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Coexisting pituicytoma and pituitary adenoma: a second coincidence?
Coexisting pituicytoma and pituitary adenoma; a second coincidence? Maxime Richer MD, PhD, FRCPC, Julia Keith MD,FRCPC PII: DOI: Reference:
S0046-8177(16)30069-7 doi: 10.1016/j.humpath.2016.03.023 YHUPA 3898
To appear in:
Human Pathology
Received date: Accepted date:
8 March 2016 31 March 2016
Please cite this article as: Richer Maxime, Keith Julia, Coexisting pituicytoma and pituitary adenoma; a second coincidence?, Human Pathology (2016), doi: 10.1016/j.humpath.2016.03.023
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Coexisting pituicytoma and pituitary adenoma; a second coincidence?
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Dear Editor,
We read with interest your recent publication of a synchronous pituicytoma and
SC
pituitary adenoma [1] as we too have encountered these lesions in coexistence. A sellar
NU
mass was found incidentally on neuroimaging of a 65-year-old man, visual field testing revealed superior bitemporal quadrantanopia, and a 22 × 18 × 25 mm mass filling and
MA
expanding the sella was seen on magnetic resonance imaging. The patient underwent endonasal trans-sphenoidal resection, and the intra-operative impression was of one
ED
uniform lesion.
PT
On histology, approximately half of the resected specimen was an adenoma with lobules of cells with basophilic cytoplasm and round, mildly pleomorphic neuroendocrine
CE
nuclei (Fig. A). These cells were immunopositive for synaptophysin (Fig. B) and
AC
chromogranin. Scattered cells expressed LH and/or FSH (Fig. C and D). Prolactin, GH, TSH and TTF-1 were negative. The remainder of the specimen was a spindle cell tumour with a fascicular and focally storiform architecture, abundant eosinophilic but not granular cytoplasm and elongated nuclei with small nucleoli (Fig. E). The spindle cells were immunopositive for vimentin (Fig. F), TTF-1 (Fig. G), and S100 but were immunonegative for synaptophysin, GFAP, mIDH1 (R132H), SOX10, NF, EMA, PR, CD34, SMA, desmin, and CD68. The interface between the two histologies was not captured, but the pituicytoma was intimately associated with the neurohypophysis.
ACCEPTED MANUSCRIPT Pituicytomas are rare World Health Organization grade I sellar/suprasellar tumours with fascicles or storiforms of homogeneous spindled cells [2]. Their
T
histogenetic origin has been a subject of debate, but the neurohypophysial pituicyte is the
RI P
main candidate cell of origin on neuroanatomic, morphological and
immunohistochemical grounds [2]. The spectrum of pituicytomas has recently been
SC
expanded to include “granular cell” and “oncocyte” subtypes, previously thought to be
NU
distinct sellar tumours [3]. Your publication showing coexistence of pituicytoma and adenoma with distinct DNA methylation profiles and copy numbers [1] informs our
MA
collective understanding of the pathogenesis of pituicytoma and supports this being a chance “collision” occurrence; however, given the rarity of pituicytomas and this second
ED
example of a coexisting pituicytoma-adenoma, we predict there may be more to this
PT
story.
AC
CE
Maxime Richer MD, PhD, FRCPC Julia Keith MD, FRCPC
Department of Anatomical Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N3M5, Canada E-mail [email protected]
References [1] Neidert MC, Leske H, Burkhardt JK, et al. Synchronous pituitary adenoma and pituicytoma. HUM PATHOL 2016;47:138-43.
ACCEPTED MANUSCRIPT [2] Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, editors. WHO Classification of Tumours of the Central Nervous System. Lyon: IARC; 2007
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[3] Mete O, Lopez MB, Asa S. Spindle cell oncocytomas and granular cell tumours of the
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pituitary gland are variants of pituicytoma. Am J Surg Pathol 2013;37:1694-9.
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Figure legend
Fig. The gonadotroph pituitary adenoma consists of featureless sheets and large lobules
MA
of neuroendocrine cells on H&E (A) immunoreactive for synaptophysin (B), LH (C), and FSH (D). The pituicytoma consists of spindle cells with elongated nuclei and
AC
CE
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vimentin (F) and TTF-1 (G)
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homogeneous cytoplasm forming compact fascicles on H&E (E), immunoreactive for
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Fig. 1a
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Fig. 1b
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Fig. 1c
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Fig. 1d
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Fig. 1e
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Fig. 1f
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S0046-8177(16)30069-7 doi: 10.1016/j.humpath.2016.03.023 YHUPA 3898
To appear in:
Human Pathology
Received date: Accepted date:
8 March 2016 31 March 2016
Please cite this article as: Richer Maxime, Keith Julia, Coexisting pituicytoma and pituitary adenoma; a second coincidence?, Human Pathology (2016), doi: 10.1016/j.humpath.2016.03.023
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Coexisting pituicytoma and pituitary adenoma; a second coincidence?
RI P
T
Dear Editor,
We read with interest your recent publication of a synchronous pituicytoma and
SC
pituitary adenoma [1] as we too have encountered these lesions in coexistence. A sellar
NU
mass was found incidentally on neuroimaging of a 65-year-old man, visual field testing revealed superior bitemporal quadrantanopia, and a 22 × 18 × 25 mm mass filling and
MA
expanding the sella was seen on magnetic resonance imaging. The patient underwent endonasal trans-sphenoidal resection, and the intra-operative impression was of one
ED
uniform lesion.
PT
On histology, approximately half of the resected specimen was an adenoma with lobules of cells with basophilic cytoplasm and round, mildly pleomorphic neuroendocrine
CE
nuclei (Fig. A). These cells were immunopositive for synaptophysin (Fig. B) and
AC
chromogranin. Scattered cells expressed LH and/or FSH (Fig. C and D). Prolactin, GH, TSH and TTF-1 were negative. The remainder of the specimen was a spindle cell tumour with a fascicular and focally storiform architecture, abundant eosinophilic but not granular cytoplasm and elongated nuclei with small nucleoli (Fig. E). The spindle cells were immunopositive for vimentin (Fig. F), TTF-1 (Fig. G), and S100 but were immunonegative for synaptophysin, GFAP, mIDH1 (R132H), SOX10, NF, EMA, PR, CD34, SMA, desmin, and CD68. The interface between the two histologies was not captured, but the pituicytoma was intimately associated with the neurohypophysis.
ACCEPTED MANUSCRIPT Pituicytomas are rare World Health Organization grade I sellar/suprasellar tumours with fascicles or storiforms of homogeneous spindled cells [2]. Their
T
histogenetic origin has been a subject of debate, but the neurohypophysial pituicyte is the
RI P
main candidate cell of origin on neuroanatomic, morphological and
immunohistochemical grounds [2]. The spectrum of pituicytomas has recently been
SC
expanded to include “granular cell” and “oncocyte” subtypes, previously thought to be
NU
distinct sellar tumours [3]. Your publication showing coexistence of pituicytoma and adenoma with distinct DNA methylation profiles and copy numbers [1] informs our
MA
collective understanding of the pathogenesis of pituicytoma and supports this being a chance “collision” occurrence; however, given the rarity of pituicytomas and this second
ED
example of a coexisting pituicytoma-adenoma, we predict there may be more to this
PT
story.
AC
CE
Maxime Richer MD, PhD, FRCPC Julia Keith MD, FRCPC
Department of Anatomical Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N3M5, Canada E-mail [email protected]
References [1] Neidert MC, Leske H, Burkhardt JK, et al. Synchronous pituitary adenoma and pituicytoma. HUM PATHOL 2016;47:138-43.
ACCEPTED MANUSCRIPT [2] Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, editors. WHO Classification of Tumours of the Central Nervous System. Lyon: IARC; 2007
T
[3] Mete O, Lopez MB, Asa S. Spindle cell oncocytomas and granular cell tumours of the
SC
RI P
pituitary gland are variants of pituicytoma. Am J Surg Pathol 2013;37:1694-9.
NU
Figure legend
Fig. The gonadotroph pituitary adenoma consists of featureless sheets and large lobules
MA
of neuroendocrine cells on H&E (A) immunoreactive for synaptophysin (B), LH (C), and FSH (D). The pituicytoma consists of spindle cells with elongated nuclei and
AC
CE
PT
vimentin (F) and TTF-1 (G)
ED
homogeneous cytoplasm forming compact fascicles on H&E (E), immunoreactive for
AC
Fig. 1a
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Fig. 1b
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Fig. 1c
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Fig. 1d
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Fig. 1e
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Fig. 1f
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Fig. 1g
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