Pituitary pathology

Question 1

1. Contrast the normal histology and the pathology of a pituitary adenoma.

Answer 1

lack of reticulin

Question 2

2. List the different types of anterior pituitary tumors and their prevalence.

Answer 2

pituitary adenoma most common
craniopharyngiomas next
Hypophysitis next
pituicytomas next
spindle cell oncocytomas next

Question 3

4. Describe clinical findings related to the disruption of structures surrounding the sella turcica by a large pituitary tumor.

Answer 3

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

Question 4

pituitary adenomas

Answer 4

85%+ of sellar region masses are pituitary adenomas,
not formally graded, are equivalent to WHO grade I; almost all the other non-pituitary adenoma sellar region masses are also WHO grade I and treated by surgical resection except in instances where medical therapies are available

Question 5

Hyperfucntioning vs. nonfunctioning

Answer 5

Some pituitary adenomas are hyperfunctioning and 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 6

Most uncommon

Answer 6

Most uncommon (Rathke cleft cyst), or rare, sellar region masses (pituicytoma, spindle cell oncocytoma, hypophysitis) closely mimic pituitary adenomas on neuroimaging and clinically mimic clinically non functioning pituitary adenomas in that they present with mass effects or visual disturbance

Question 7

pituitary tumors affect what age groups?

Answer 7

All except craniopharyngioma predominantly affect middle age adults

Question 8

whats most common pituitary tumor?

Answer 8

prolactinoma (benign)

Question 9

good stains to look for pit tumors?

Answer 9

Synaptophysin

Reticulin

Question 10

what size are most ACTH adenomas?

what size are most prolactinomas?

Answer 10

85% of usual ACTH adenomas are microadenomas,
most prolactinomas in premenopausal women are microadenomas
in men macroadenomas

Question 11

Craniopharyngioma demographics

molecular pathway

Answer 11

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

Beta Catenin
papillary BRAF

Question 12

Pituicytoma

Answer 12

TTF1

Question 13

Spindle cell oncocytoma

Answer 13

1