Cushing's Syndrome from an Ectopic Pituitary Adenoma with Peliosis: A Histological,Immunohistochemical, and Ultrastructural Study and Review of the Literature

Ectopic pituitary adenoma (EPA) is rare and, to the authors’ knowledge, its association with peliosis has not yet been described. The case of a 38-yr-old woman with clinical and biochemical evidence of Cushing’s syndrome is reported. Magnetic resonance imaging (MRI) disclosed a normal pituitary and a separate mass in the sphenoid sinus. The surgically remove’s hyaline change in the corticotrophs, indicating exposure to glucocorticoid excess. By histology, the mass in the sphenoid sinus was a congested, chromophobic, partly basophilic, periodic acid-Schiff (PAS)-positive pituitary adenoma composed of pleomorphic, adrenocorticotropic hormone (ACTH)-positive, corticotrophs. There was focal immunopositivity for MIB-1 and proliferating cell nuclear antigen (PCNA). Electron microscopy confirmed the diagnosis of corticotroph adenoma. A striking finding, consistent with the diagnosis of peliosis, was the presence of multiple large blood-filled spaces lacking an endothelial lining. The capillaries were dilated, but often appeared empty and the fenestrated endothelium exhibited discontinuities. The cause of peliosis is obscure. It may be that the venous outflow was impaired in this case leading to capillary dilation, congestion, hyperpermeability, rupture, and accumulation of blood in extravascular spaces.     

Xanthomatous Hypophysitis: A Novel Entity of Obscure Etiology

We report a case of xanthomatous hypophysitis, a recently described entity of obscure etiology affecting the pituitary gland, in a 43-yr-old women. Histologically it is characterized by infiltration of the anterior pituitary by foamy histiocytes which are strongly immunoreactive for CD68 (histiocytic marker) and are immunonegative for S100 and CD1a. Electron microscopy revealed histiocytes with abundant cytoplasmic lipid droplets and membrane bound vacuoles. Fragments of intact anterior pituitary with preserved vascular and reticulin networks are seen. Xanthomatous hypophysitis resembles neoplasm on clinical and radiologic grounds.     

Effect of treatment with octreotide on the morphology of growth hormone—secreting pituitary adenomas: Study of 24 cases

Twenty-four acromegalic patients were treated with octreotide subcutaneously for periods of 3 to 6 weeks (group I, 12 cases) or 6 months (group II, 12 cases) before transsphenoidal surgery. Radiological studies performed in 19 patients before and at the end of this treatment period revealed no changes in 8 cases. In 8 other cases, a slight reduction in tumorsize was observed, and in 3 cases an important shrinkage was documented. At surgery, the adenomatous tissue appeared softer than in nonpretreated patients, facilitating the operation. Pathological examination revealed widening of perivascular spaces with accumulation of fibrous tissue and more crinophagy than in nonpretreated patients but failed to reveal morphologically pronounced cell involution as observed in prolactin-producing adenomas treated with dopamine agonists. No significant difference in frequency or extent of cellular changes was noted between the two groups. These morphological findings seem to be more consistent with a functional inhibition of growth hormone release than with cellular alterations induced by octreotide.     

Copolymers with soft and hard segments based on 2,2-dimethyltrimethylene carbonate and ε-caprolactone

Thermoplastic elastomers with ABA-block structure, A representing the hard segment and B the soft segment, were prepared by ring-opening polymerization from 2,2-dimethyltrimethylene carbonate (DTC, 1 ) and ε-caprolactone (ECL, 2 ) as monomers. Typical anionic initiators, viz. the dilithium salt of hydroxytelechelic poly(ethylene oxide) 200 ( 4 ) and of polytetrahydrofuran 1000 ( 5 ) and as an insertion initiator the bis(diethylaluminium) salt of triethylene glycol were used. The soft block is formed by a sequence of random (or tapered) structure comprising equimolar amounts of the two monomers and obtained by simultaneous polymerization of DTC and ECL. The hard blocks consist of highly crystalline poly(2,2-dimethyltrimethylene carbonate) sequences. The thermal properties of the polymers depend on the sequence length, the content of heterodiads in the soft block and the thermal history of the samples. Copolymer films with short end blocks and high content of heterodiads show rubber-elastic properties at normal conditions.     

CD23 and CD21 function as adhesion molecules in homotypic aggregation of human B lymphocytes

We have previously found that interleukin-4 and CD40 monoclonal antibodies (mAb) are strong potentiatiors of homotypic B cell aggregation which is dependent on LFA-1. We show here that CD23 mAb were also able to inhibit aggregation to a similar extent as LFA-1 antibodies. This inhibition was restricted to the MHM6 epitope of CD23 and antibodies to other epitopes [Epstein-Barr virus (EBV) CS-1, EBV CS-2, EBV CS-5 and mAb 25] or occupation of the Fc-binding site by IgE had no or a slightly enhancing effect on aggregation. When testing two antibodies to CD21, the recently defined ligand for CD23, one of these (BU32) was found to be inhibitory whereas the other (THB5) had no effect. By combining antibodies to LFA-1 and CD23, aggregation was often completely inhibited. These data suggest that LFA-1/ICAM-1 and CD23/CD21 are the major molecules involved in homotypic aggregation of human B cells.     

Terbutaline Depot Tablets in Asthma

A sustained release preparation of terbutaline sulphate has been formulated (Bricanyl® depot tablets) in order to extend the duration and accordingly change the dosage regimen to twice a day. This presentation gives a summary of a clinical trial performed in order to study effect and side effects of terbutaline depot tablets 7.5 mg twice a day compared to terbutaline tablets 5 mg three times a day.
Patients suffering from perennial asthma and with daily requirement of asthma medicine were accepted for the study. The trial was a double-blind cross-over, double dummy and randomized. The tablets were given in two consecutive periods of 7 day's duration each. The effect of terbutaline depot tablets was equal to the effect of the ordinary terbutaline tablets. The indication for using depot tablets in the basic treatment of bronchial asthma is a better patient compliance due to medication twice a day. Furthermore in patients with unstable bronchial asthma and in patients with morning dips in PEF the more stable plasma concentration may perhaps keep the patients in a more steady state.     

In vivo treatment with W3/13 (anti-pan T) but not with OX8 (anti-suppressor/cytotoxic T) monoclonal antibodies impedes the development of adjuvant arthritis in rats.

The involvement of phenotypically defined cells in the pathogenesis of adjuvant arthritis in rats has been investigated in two different ways. Firstly, immunohistochemical methods have been used to characterize the cellular composition of the arthritic synovial tissue, in particular the pannus tissue close to the destroyed cartilage. It is shown that T-helper lymphocytes dominate the lymphoid infiltrates, and that large numbers of cells expressing Ia are present in the pannus. Secondly, different anti-T cell monoclonal antibodies have been injected into rats in vivo and disease course and phenotypes of synovial cells investigated after different types of treatment. It is shown that the injection of W3/13 (anti-pan T-cell antibodies) delays the development of adjuvant arthritis, whereas a complete elimination of the suppressor/cytotoxic T-cell subset after injection of OX8 antibodies does not affect the disease course.