10/6- Pathology of the Pituitary and Pineal Glands Flashcards
What is seen here?
Normal Sellar Region (coronal MRI)
What is seen here?
Sellar region with small pituitary mass (under 10 mm) (coronal MRI)
What is seen here?
Pituitary mass to chiasm (sellar coronal section MRI)
What is seen here?
Huge pituitary mass (sellar coronal section MRI)
What is see here?
Normal acinar pattern in pituitary gland
What is seen here?
(Reticulum stain)
Left: normal acinar pattern in pituitary gland
Right: effacement of acinar pattern in pituitary adenoma
What is seen here?
Effacement of acinar pattern in pituitary adenoma
What does this picture show in regards to immunohistochemical staining of this pituitary adenoma?
Overproduction of hormone
What are symptoms of hyperprolactinemia?
Women:
- Galactorrhea
- Menstrual irregularities
Men
- Loss of libido
- Breast enlargement
____ is the most common hormonal abnormality associated with pituitary adenomas and may be due to ______
Hyperprolactinemia is the most common hormonal abnormality associated with pituitary adenomas and may be due to primary hypersecretion
What else (other than primary hypersecretion) may contribute to hyperprolactinemia?
Any pituitary region mass, via “stalk effect”
- Flow of prolactin inhibitory factor (dopamine) is impeded
What is medical treatment of prolactinoma?
Dopamine agonist
- May normalize endocrine function and recue size of adenoma
Also surgical management
- Transsphenoidal removal of pituitary tumor (through the nose)
Excess secretion of growth hormone results in what?
- Giantism in childhood
- Acromegaly in adulthood
Symptoms/prognosis of acromegaly?
- Co-morbidities?
- Characterized by coarse facial features and enlarged hands and feet
- Acromegaly is NOT benign; these pts may develop diabetes and congestive heart failure
What is the underlying circuitry/pathophysiology of excess ACTH production in Cushing’s?
In Cushing’s, there is chronic driving of the adrenal glands by a hyeprsecreting pituitary adenoma
What are signs/symptoms of Cushing’s?
- Serum corticosteroid levels
- Co-morbidities
- Elevated serum corticosteroids (leading to potentially lethal endocrinopathy) characterized by:
- Hypertension
- Diabetes
- Poor wound healing
- Immune compromise
- Central redistribution of fat
What is seen here?
Possible symptoms?
Sellar region meningioma; may result in:
- Hypo-pit
- Bitemporal hemianopia
- Stalk effect
What is seen here?
Sellar region meningioma
What is seen here?
Sellar region craniopharyngioma
- Epithelial tumor; can make keratin
- Doesn’t differentiate into the pituitary, as it should have
What is seen here?
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
What is seen here?
Fluid in a craniopharyngioma
- “Motor oil”
What is seen here?
Craniopharyngioma with adjacent compressed brain with Rosenthal fibers
- Rosenthal fibers = fibers of condensed GFAP (happens with any chronic compressed brain region)
What is seen here?
Optic glioma
What is seen here?
Possible symptoms (neuro and endocrine)?
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)
What is the most common pineal region mass?
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
What is seen here? Characteristics of this tumor type?
Germinoma (most common pineal region mass)
- Large cells
- Big nuclei and nucleoli
