Ectopic pituitary adenoma located at the pituitary stalk. Case report

Suprasellar located ectopic pituitary adenomas are unusual tumors. We report a rare case of suprasellar prolactinoma arising from the pars tuberalis in a 37-year-old woman. Menstrual disregulation and bitemporal hemianopsia were the main complaints. Blood tests revealed hyperprolactinemia. In magnetic resonance the tumor was totally supradiaphragmatic. Pterional craniotomy and total tumor excision was performed. The pituitary stalk was preserved. Histopathologic diagnosis was a pituitary adenoma immunoreactive for prolactin. Pituitary hormonal functions returned to normal at 6 months postoperatively. No complications were seen in the postoperative period. An ectopic adenoma should be suspected in a patient with suprasellar tumor and hyperprolactinemia. Surgical excision of this tumor may result with normal pituitary functions and normal visual acuity.     

Xanthogranuloma of the third ventricle. Case report.

The case history of a patient with a xanthogranuloma of the third ventricle is presented. This type of lesion formed by desquamation of epithelium is usually noted as an incidental autopsy finding in the choroid plexus of the lateral ventricles. Total removal via a transcortical transventricular route led to complete recovery. These tumors should be suspected in the geriatric population. The computerized tomography findings and a review of the literature are included.     

Median third ventricle meningioma. Case report

A case of meningioma located in the median part of the third ventricle and revealed by autoptic examination in a patient who died for meningoencephalitis is reported.     

Intracranial ectopic pituitary adenoma. Case report.

The authors report a unique case of ectopic intracranial pituitary adenoma, associated clinically with generalized seizures and aggressive behavior. The lesion presumably arose from cells in the pars tuberalis and did not involve the sella turcica.     

Ectopic pituitary adenoma in the suprasellar cistern: case report

The case of a 56-year-old man with an ectopic pituitary adenoma is reported. Neurological examinations, neurodiagnostic imaging, surgical observation, endocrinological evaluation, histological examination, and immunohistological study demonstrated evidence of ectopic prolactinoma in the suprasellar cistern and the presence of a normal pituitary in the sella turcica. The patient underwent total removal of the suprasellar mass by a pterional approach, leading to a surgical and endocrinological cure.     

Pituitary hemorrhage extending into the third ventricle. Case report

A case of pituitary apoplexy causing pituitary hemorrhage with extension into the third ventricle is reported. The patient was a 73-year-old, obese female admitted with sudden onset of vomiting and impaired consciousness. Neurological examination revealed that she was stuporous, with marked neck stiffness and a dilated left pupil. A plain skull X-ray showed sellar enlargement and destruction of the dorsum sellae. Computed tomography demonstrated a high-density area in the third and lateral ventricles and a round, high-density mass in the suprasellar cistern. The patient died the next day. Autopsy revealed a large tumor in the sellar and suprasellar areas. The tumor and the hematoma within it compressed the floor of the third ventricle and passed through the lamina terminalis and the hypothalamic region. Histological examination disclosed a basophilic adenoma. The pituitary hemorrhage appeared to be the result of ischemia and necrosis within the pituitary adenoma caused by its acute expansion. The extension of the hematoma into the third ventricle was attributable to the large size of the tumor and its close adhesion to the floor of third ventricle.     

Spontaneous resolution of residual pituitary adenoma. Case report

A 34-year-old man presented with progressive diminution of vision in the left eye for 7 years. He had suffered left hemicranial headache associated with left retro-orbital pain and diplopia for 3 months. Magnetic resonance (MR) imaging revealed a pituitary tumor located in the sella and extending into the right cavernous sinus. After transsphenoidal surgery, the vision improved drastically but the diplopia persisted. Postoperative MR imaging showed residual tumor in the right cavernous sinus. Follow-up examination after 3 years showed the diplopia had completely recovered and the residual tumor in the cavernous sinus had disappeared. Spontaneous resolution of a large intracavernous sinus residue of a pituitary adenoma may occur due to tumor necrosis.     

Meningioma of the anterior part of the third ventricle. Case report.

The authors present a case of meningioma located in the anterior part of the third ventricle. The mass was successfully removed through a right-sided transventricular approach after stereotaxic biopsy. A review of the relevant literature is included.     

Hypophyseal metastatic hypernephroma mimicking a pituitary adenoma. Case report

A patient with a remote history of nephrectomy for hypernephroma presented a visual field defect with hypopituitarism. Neuro-imaging studies showed a highly vascularized sellar mass with suprasellar extension. Surgery, which was performed via the subfrontal approach, disclosed the pituitary tumor to be a hypernephroma. Although anterior pituitary involvement is rare, chiasmal compression is much rarer in metastatic pituitary carcinomas, a review of previously reported cases of metastatic pituitary hypernephroma and our own case indicated that pituitary metastasis from this carcinoma, in contrast to other metastatic pituitary tumors, often mimics pituitary adenoma.     

Calcified pituitary adenoma associated with severe hyperprolactinemia. Case report

A patient with a completely calcified chromophobe adenoma is reported. Endocrine evaluation revealed very high prolactin levels. Such extensive calcifications in prolactin-secreting adenomas are extremely rare. The possible pathogenetic mechanisms of this association are discussed.     

Ectopic pituitary adenoma in the cavernous sinus causing oculomotor nerve paresis--case report

A 24-year-old woman presented with a rare adrenocorticotropic hormone (ACTH)-positive pituitary adenoma in the cavernous sinus, manifesting as sudden onset of oculomotor nerve paresis. Neuroimaging revealed a tumor in the cavernous sinus bulging into the subdural space. There was no continuity between the tumor and the pituitary gland in the sella turcica. Gross total removal of the tumor was performed through the orbitozygomatic approach followed by stereotactic radiosurgery. The oculomotor nerve paresis was resolved. Histological examination revealed an adenoma positive for ACTH. Ectopic pituitary adenoma occurs mostly in the sphenoid sinus or the suprasellar region. This extremely rare case of ectopic macroadenoma in the cavernous sinus manifested as oculomotor nerve paresis without signs of Cushing's syndrome.     

Case report of giant calcified pituitary adenoma]

The exceptional nature of compact, extensive calcifications in a giant pituitary adenoma points to the possibility of immunological, histological and chemical mechanisms in the calcification process.     

Ectopic pituitary adenoma with malignant transformation

We report here a case of ectopic pituitary adenoma with malignant transformation after repeated relapses. First, an ectopic pituitary adenoma producing follicle-stimulating hormone was found in the nasal cavity extending to the frontal cranial fossa. Despite repeated surgical resections of the tumor, it recurred three times in 2 years. The tumor gradually showed cellular atypia, mitosis, and necrosis. Immunohistochemical analyses revealed that the expressions of proliferating cell nuclear antigen and MIB-1 increased progressively. Moreover, the expression of p53 was detected at the second recurrence. Finally, at the third recurrence the tumor showed dissemination to the subarachnoid space and multiple metastases in the brain. The patient died of the tumor 10 months after the last resection. These findings indicate that the ectopic pituitary adenoma became malignant. To our knowledge, this is the first report on malignant transformation of ectopic pituitary adenoma. It is important to know that ectopic pituitary adenomas show malignant transformation and that the above parameters (proliferating cell nuclear antigen, MIB-1, and p53) may be useful indicators of the malignant potential of both ectopic and sellar pituitary tumors.     

Supra-diaphragmatic pituitary adenoma removed through the trans-tuberculum sellae approach. Case report

A 59-year-old woman presented with a rare supra-diaphragmatic pituitary adenoma manifesting as a mass lesion. Her baseline data and the response of anterior pituitary hormones to the provocation test were within the normal range. Magnetic resonance imaging showed a homogeneously enhanced tumor located on the diaphragma sellae. The tumor was totally removed by the endonasal trans-tuberculum sellae approach under combined microscopic and endoscopic observation. Her postoperative course was uneventful and the histological diagnosis was pituitary adenoma located in the suprasellar region. The trans-tuberculum sellae approach is a less invasive method to remove pituitary adenoma located in the suprasellar region.