Pituitary Pathology Flashcards
What are the most common sellar region masses?
Pituitary adenomas make up 85%!
Equivalent to WHO Grade I
Hyperfunctioning vs mass effect pituitary adenomas
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
What is the typical age of presentation for a stellar region mass?
All except craniopharyngioma predominantly affect middle age adults
Craniopharyngioma has two age peaks, pediatric (5-15 yrs) and middle age (45-60 yrs) adults
Are most pituitary tumors familial or sporadic?
more than 95% are sporadic
More suspicious for familial if in a pt under 18
Are most ACTH adenomas micro or macro adenomas?
85% are micro (less than 1 cm)
Are most prolactinomas in premenopausal women micro or macro adenomas?
Micro!
What are the symptoms of mass effect?
Headaches
Visual Field Deficits
Cranial Nerve Palsies
Ptosis (eyelid droop)
Diplopia (double vision)
Pituitary Hormone Deficits
(Panhypopituitarism)
Rarely
Seizures
Stroke
CSF LeakWhat is the most common type of clinically non functioning adenoma and the most common type to come to surgery?
Gonadotroph adenoma
Hormone negative adenoma
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
Prolactinoma
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
Rathke cleft cyst
remnant of Rathke’s pouch, an embryologic structure
Generally an incidental finding, but sometimes can compress and cause diabetes insipidus
Does size equal aggressiveness for pituitary adenomas?
NO!
What can macro adenomas invade?
bone, sphenoid sinus, dura
What’s the number one treatment for pituitary adenomas?
surgery
Path findings in an adenoma
Disrupted reticulin pattern
What stain is commonly used to see if there are secreting-cells in a pituitary adenoma?
Synaptophysin, but doesn’t tell you which kind of secreting cell
Why does sub typing of adenomas matter?
It correlates with behavior
Path findings of gonadotroph adenomas of the pituitary
Can look aggressive
Patchy staining for hormones is common
Do you need radiation for gonadotroph adenomas of the pituitary?
No
Histology of growth hormone tumors
Not patchy
More dense
Acidophil stem cell adenoma
Wacky tumor
Pit-1 tumor
Weird giant mitochondria filled with vaculoles
Crooke cells
Abnormal cells seen in histology in adjacent regions when too much cortisol
Adamantinomatous craniopharyngiomas
Kids Not hypersecretory Can squish stuff like hypothalamus Problematic Beta catenin
What the most common metastasis in the pituitary
Breast cancer
