Pituitary Pathology

Question 1

What are the most common sellar region masses?

Answer 1

Pituitary adenomas make up 85%!

Equivalent to WHO Grade I

Question 2

Hyperfunctioning vs mass effect pituitary adenomas

Answer 2

Hyper functioning: produce physiologically-unregulated excess of endocrine hormone(s)

Many are clinically non functioning and produce mass effect or visual disturbances due to compression of critical nearby anatomical structures

Question 3

What is the typical age of presentation for a stellar region mass?

Answer 3

All except craniopharyngioma predominantly affect middle age adults

Craniopharyngioma has two age peaks, pediatric (5-15 yrs) and middle age (45-60 yrs) adults

Question 4

Are most pituitary tumors familial or sporadic?

Answer 4

more than 95% are sporadic

More suspicious for familial if in a pt under 18

Question 5

Are most ACTH adenomas micro or macro adenomas?

Answer 5

85% are micro (less than 1 cm)

Question 6

Are most prolactinomas in premenopausal women micro or macro adenomas?

Answer 6

Micro!

Question 7

What are the symptoms of mass effect?

Answer 7

Headaches
Visual Field Deficits
Cranial Nerve Palsies
Ptosis (eyelid droop)
Diplopia (double vision)
Pituitary Hormone Deficits
     (Panhypopituitarism)
Rarely
Seizures
Stroke
CSF Leak

Question 8

What is the most common type of clinically non functioning adenoma and the most common type to come to surgery?

Answer 8

Gonadotroph adenoma

Question 9

Hormone negative adenoma

Answer 9

Hormone negative adenomas are clinically non functioning AND show no IHC(+) for GH, PRL, FSH, LH, TSH, ACTH; most of these are SF-1 (+), indicating gonadotroph lineage

Question 10

Prolactinoma

Answer 10

Amenorrhea
Galactorrhea
Symptoms may be subtle, and presentation is often to the OB-Gyn doctor for premenopausal women
Cause unknown but not related to use of birth control pills
Impotence in men (often longstanding, tumors almost always macroadenomas, sometimes giant adenomas >4 cm.)
Only pituitary tumor where you treat with meds and not surgery
Can look aggressive

Question 11

Rathke cleft cyst

Answer 11

remnant of Rathke’s pouch, an embryologic structure

Generally an incidental finding, but sometimes can compress and cause diabetes insipidus

Question 12

Does size equal aggressiveness for pituitary adenomas?

Answer 12

NO!

Question 13

What can macro adenomas invade?

Answer 13

bone, sphenoid sinus, dura

Question 14

What’s the number one treatment for pituitary adenomas?

Answer 14

surgery

Question 15

Path findings in an adenoma

Answer 15

Disrupted reticulin pattern

Question 16

What stain is commonly used to see if there are secreting-cells in a pituitary adenoma?

Answer 16

Synaptophysin, but doesn’t tell you which kind of secreting cell

Question 17

Why does sub typing of adenomas matter?

Answer 17

It correlates with behavior

Question 18

Path findings of gonadotroph adenomas of the pituitary

Answer 18

Can look aggressive

Patchy staining for hormones is common

Question 19

Do you need radiation for gonadotroph adenomas of the pituitary?

Answer 19

No

Question 20

Histology of growth hormone tumors

Answer 20

Not patchy

More dense

Question 21

Acidophil stem cell adenoma

Answer 21

Wacky tumor
Pit-1 tumor
Weird giant mitochondria filled with vaculoles

Question 22

Crooke cells

Answer 22

Abnormal cells seen in histology in adjacent regions when too much cortisol

Question 23

Adamantinomatous craniopharyngiomas

Answer 23

Kids
Not hypersecretory
Can squish stuff like hypothalamus 
Problematic  
Beta catenin

Question 24

What the most common metastasis in the pituitary

Answer 24

Breast cancer