Primary/recurrent lesions and metastatic
tumors differed according to their respective mean mitotic indices
(1.2/10 hpf compared with 4.3/10 hpf), MIB-1 labeling (1.7% compared
with 8%), p53 staining (37.3% compared with 49.9%), and p27 labeling
(48% compared with 25%). Cyclin D, immunoreactivity provided no
prognostically significant information. Glucocorticoid receptor mRNA was
detected in all cases. Results of a ploidy analysis were variable and
nonprognostic. In keeping with the 2000 World Health Organization
classification of endocrine neoplasms, our findings support the concept
that primary tumors that exhibit mitotic activity, an increased (> 3%)
MIB-1 labeling index, and/or p53 immunoreactivity should be termed
"atypical adenomas" to denote their aggressive potential and the
possibility of future malignant transformation.
9
UI - 11853229
AU - Wen WN
TI -
Methemoglobin contributes to the growth of human tumor cells.
SO - Life Sci 2002 Jan 11;70(8):907-16
AD - Institute of Biochemistry, College of Medicine, National Taiwan
University, Taipei. wwn@ha.mc.ntu.edu.tw
Methemoglobin (metHb) has been reported to be present in areas
surrounding solid tumors. The effects of human metHb on the growth of
one human hepatocellular carcinoma cell line and one human glioma cell
line that simply replicate in Ham's nutrient mixture F12 (F12) were
investigated. MetHb, depending on its concentration, stimulated or
inhibited the in vitro growth of both cancer cell lines. The stimulatory
or inhibitory effect was due to the release of hemin from metHb, which
was recognized by its characteristic light absorption spectrum. The
possibility of metHb or hemin acting initially through a 3', 5'-cyclic
guanosine monophosphate- (cGMP-) or prostaglandin E2- (PGE2-) mediated
pathway to enhance cell growth was excluded. Ferric iron derived from
the catabolic degradation of hemin increased cell growth, whereas
biliverdin (Bv) and its reduction product, bilirubin (Br), decreased
cell growth. Hemoglobin oxidized to metHb in conditions found in tumors
showing neovascularization and hemorrhage may contribute significantly
to increased proliferation of cancerous cells.
10
UI - 11857307
AU - Vidal S; Kovacs K; Lloyd RV; Meyer FB; Scheithauer BW
TI -
Angiogenesis in patients with craniopharyngiomas: correlation with
treatment and outcome.
SO - Cancer 2002 Feb 1;94(3):738-45
AD - Department of Laboratory Medicine, St. Michael's Hospital, University of
Toronto, Toronto, Ontario, Canada.
BACKGROUND: Craniopharyngiomas are histologically benign epithelial
neoplasms of the sellar region that often exhibit aggressive and
invasive growth. The authors hypothesized that tumor proliferation,
spread, and recurrence are angiogenesis dependent and investigated the
significance of vascularization relative to biologic behavior. To the
authors' knowledge, angiogenesis for patients with craniopharyngiomas
has not been examined to date. METHODS: The authors measured microvessel
densities in resected, histologically proven craniopharyngiomas using
immunostains for CD-34, a monoclonal antibody that selectively
recognizes endothelial cells. Both histologic types of
craniopharyngiomas, adamantinomatous and papillary, were included in the
study. In addition, the cellular distribution of vascular endothelial
growth factor (VEGF), a strong stimulator of new vessel formation, was
assessed by both immunohistochemistry and in situ hybridization for VEGF
receptor 2 (VEGFR-2) mRNA expression. RESULTS: Histologically, small
numbers of capillaries were identified in temporal stroma but not in
their epithelial components. Immunohistochemistry revealed strong,
conclusive cytoplasmic immunoreactivity for VEGF in the epithelial cells
of both adamantinomatous craniopharyngiomas and papillary
craniopharyngiomas. In situ hybridization showed that VEGFR-2 mRNA was
expressed widely, not only in neoplastic epithelium but also in
capillary endothelium. CONCLUSIONS: Tumors with greater microvessel
density regrow more frequently compared with tumors that have lower
microvessel density, suggesting that the extent of angiogenesis is of
prognostic value in patients with craniopharyngioma. VEGFR-2 may act as
a key modulator of VEGF activity in endothelial cells and nonendothelial
cells, indicating that VEGF plays an important role in the behavior of
craniopharyngiomas. Copyright 2002 American Cancer Society. DOI
10.1002/cncr.10281
11
UI - 11850841
AU - Simpson DJ; Clayton RN; Farrell WE
TI -
Preferential loss of Death Associated Protein kinase expression in
invasive pituitary tumours is associated with either CpG island
methylation or homozygous deletion.
SO - Oncogene 2002 Feb 14;21(8):1217-24
AD - Centre for Cell and Molecular Medicine, School of Postgraduate Medicine,
Keele University, North Staffordshire Hospital, Stoke-on-Trent, ST4 7QB,
UK.
Death Associated Protein kinase (DAP kinase) a novel
calmodulin-dependent serine/threonine kinase was first identified as a
positive mediator of programmed cell death. Loss of DAP kinase
expression was first demonstrated in highly metastatic cells, whilst
re-expression of the protein resulted in delayed local tumour growth and
a decreased incidence of metastasis. Although loss of DAP kinase
expression has been reported in several cell lines derived from human
malignancies the mechanisms responsible have not been defined. In this
study we have examined 32 sporadic pituitary tumours for expression of
the DAP kinase protein and transcript. In addition, we examined the
methylation and deletion status of the DAP kinase CpG island as possible
mechanisms for the inactivation of the DAP kinase gene. Eleven of 32
(34%) tumours had undetectable DAP kinase expression, by Western blot
and/or RT-PCR analysis. Loss of DAP kinase expression was significantly
(P=0.004) associated with invasive tumours (10 of 17; 59%) compared to
their non-invasive (1 of 15; 7%) counterparts. Of 11 tumours that failed
to express DAP kinase, five (45%) showed de novo methylation of the CpG
island contained within the promoter region, while four (36%) had
evidence of homozygous deletion of this region. Statistical analysis
showed that loss of DAP kinase expression was significantly (P=<0.001)
associated with methylation or deletion of the DAP kinase CpG island.
With two exceptions, none of the remaining tumours or five
histologically normal post-mortem pituitaries examined had evidence of
methylation or deletion within this region. To our knowledge this is the
first report that describes two mutually exclusive mechanisms associated
with loss of DAP kinase gene expression. In addition, we also show that
loss of the DAP kinase protein and associated genetic aberrations
preferentially segregates with tumours that show an invasive phenotype.
12
UI - 11577756
AU - Kojima T; Mizumura S; Kumita SI; Kumazaki T; Teramoto A
TI -
Is technetium-99m-MIBI taken up by the normal pituitary gland? A
comparison of normal pituitary glands and pituitary adenomas.
SO - Ann Nucl Med 2001 Aug;15(4):321-7
AD - Department of Neurosurgery and Radiology, Nippon Medical School, Japan.
toyoyuki@nms.ac.jp
PURPOSE: The aim of this study was to compare the behavioral uptake of a
normal gland and a pituitary adenoma and to assess the ability to
diagnose pituitary adenoma by means of
technetium-99m-hexakis-2-methoxy-isobutyl-isonitrile (MIBI) single
photon emission computed tomography (SPECT). METHODS: The study included
15 patients with pituitary adenomas (mean age = 44.0 years, range 19-63)
and 15 control subjects (mean age = 50.7 years, range 20-67). SPECT was
performed 15 minutes after an intravenous injection of MIBI 600 MBq. The
shape and location of MIBI uptake were evaluated on a magnetic resonance
(MR) imaging/SPECT registration image. The shape patterns and location
were classified as follows: Shape C (circular); LO (longitudinal oval);
T/R (triangular or rectangular) and location P (pituitary gland or
adenoma); D/C (dorsum sellae and/or clivus). RESULTS: Analysis of the
uptake showed that 10 (67%) adenomas were C, and 5 (33%) were LO. Of the
controls, 5 (33%) were C, and 10 (69%) were T/R. With regard to
location, all patients with pituitary adenomas were classified as P, and
all control subjects (93%) but one showed uptake in the dorsum sellae
and clivus (D/C). CONCLUSION: MIBI was taken up in the dorsum sellae or
clivus but not the normal pituitary gland and had a strong affinity for
the pituitary adenoma. This result implies that MIBI SPECT may be a
useful new auxiliary examination technique for the location diagnosis of
pituitary adenoma.
13
UI - 11836449
AU - Riminucci M; Collins MT; Lala R; Corsi A; Matarazzo P; Gehron Robey P;
TI -
Bianco P
An R201H activating mutation of the GNAS1 (Gsalpha) gene in a
corticotroph pituitary adenoma.
SO - Mol Pathol 2002 Feb;55(1):58-60
AD - Dipartimento di Medicina Sperimentale, Universita dell'Aquila, Via
Vetoio, Coppito II, 67100 L'Aquila, Roma, Italy.
In the pituitary gland, activating mutations of the GNAS1 (Gsalpha) gene
at Gln227 have been identified in adrenocorticotrophin secreting, growth
hormone secreting, and prolactin secreting adenomas. To date, mutations
at the codon encoding R201, typically underlying the McCune-Albright
syndrome and isolated fibrous dysplasia of bone, have been demonstrated
only in growth hormone secreting pituitary adenomas. In this study, a
polymerase chain reaction amplified target sequence in exon 8 of the
GNAS1 gene was sequenced, identifying the first R201 mutation seen in an
isolated basophilic adenoma which generated Cushing's disease in a
child. This case adds Cushing's disease to the range of human diseases
caused by R201 mutations of the GNAS1 gene.
14
UI - 11603817
AU - Egensperger R; Scheithauer BW; Horvath E; Kovacs K; Giannini C; Young
TI -
WF; Lloyd R; Atkinson J; Nippoldt TB
Cushing's disease due to plurihormonal adrenocorticotropic hormone and
gonadotropin-producing pituitary adenoma.
SO - Acta Neuropathol (Berl) 2001 Oct;102(4):398-403
AD - Department of Pathology, Mayo Clinic, Rochester, MN 55905, USA.
A 67-year-old woman presented with clinical features of hypercortisolism
in association with an invasive pituitary macroadenoma.
Adrenocorticotropic hormone (ACTH)-dependent Cushing's disease was
documented, and the resected tumor was chromophobic, weakly positive
with periodic-Schiff reagent, and showed immunostaining for ACTH and
beta-endorphin in a minority of adenoma cells. Both luteinizing hormone
and alpha-subunit staining were also observed, but no
follicle-stimulating hormone reactivity was seen. Ultrastructurally, the
tumor showed typical features of a gonadotroph adenoma of female type.
Immunoelectron microscopy showed that ACTH was not produced in
corticotrophs, but in cells with the characteristic features of
gonadotrophs. This represents the second report of a plurihormonal
gonadotroph adenoma producing sufficient ACTH to result in
pituitary-dependent Cushing's disease.
15
UI - 11865014
AU - Sironi M; Cenacchi G; Cozzi L; Tonnarelli G; Iacobellis M; Trere D; Assi
TI -
A
Progression on metastatic neuroendocrine carcinoma from a recurrent
prolactinoma: a case report.
SO - J Clin Pathol 2002 Feb;55(2):148-51
AD - Department of Pathology, Legnano General Hospital, Legnano, Milano,
Italy.
A 54 year old man was referred to the department of neurosurgery for
frontal headache and vomiting. The patient was known in the department
because of previous multiple surgery for a locally invasive pituitary
prolactinoma (eight years, three years, and one year previously). The
neurological examination revealed a frontal mass, which adhered to the
dura, suggesting a meningioma. One year later, a left temporal
metastasis was removed. Three months later, the patient died, with
spinal metastases, of massive lung embolism. Histology revealed a
progression of adenohypophyseal prolactinoma on neuroendocrine
carcinoma, with an increase in proliferating indexes and modification of
hormone production. This study documents a 10 year history of a rare
prolactin producing pituitary carcinoma, which metastasised via liquoral
flow.
16
UI - 11807644
AU - Saeki N; Murai H; Kubota M; Fujimoto N; Iuchi T; Yamaura A; Sunami K
TI -
Heavily T2 weighted MR images of anterior optic pathways in patients
with sellar and parasellar tumours - prediction of surgical anatomy.
SO - Acta Neurochir (Wien) 2002 Jan;144(1):25-35
AD - Department of Neurosurgery, Chiba University, School of Medicine, Chiba
City, Japan.
OBJECTIVE: Location of anterior optic pathways in sellar and parasellar
tumours was preoperatively evaluated, by use of heavily T2 weighted MR
images. METHODS: Heavily T2 and conventional T1 weighted images were
studied in 20 patients with sellar and parasellar tumours who underwent
craniotomy. Pathology revealed pituitary adenoma in 5 patients,
craniopharyngioma in 8 and parasellar meningioma in 7. Maximum sizes
ranged from 15 mm to 58 mm. Sequence parameters of TR/TE for heavily T2
weighted and T1 weighted images were 5800/220 msec and 600/20 msec,
respectively, and slice thickness was 3 mm for both. RESULTS: The
anterior optic pathway was detected in 95% on heavily T2 weighted images
and 50% on T1 weighted images. All preoperative heavily T2 weighted
images were compatible with operative findings. The optic chiasms were
most commonly supero-posterior in pituitary adenomas, anterior
(prefixed) in craniopharyngiomas and posterior in meningiomas. The optic
nerves were commonly located superior or lateral to the tumours.
However, parasellar meningiomas, off the midline, revealed the optic
nerves in various locations, depending on the tumour origin. In such
tumours, heavily T2 weighted images provided surgical information on the
width of the working space through prechiasmal and/or optico-carotid
spaces in the pterional approach. Spatial relation of the tumours to the
lamina terminalis, anterior commissure and anterior communicating artery
complex was clearly shown in craniopharyngioma patients, who underwent
the anterior interhemispheric approach. CONCLUSION: Heavily T2 weighted
MR images are useful in determining the location of optic pathways and
surgical approach and in individual prediction of the anatomy for even
large sellar and parasellar tumours.
17
UI - 11807645
AU - Rauhut F; Stuschke M; Sack H; Stolke D
TI -
Dependence of the risk of encephalopathy on the radiotherapy volume
after combined surgery and radiotherapy of invasive pituitary tumours.
SO - Acta Neurochir (Wien) 2002 Jan;144(1):37-45; discussion 45-6
AD - University Hospital Essen, Department of Neurosurgery, Essen, Germany.
The effectiveness of radiotherapy in reducing tumour recurrence of
pituitary adenomas is well documented. On the other hand, the risk of
side effects to the surrounding central nervous system normal tissue
should not be underestimated. This retrospective study includes 58
patients with subtotally resected pituitary tumours. Photon from a 5,7
MV linear accelerator of a 60 cobalt unit with a source-isocenter
distance of 80 cm were used throughout for treatment. The doses per
fraction ranged from 45 Gy to 60 Gy. For a direct comparison of the
different fractionation schedules, the biological effective total dose
with 2 Gy per fraction was calculated for all the different application
schemes with doses per fraction longer or smaller than 2 Gy. To do this,
a fractionation sensitivity of the normal cerebral tissue by an square /
square value of 2 Gy was assumed. Encephalopathy developed in 17 cases
(28 percentage) after follow-up times of more than 5 years. Pathological
CT- or MRI-findings were seen in 13 cases. Two factors were important
for the genesis of radiogenic encephalopathy: 1. Multivariate analysis
revealed that the risk of encephalopathy was associated with the
radiation volume. 2. The location of the upper field border line was the
strongest prognostic factor associated with the risk of encephalopathy
(p<0.05).
18
UI - 11792476
AU - Mastronardi L; Guiducci A; Puzzilli F; Maira G
TI -
Anterior pituitary adenomas in patients aged more than 65 years:
analysis of growth fraction (using the MIB-1 monoclonal antibody) and of
clinical features in comparison to younger patients.
SO - Clin Neurol Neurosurg 2002 Jan;104(1):44-8
AD - Sandro Pertini Hospital, Division of Neurosurgery, via Archimede 120,
00197, Rome, Italy. mastro@tin.it
AIMS AND BACKGROUND: The incidence of pituitary adenomas (PA). in
patients aged more than 65 years is relatively low. The goal of this
study was to evaluate the growth fraction and the clinical features of
PA affecting old patients and to compare the results to those of younger
subjects. METHODS: We evaluated the Ki-67 LI using the monoclonal
antibody MIB-1 in 21 patients of more than 65 years of age affected by
PA consecutively operated on and compared the mean LI with that one of
104 patients under 65 operated on in the same period. The clinical
behavior of PA was also analyzed in both groups. RESULTS: In older cases
PA occurred more frequently with visual disturbances: 17 out of 21
(80.9%) older patients showed pre-operative visual disturbances, versus
43 out of 104 (41.3%) younger patients (P=0.0009). Fifteen out of 21
(71.4%) older patients had a non-functioning PA, versus 38 out of 66
(36.5%) younger patients (P=0.003). In relation to surgically verified
infiltration of sellar floor dura and bone, we identified non-invasive
(12/21 older cases) and invasive (9 cases) adenomas; the wall of the
cavernous sinus was infiltrated in 5 cases. The overall mean Ki-67 LI
was 4.06+/-6.73 versus 2.35+/-2.54% of younger patients (P=0.04).
CONCLUSIONS: Our data confirm that Ki-67 LI detected by the MIB-1
monoclonal antibody is a useful marker in the determination of the
growth fraction of PA. In relation to our preliminary results, PA in the
elderly seem to have a higher growth fraction than in younger patients,
are more often non-functioning and occur frequently with visual
disturbances. In order to confirm our data further larger studies are
necessary.
19
UI - 11852512
AU - Garcia Lafuente N; Berna Gascon MT; Pujalte Lopez E; Falco Jover G;
TI -
Dominguez Escribano JR
[Response of thyrotropinoma to somatostatin analogues: report of a case]
SO - An Med Interna 2001 Dec;18(12):663
20
UI - 11700887
AU - Schmid M; Munscher A; Saeger W; Schreiber S; Ludecke DK
TI -
Pituitary hormone mRNA in null cell adenomas and oncocytomas by in situ
hybridization comparison with immunohistochemical and clinical data.
SO - Pathol Res Pract 2001;197(10):663-9
AD - Institute of Pathology, Marienkrankenhaus, Hamburg, Germany.
Null cell adenomas and oncocytomas are clinically inactive adenomas of
the pituitary gland. They do not show any significant hormone content
detectable by immunohistochemistry. This study aimed at demonstrating
mRNAs for all main pituitary hormones in 32 null cell adenomas and 31
oncocytomas by non-isotopic in situ hybridization using
digoxigenin-labeled oligonucleotide probes. The results were compared
with immunohistochemical and clinical data. Immunohistochemistry (ABC
method) was done with monoclonal antibodies against PRL, GH, FSH, LH,
TSH, ACTH, alpha-subunit, and Ki-67 (mib-1). The signals for hormone
production were detected in both adenoma types in a range from 42% for
GH in oncocytomas to 78% for beta-FSH in null cell adenomas. However,
these signals are apparently not effective on hormone production, as was
shown by almost negative immunostaining. Owing to the simultaneous
detection of at least two mRNAs in 78% of null cell adenomas and in 94%
of oncocytomas, we assume that both tumor types originate from
pluripotential precursor cells that are capable of producing various
hormones. According to our data, it is unlikely that the signals
influence the clinical behavior.
21
UI - 11808216
AU - Miyachi Y; Katayanagi N; Yamamoto N; Shimojo M
TI -
[Prolactin producing pituitary tumor]
SO - Nippon Rinsho 2001 Dec;59 Suppl 8():12-6
AD - First Department of Internal Medicine, University of Toho.
22
UI - 11740049
AU - Ruebel KH; Jin L; Zhang S; Scheithauer BW; Lloyd RV
TI -
Inactivation of the p16 gene in human pituitary nonfunctioning tumors by
hypermethylation is more common in null cell adenomas.
SO - Endocr Pathol 2001 Fall;12(3):281-9
AD - Department of Laboratory Medicine and Pathology, Mayo Clinic and
Foundation, Rochester, MN 55905, USA.
Recent studies have shown that methylation of the CpG island within the
p16/CDKN2A/MTS1 (p16) gene is associated with loss of expression of p16
protein in pituitary tumors. We analyzed a series of 21 pituitary
adenomas and three normal pituitaries along with a human pituitary cell
line (HP75) for methylation of exon 1 by methylation-specific PCR,
immunohistochemistry, and Western blotting. PCR analysis showed that 5/7
(71%) of null cell adenomas, but only 2/7 (29%) gonadotroph tumors were
hypermethylated. In addition,1 of 2 ACTH tumors but no GH (n = 4) or PRL
(n = 1) adenoma examined were hypermethylated. Immunostaining and
Western blot analysis of protein expression supported the
methylation-specific PCR analyses. These results show that p16 gene
silencing by hypermethylation is more common in null cell adenomas
compared to other nonfunctioning adenomas such as gonadotroph tumors and
that the role of p16 in the pathogenesis of pituitary adenomas is
restricted to specific tumor subtypes.
23
UI - 11740052
AU - Saeger W
TI -
CD markers in pituitary adenomas.
SO - Endocr Pathol 2001 Fall;12(3):307-13
AD - Institute of Pathology of the Marienkrankenhaus Hamburg.
WolfgangSaeger.HH@t-online. de
Immunostaining of CD markers in normal pituitary cells has been
reported, but a study of these markers in pituitary adenomas has not
been done. The expression of CD 3, CD 8, CD 15, CD 20, CD 30, CD 43, CD
45R0, CD 45 R, CD 79 alpha, and VS-38c was investigated in a collection
of 65 pituitary adenomas of various types. CD 3 was present in 75%, CD 8
in 18.5%, CD 15 in 12.3%, CD 20 in 66.1%, CD 30 in 10.8%, CD 43 in
10.8%, CD 45 RO in 72.3%, CD 45 R in 16.9%, CD 79alpha in 0% and VS-38 c
in 44.6%. Densely granulated GH cell adenomas expressed CD 3, CD 20, CD
45 RO, and CD 45 R, but no other markers. Sparsely granulated GH cell
adenomas showed CD 3, CD 8, CD 20, CD 43, and CD 45 RO. Mixed
GH/prolactin cell adenomas contained CD 3, CD 8, CD 20, CD 30, CD 45RO,
CD 45 R, and VS-38c. Mammosomatotroph cell adenomas were positive only
for CD 3, CD 8, CD 20, CD 43, and CD 45 RO. Prolactin cell adenomas
expressed CD 3, CD 8, and CD 20. ACTH cell adenomas showed CD 3, CD 15,
CD 20, CD 30, CD 45 RO, CD 45 R, and VS-38c. TSH cell adenomas contained
CD 3, CD 8, CD 15, CD 20, CD 45 RO, and VS-38c. Gonadotroph cell
adenomas were positive for CD 3, CD 8, CD 20, CD 45 RO, CD 45 R, and
VS-38c. Alpha-subunit-only adenomas expressed CD 3, CD 8, CD 15, CD 20,
CD 30, CD 45 RO, and VS-38c. Plurihormonal adenomas contained CD 3, CD
8, CD 20, CD 30, CD 43, CD 45 RO, CD 45 R, and VS-38c. Oncocytic
adenomas were positive for all markers except CD 45 RA and CD 79 alpha.
We conclude that the spectra of different adenoma types expressing CD
markers varies greatly and that significant correlations do not exist,
although noninvasive adenomas appear to express CDs more frequently than
invasive adenomas. We have no clear-cut explanations for the various
expressions and suggest that it may be a sign of local inter-actions
between the immune system and pituitary adenomas.
24
UI - 11740054
AU - Holthouse DJ; Robbins PD; Kahler R; Knuckey N; Pullan P
TI -
Corticotroph pituitary carcinoma: case report and literature review.
SO - Endocr Pathol 2001 Fall;12(3):329-41
AD - Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth,
Western Australia.
Pituitary carcinomas, currently defined as primary adenohypophyseal
neoplasms with evidence of either brain invasion or metastatic spread,
are exceptionally rare. A case of corticotroph pituitary carcinoma is
reported. A 17-year-old female first presented with an invasive and
clinically non-functioning pituitary macroadenoma. The primary pituitary
lesion lacked atypical histological features and retrospective
immunohistochemical studies confirmed its corticotrophic nature.
Repeated episodes of local recurrence followed together with the
acquisition of severe Cushing's disease. Local disease control was not
obtained despite repeated surgical decompression and courses of
radiation therapy. Systemic dissemination with multiple bone metastases
became manifest eleven years after the first presentation. Atypical
histological features and Crooke's hyaline change were evident in both
the recurrent and metastatic disease. She remains alive at last
follow-up with severe complications relating to persisting sellar and
metastatic disease and ongoing endocrine dysfunction. A further 32 cases
of pituitary corticotroph carcinoma reported in English are reviewed to
highlight the clinicopathological features of this rare form of
pituitary neoplasm. Difficulties associated with the diagnosis and
management of pituitary carcinoma are also discussed.
25
UI - 11883703
AU - Beinfeld MC; Wang W
TI -
CCK processing by pituitary GH3 cells, human teratocarcinoma cells NT2
and hNT differentiated human neuronal cells evidence for a
differentiation-induced change in enzyme expression and pro CCK
processing.
SO - Life Sci 2002 Feb 1;70(11):1251-8
AD - Department of Pharmacology and Experimental Therapeutics, Tufts
University School of Medicine, Boston, MA 02111, USA.
Margery.Beinfeld@tufts.edu
Human teratocarcinoma Ntera2/c 1.D1 (NT2) cells express very low levels
of the prohormone convertase enzyme PC1, moderate levels of PC2 and
significant levels of PC5. When infected with an adenovirus which
expresses rat CCK mRNA, several glycine-extended forms were secreted
that co-eluted with CCK 33, 22 and 12. Amidated CCK is not produced
because these cells appear to lack the amidating enzyme. Pituitary GH3
cells express high levels of PC2 and PC5. CCK adenovirus-infected GH3
cells secrete amidated versions of the same peptides as NT2 cells.
Differentiation of NT2 cells into hNT cells with retinoic acid and
mitotic inhibitors increased expression of PC5 and decreased expression
of PCI and PC2. CCK adenovirus-infected differentiated hNT cells also
secrete glycine extended CCK products and the major molecular form
produced co-eluted with CCK 8 Gly. These experiments demonstrate that
the state of differentiation of this neuronal cell line influences its
expression of PC 1,2, and 5 and its cleavage of pro CCK and suggests
that these cells may make an interesting model to study how
differentiation alters prohormone processing. These results also support
the hypothesis that PC5 in differentiated neuronal cells is capable of
processing pro CCK to glycine-extended CCK 8.
26
UI - 11817298
AU - Mukherjee JJ; Lee CH; Ong PL; Teo J
TI -
Panhypopituitarism due to pituitary cyst of Rathke's cleft origin--two
case reports.
SO - Ann Acad Med Singapore 2001 Nov;30(6):651-5
AD - Division of Endocrinology, Department of Medicine, National University
Hospital, 5 Lower Kent Ridge Road, Singapore 119074.
INTRODUCTION: Rathke's cleft cysts are cystic sellar and suprasellar
lesions, characteristically lined by a single layer of ciliated cuboidal
or columnar epithelium. CLINICAL PICTURE: We report 2 patients who
presented with gastrointestinal symptoms and were initially investigated
for dyspepsia. However, attention was subsequently drawn to persistent
hyponatraemia that led to the diagnosis of panhypopituitarism due to
Rathke's cleft cyst. TREATMENT: Transsphenoidal surgery followed by
drainage of the cyst and partial excision of the cyst wall in both
patients. OUTCOME: No recurrence of the lesions over a mean follow-up of
16 months. There has been an improvement of the
hypothalamo-pituitary-adrenal axis in 1 patient and the
hypothalamo-pituitary-thyroid axis and visual fields in the other.
CONCLUSION: Symptomatic Rathke's cleft cysts are rare and can
occasionally cause panhypopituitarism. Ideal management of these cysts
is unclear, but aspiration followed by partial excision of the cyst wall
seems the best initial option.
27
UI - 11846897
AU - Carpentieri SC; Waber DP; Scott RM; Goumnerova LC; Kieran MW; Cohen LE;
TI -
Kim F; Billett AL; Tarbell NJ; Pomeroy SL
Memory deficits among children with craniopharyngiomas.
SO - Neurosurgery 2001 Nov;49(5):1053-7; discussion 1057-8
AD - Division of Psychology, Department of Psychiatry, Children's Hospital
and Harvard Medical School, 300 Longwood Ave., Boston, Massachusetts
02115, USA. sarah.carpentier@carpenburymed.com
OBJECTIVE: To describe neuropsychological functioning (with a specific
focus on cognition and memory) after surgical treatment of
craniopharyngiomas. METHODS: Sixteen patients who were between 6 and 15
years of age at the time of surgery comprised the sample. Each child had
been treated for a craniopharyngioma with surgery only, on Dana-Farber
Cancer Institute Protocol 92-077. RESULTS: The overall level of
cognitive functioning was well within the average range, with both
language and visuospatial functioning being generally intact; however,
specific memory problems, in both the language and visuospatial domains,
were evident. CONCLUSION: Although general cognitive functioning was
intact after the surgical treatment of craniopharyngiomas, difficulties
in the retrieval of learned information were observed.
Neuropsychological assessments, with a focus on memory recall, should be
a component of the medical management plan for each child.
28
UI - 11846908
AU - Bohinski RJ; Warnick RE; Gaskill-Shipley MF; Zuccarello M; van Loveren
TI -
HR; Kormos DW; Tew JM Jr
Intraoperative magnetic resonance imaging to determine the extent of
resection of pituitary macroadenomas during transsphenoidal
microsurgery.
SO - Neurosurgery 2001 Nov;49(5):1133-43; discussion 1143-4
AD - Department of Neurosurgery, The Neuroscience Institute, University of
Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, Ohio
45267-0515, USA.
OBJECTIVE: Well-established surgical goals for pituitary macroadenomas
include gross total resection for noninvasive tumors and debulking with
optic chiasm decompression for invasive tumors. In this report, we
examine the safety, reliability, and outcome of intraoperative magnetic
resonance imaging (iMRI) used to assess the extent of resection, and
thus the achievement of preoperative surgical goals, during
transsphenoidal microneurosurgery. METHODS: Our magnetic resonance
operating room contains a Hitachi AIRIS II 0.3-T, vertical-field open
magnet (Hitachi Medical Systems America, Inc., Twinsburg, OH). A
motorized scanner tabletop moves the patient between the imaging and
operative positions. For transsphenoidal surgery, the patient is
positioned directly on the scanner tabletop so that the surgical field
is located between 1.2 and 1.6 m from the magnet isocenter. At this
location, the magnetic field strength is low (<20 G), thus permitting
the use of many conventional surgical instruments. Thirty consecutive
patients with pituitary macroadenomas underwent tumor resection in our
magnetic resonance operating room by use of a standard transsphenoidal
approach. After initial resection, the patient was advanced into the
scanner for imaging. If residual tumor was demonstrated and deemed
surgically accessible, the patient underwent immediate re-exploration.
RESULTS: iMRI was performed successfully in all 30 patients. In one
patient, iMRI was used to clarify the significance of hemorrhage from
the sellar region and resulted in immediate conversion of the procedure
to a craniotomy. In the remaining 29 patients, initial iMRI demonstrated
that the endpoint for extent of resection had been achieved in only 10
patients (34%) after an initial resection attempt, whereas 19 patients
(66%) still had unacceptable residual tumor. All 19 of these latter
patients underwent re-exploration. Ultimately, re-exploration resulted
in the achievement of the planned endpoint for extent of resection in
all of the 29 completed transsphenoidal explorations. Operative time was
extended in all cases by at least 20 minutes. CONCLUSION: iMRI can be
used to safely, reliably, and objectively assess the extent of resection
of pituitary macroadenomas during the transsphenoidal approach. The
surgeon is frequently surprised by the extent of residual tumor after an
initial resection attempt and finds the intraoperative images useful for
guiding further resection.
29
UI - 11894972
AU - Erfurth E M; Bulow B; Mikoczy Z; Svahn-Tapper G; Hagmar L
TI -
Is there an increase in second brain tumours after surgery and
irradiation for a pituitary tumour?
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