10/6- Pathology of the Pituitary and Pineal Glands

Question 1

What is seen here?

Answer 1

Normal Sellar Region (coronal MRI)

Question 2

What is seen here?

Answer 2

Sellar region with small pituitary mass (under 10 mm) (coronal MRI)

Question 3

What is seen here?

Answer 3

Pituitary mass to chiasm (sellar coronal section MRI)

Question 4

What is seen here?

Answer 4

Huge pituitary mass (sellar coronal section MRI)

Question 5

What is see here?

Answer 5

Normal acinar pattern in pituitary gland

Question 6

What is seen here?

Answer 6

(Reticulum stain)

Left: normal acinar pattern in pituitary gland

Right: effacement of acinar pattern in pituitary adenoma

Question 7

What is seen here?

Answer 7

Effacement of acinar pattern in pituitary adenoma

Question 8

What does this picture show in regards to immunohistochemical staining of this pituitary adenoma?

Answer 8

Overproduction of hormone

Question 9

What are symptoms of hyperprolactinemia?

Answer 9

Women:

• Galactorrhea
• Menstrual irregularities

Men

• Loss of libido
• Breast enlargement

Question 10

____ is the most common hormonal abnormality associated with pituitary adenomas and may be due to ______

Answer 10

Hyperprolactinemia is the most common hormonal abnormality associated with pituitary adenomas and may be due to primary hypersecretion

Question 11

What else (other than primary hypersecretion) may contribute to hyperprolactinemia?

Answer 11

Any pituitary region mass, via “stalk effect”

• Flow of prolactin inhibitory factor (dopamine) is impeded

Question 12

What is medical treatment of prolactinoma?

Answer 12

Dopamine agonist

• May normalize endocrine function and recue size of adenoma

Also surgical management

• Transsphenoidal removal of pituitary tumor (through the nose)

Question 13

Excess secretion of growth hormone results in what?

Answer 13

• Giantism in childhood
• Acromegaly in adulthood

Question 14

Symptoms/prognosis of acromegaly?

• Co-morbidities?

Answer 14

• Characterized by coarse facial features and enlarged hands and feet
• Acromegaly is NOT benign; these pts may develop diabetes and congestive heart failure

Question 15

What is the underlying circuitry/pathophysiology of excess ACTH production in Cushing’s?

Answer 15

In Cushing’s, there is chronic driving of the adrenal glands by a hyeprsecreting pituitary adenoma

Question 16

What are signs/symptoms of Cushing’s?

• Serum corticosteroid levels
• Co-morbidities

Answer 16

• Elevated serum corticosteroids (leading to potentially lethal endocrinopathy) characterized by:
• Hypertension
• Diabetes
• Poor wound healing
• Immune compromise
• Central redistribution of fat

Question 17

What is seen here?

Possible symptoms?

Answer 17

Sellar region meningioma; may result in:

• Hypo-pit
• Bitemporal hemianopia
• Stalk effect

Question 18

What is seen here?

Answer 18

Sellar region meningioma

Question 19

What is seen here?

Answer 19

Sellar region craniopharyngioma

• Epithelial tumor; can make keratin
• Doesn’t differentiate into the pituitary, as it should have

Question 20

What is seen here?

Answer 20

Sellar region craniopharyngioma

• Moved upward and destroyed hypothalamus
• May be solid (like here) or cystic and fluid filled
• Invading brain; can’t really get complete surgical resection when it’s this big

Question 21

What is seen here?

Answer 21

Fluid in a craniopharyngioma

• “Motor oil”

Question 22

What is seen here?

Answer 22

Craniopharyngioma with adjacent compressed brain with Rosenthal fibers

• Rosenthal fibers = fibers of condensed GFAP (happens with any chronic compressed brain region)

Question 23

What is seen here?

Answer 23

Optic glioma

Question 24

What is seen here?

Possible symptoms (neuro and endocrine)?

Answer 24

Pineal region mass

Neurological Sx:

• Obstructive hydrocephalus (obstructs aqueduct)
• Headache (increased ICP)
• Vertical gaze and pupil issues (midbrain)

Endocrine Sx:

• Precocious puberty
• Involved in daily, monthly, and lifelong rhythms
• “The third eye”; has photoreceptors (can sense daily and seasonal changes in light exposure)

Question 25

What is the most common pineal region mass?

Answer 25

Germinoma

(Germinomas may be found anywhere int he midline; most commonly found in gonads; “germinoma” in ovares or “seminoma” in testes)

• Pineal gland also has all brain components (dura, glial cells, etc.) that can result in primary brain tumors in this area; germinoma is just more common

Question 26

What is seen here? Characteristics of this tumor type?

Answer 26

Germinoma (most common pineal region mass)

• Large cells
• Big nuclei and nucleoli