Sellar gangliocytoma with adrenocorticotropic and prolactin adenoma |
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| Affiliation: | 1. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;2. Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA;1. Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 5-185, Baltimore, MD 21287, USA;2. Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA;1. Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA;2. Department of Population Health, New York University School of Medicine, New York, NY, USA;3. Department of Ophthalmology, New York University School of Medicine, New York, NY, USA;1. Department of Anesthesia and Perioperative Care, University of California San Francisco, 500 Parnassus Ave. Box 0648, San Francisco, CA 94143, USA;2. Division of Neuro Interventional Radiology, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA;3. Department of Bioengineering, University of California Berkeley, Berkeley, CA, USA;4. Department of Statistics, University of California Irvine, Irvine, CA, USA;5. Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada |
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| Abstract: | We report a case of a 60-year-old man who presented with weight gain, headaches, dizziness, erectile dysfunction and decreased libido. He was found to have elevated adrenocorticotropic hormone (ACTH) and prolactin serum levels. The imaging studies revealed a 1.4 cm sella/suprasellar mass which was compressing the optic chiasm. Histologic slides of the lesion showed a pituitary adenoma, marked by a proliferation of biphenotypic appearing cells, associated with a gangliocytoma, and marked by a proliferation of atypical appearing neuronal cells arranged against a glial-appearing background. Pituitary adenoma-gangliocytomas are benign combination tumors that rarely occur in the sellar region. Adenomas in this setting are sometimes functional, and rare patients with mixed adenomas (adenomas secreting more than one hormone) have been reported. To our knowledge, there has been only one other report of a combined ACTH and prolactin-producing adenoma with gangliocytoma, reported in a patient who also had acromegaly. In our patient, the immunohistochemical stains demonstrated that the bulk of the adenoma cells stained with prolactin antibody, and scattered clusters of cells within the adenoma stained positively for ACTH. The adenoma did not stain with antibodies to any of the other anterior pituitary hormones. Postoperatively, the elevated prolactin and ACTH levels returned to normal levels and there was no evidence of residual tumor. Adequate sampling and immunohistochemistry are important in rendering a correct diagnosis and in identifying the hormone status of mixed adenoma-gangliocytomas. |
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| Keywords: | Adrenocorticotropic hormone adenoma Mixed adenoma-gangliocytoma Pituitary adenoma Prolactinoma Sellar gangliocytoma |
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