Suprasellar adrenocorticotropic hormone-secreting ectopic pituitary adenoma: case report and literature Review

OBJECTIVE AND IMPORTANCE: Functional ectopic pituitary adenomas are rare and can be misdiagnosed as extensions of pituitary adenomas when they are located in the vicinity of the normal gland. In this report, we present a case of an ectopic adrenocorticotropic hormone-secreting suprasellar pituitary adenoma that caused Cushing's disease. A literature review of previously reported ectopic pituitary adenomas is included to illustrate the diverse clinical manifestations of this disease entity. CLINICAL PRESENTATION: An 11-year-old boy was noted to have hirsutism, a buffalo hump, and unexplained weight gain consistent with Cushing's syndrome. Laboratory investigations revealed that the boy had elevated adrenocorticotropic hormone and serum cortisol levels unsuppressed by dexamethasone. Magnetic resonance imaging scans were suggestive of a pituitary adenoma with suprasellar extension. INTERVENTION: The initial transsphenoidal approach failed to achieve complete surgical resection. A repeat operation in which the pterional approach was used revealed a suprasellar pituitary adenoma without association with intrasellar contents. The patient's cushingoid symptoms improved significantly 3 months after surgery. CONCLUSION: Ectopic pituitary adenomas should be considered in the differential diagnosis for all patients with Cushing's syndrome. Furthermore, surgical approaches should be chosen carefully once the diagnosis of ectopic pituitary adenoma is made.     

Suprasellar pituitary adenoma arising from the pars tuberalis: case report

A rare case of suprasellar pituitary adenoma arising from the pars tuberalis in a 53-year-old woman is presented. The tumor was located exclusively above the diaphragma sellae, and no invasion into the sella turcica was noted.     

Clival pituitary adenoma with acromegaly: case report and review of literature.

The pituitary develops as a result of complex, intricate, and precise neuro-embryological events in the sixth to eighth weeks of gestation. Some ectopic cell rests can become adenomatous. Rarely, these cell rests in the clivus can be the site of formation of adenoma. Our patient, a 35-year-old parous woman, was being treated for acromegaly, and imaging studies revealed a clival mass lesion. Trans-sphenoidal excision was done and immunohistochemistry revealed the tumor to be a growth hormone-secreting tumor.     

Radiation-induced meningioma after treatment for pituitary adenoma: case report and literature review

Radiation-induced meningiomas are becoming increasingly well-recognized. We report a case of a 35-year-old man who developed a suprasellar meningioma 9 years after receiving a radiation dose of 4480 cGy for a pituitary adenoma. The literature is also reviewed.     

Ectopic pituitary adenoma of the sphenoid sinus: report of a case and review of the literature

Ectopic pituitary adenoma of the sphenoid sinus in a 68-year-old woman is presented. The confusing discrepancy between the imaging features and the mild clinical manifestations of extensive bone destruction of the skull base is emphasized. A definite diagnosis can be established only by histopathological examination supported by immunohistochemical studies.     

Supratrigonal ectopic prostate: case report and review of the literature

A 76-year-old man with a 6-month history of dysuria and frequency had a sessile tumor at the bladder dome containing benign prostatic glandular tissue. The presence of benign prostatic polyps in the prostatic urethra and bladder neck is a common finding. Ectopic prostatic tissue elsewhere is rare, it has been described previously in a few cases in the trigonum and only once in the supratrigonal area. The origin of prostate glands in this unlikely location is not yet fully understood. Prostatic tissue at any ectopic location is benign, although local recurrence has been reported.     

Pediatric metanephric adenoma: case report and review of the literature

Metanephric adenomas are rare benign renal neoplasms, uncommonly seen in the pediatric population. They are typically detected incidentally on imaging studies performed for unrelated clinical presentations. Preoperatively, the imaging appearance of this tumor overlaps with the appearance of more common and more aggressive renal neoplasms such as Wilms’ tumor or renal cell carcinoma. We present a case of a pathologically proven metanephric adenoma, monitored preoperatively for approximately 5 years, prior to definitive nephrectomy. As the majority of solid renal masses are resected soon after they are detected, to the best of our knowledge, this case is the first to demonstrate the natural in vivo progression of a pathologically proven metanephric adenoma.     

双侧后肾腺瘤报告并文献复习

目的:探讨后肾腺瘤(MA)的临床病例特征,提高对MA的认识。方法:观察1例MA的病理组织学表现,结合临床资料及相关文献进行分析。结果:肿瘤细胞丰富,排列密集,形态一致的单层立方上皮的小管结构。免疫组化:WT1(+),CD57散在(+),Vim散在少许(+),PCK、EMA、CK7、CD10、CD117均(-),Ki67LI:1%左右。结论:MA多为单侧,双侧少见,缺乏临床特异性及影像学诊断,术前诊断较困难,难以和恶性病变相鉴别,需术前穿刺活检或术中快速冷冻病理诊断,避免肾脏全部切除。术后需注意长期随访。     

A case of ectopic large pituitary adenoma

Ectopic pituitary adenomas are very rare and only 17 cases have been reported. In this paper we present a case of large pituitary adenoma originating in the suprasellar region. A 26-year-old man was admitted to our clinic with a chief complaint of headaches. Neurological examination revealed slight disorientation and bilateral choked disk. Hormonal study revealed that the serum prolactin level was 3300ng/ml and serum growth hormone level was 29.5ng/ml. Computed tomography showed a large mass in the suprasellar region extending upward to the third ventricle and backward to the pons. T1-weighted MR imaging revealed that the intensity of the mass was the same as that of the cerebral cortex and the pituitary gland was showing high intensity in the pituitary fossa. The tumor was radically removed via the transpetrosal transtentorial approach. Histologically, the tumor was a prolactin-growth hormones producing pituitary adenoma. The literature was reviewed and the origin of the tumor was discussed.     

肝内胆管腺瘤一例报告并文献复习

肝内胆管腺瘤在临床上比较罕见,国内文献仅见3例报道.本文报告1例肝内胆管腺瘤,复习文献并对其做初步分析. 临床资料:患者男,51岁.因肺部感染、脑出血后遗症在神经内科住院治疗期间行胸部CT检查时发现左肝顶低密度结节而转入外科治疗.体检:皮肤巩膜无黄染,腹部未发现阳性体征.     

肝内胆管腺瘤一例报告并文献复习

肝内胆管腺瘤在临床上比较罕见,国内文献仅见3例报道.本文报告1例肝内胆管腺瘤,复习文献并对其做初步分析. 临床资料:患者男,51岁.因肺部感染、脑出血后遗症在神经内科住院治疗期间行胸部CT检查时发现左肝顶低密度结节而转入外科治疗.体检:皮肤巩膜无黄染,腹部未发现阳性体征.     

黏液样肾上腺皮质腺瘤一例报告及文献复习

目的 探讨黏液样肾上腺皮质腺瘤的临床病理特点及治疗方法.方法 分析1例黏液样肾上腺皮质腺瘤患者的临床资料,总结其临床表现、影像学特点、病理学结果及治疗方法,结合文献复习讨论.患者,女,43岁.主诉反复发作头痛、乏力10年,伴高血压、低血钾症.B超提示左肾上腺4.1 crux 3.4 cm低回声实性占位,CT提示肾上腺内2.5 cm×3.8 cm×4.0 cm肿物,CT值24HU,增强后瘤体外周CT值41 HU,中心未见明显强化.结果 患者行腹腔镜下手术,完整切除肿瘤及同侧肾上腺.病理报告:肿物灰粉灰红色相间,质地较硬.肿物剖面呈灰粉灰黄相间的胶冻样物,可见散在出血点.镜下肿瘤细胞大小一致,细胞境界清楚,核膜及核仁无明显异型性,未见核分裂象.肿瘤细胞内可见黏液样物质,部分区域可见细胞周围黏液样基质.免疫组织化学及特殊染色结果:波形纤维蛋白(+)、黑色素蛋白一A(+),阿尔辛蓝/对氨基水杨酸染色(+).病理诊断:黏液样肾上腺皮质腺瘤.术后患者血压及血钾等各项生化指标恢复正常,随访6个月未见肿瘤复发.结论 黏液样肾上腺皮质腺瘤是少见的肾上腺皮质肿瘤,确诊需依靠病理学检查,手术切除肿瘤及同侧肾上腺为首选治疗.     

Unilateral exophthalmos caused by a prolactin producing ectopic pituitary adenoma: case report

OBJECTIVE: We report a case of a patient with a prolactin (PRL) producing ectopic pituitary adenoma presenting a unilateral exophthalmos. CASE: This 70-year-old woman presented an ophthalmologist with progressive left-sided exophthalmos over the previous 2 months. Bone window CT scan revealed extensive bony destructions of the skull base including the clivus, sphenoid sinus and medial aspect of the middle cranial fossa. Gd-DTPA MRI revealed an abnormal enhancement lesion in the sphenoid sinus, but no abnormal enhancement was seen in the sella turcica. Since these findings suggested malignant tumors of the cranial base, several biopsies through the transnasal route were carried out to confirm the diagnosis. This procedure caused the complication of cerebrospinal fluid (CSF) leakage. Because the biopsy specimen revealed a PRL producing adenoma (serum PRL-level 645.7 ng/ml), the patient was admitted to our department. On admission neurological examination showed an exophthalmos with external ocular movement disorders and disturbance of visual acuity on the left side. She underwent transsphenoidal surgery to remove the tumor and to reconstruct the sphenoid sinus and the sellar floor. Surgical exploration revealed a yellowish and soft tumor underneath the normal mucous membrane in the sphenoid sinus. The sellar floor was destructed extensively, but the dura mater of the pituitary fossa was intact except for a small pin-hole which was thought to be produced during the several biopsy procedures. No surgical procedure was applied to the intrasellar region. The sphenoid sinus was packed with a piece of fascia and fat applied with the aid of fibrin glue to prevent CSF leakage. RESULT: The patient followed a satisfactory postoperative course. Her visual acuity disturbance and exophthalmos disappeared one year after surgery. Postoperative serum PRL level remained high (66.9 ng/ml), but, subsequently, was normalized (9.5 ng/ml) with a bromocriptine therapy (15 mg daily). CONCLUSION: As far as we are aware, this is the first case report of an ectopic pituitary adenoma causing unilateral exophthalmos. Although it is extremely rare, pituitary adenomas should be kept in mind in a differential diagnosis of exophthalmos.     

Metastasis within a pituitary adenoma presenting with bilateral abducens palsies: case report and review of the literature

A 56-year-old woman with metastatic breast carcinoma presented on her terminal hospital admission with diplopia secondary to bilateral abducens nerve palsies. Postmortem examination revealed a sellar mass composed of an unsuspected pituitary adenoma infiltrated by metastatic carcinoma. Review of the literature revealed only seven patients with this rare neoplasm-to-neoplasm metastasis, none of whom were reported to have had abducens palsies.     

Mucous gland adenoma of the trachea: case report and literature review

Adenoma arising from bronchial mucous glands is extremely rare. Such tumors are truly benign, in contradistinction to other tumors previously grouped under the term "bronchial adenoma." We present the first case reported of mucous gland adenoma arising in the trachea. This case was initially misdiagnosed as asthma, a common error with obstructing tracheo-bronchial lesions.     

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.