Xanthomatous hypophysitis
Inflammatory lesions of the hypophysis include lymphocytic hypophysitis, pituitary abscess, and granulomatous inflammation, with or without specific infections (i.e., sarcoidosis, mycobacteria). These lesions are known to mimic pituitary neoplasms. We report the clinical and pathologic findings in t...
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| Veröffentlicht in: | The American journal of surgical pathology 1998-06, Vol.22 (6), p.736-741 |
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| creator | FOLKERTH, R. D PRICE, D. L SCHWARTZ, M BLACK, P. M DE GIROLAMI, U |
| description | Inflammatory lesions of the hypophysis include lymphocytic hypophysitis, pituitary abscess, and granulomatous inflammation, with or without specific infections (i.e., sarcoidosis, mycobacteria). These lesions are known to mimic pituitary neoplasms. We report the clinical and pathologic findings in three patients who underwent transsphenoidal resection for presumed pituitary adenoma. Two were women aged 30 years (one with a 5-month history of headache, the other with a 1-year history of menstrual irregularity) and one was a 12-year-old girl with headache, nausea, and diabetes insipidus. Preoperative endocrinologic studies showed increased prolactin in one patient and normal serum thyroid stimulating hormone and prolactin levels in another. By magnetic resonance imaging (MRI), the first case had a 1.2-cm mass with increased signal on T1 and isointensity on T2, ring enhancement after gadolinium, and lateral deviation of the pituitary stalk. The second patient had a 1.1-cm "cystic" mass seen during magnetic resonance imaging with adjacent bony changes seen during computed tomography. In the third, computed tomography showed a hypodense pituitary mass that enlarged during 1-month observation. At surgery, abnormal soft tissue surrounded liquefied material in the anterior pituitary in all cases. Histologic studies showed fragments of intact normal anterior pituitary with preserved vascular and reticulin network and regions of anterior pituitary infiltrated by foamy histiocytes. Other fragments resembled granulation tissue, and some consisted of acellular debris. Histiocytes were immunoreactive for the macrophage marker CD68 and negative for S-100 and CD1a. Ultrastructurally, the normal adenohypophysis was permeated by lipid-laden macrophages. There were no well-formed granulomas or giant cells, hemosiderin, acid-fast bacilli, or fungi. Serial sections and keratin immunostains failed to identify an epithelial cyst lining or keratin among the debris. We propose the term "xanthomatous hypophysitis" for this lesion. |
| doi_str_mv | 10.1097/00000478-199806000-00011 |
| format | Article |
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D ; PRICE, D. L ; SCHWARTZ, M ; BLACK, P. M ; DE GIROLAMI, U</creator><creatorcontrib>FOLKERTH, R. D ; PRICE, D. L ; SCHWARTZ, M ; BLACK, P. M ; DE GIROLAMI, U</creatorcontrib><description>Inflammatory lesions of the hypophysis include lymphocytic hypophysitis, pituitary abscess, and granulomatous inflammation, with or without specific infections (i.e., sarcoidosis, mycobacteria). These lesions are known to mimic pituitary neoplasms. We report the clinical and pathologic findings in three patients who underwent transsphenoidal resection for presumed pituitary adenoma. Two were women aged 30 years (one with a 5-month history of headache, the other with a 1-year history of menstrual irregularity) and one was a 12-year-old girl with headache, nausea, and diabetes insipidus. Preoperative endocrinologic studies showed increased prolactin in one patient and normal serum thyroid stimulating hormone and prolactin levels in another. By magnetic resonance imaging (MRI), the first case had a 1.2-cm mass with increased signal on T1 and isointensity on T2, ring enhancement after gadolinium, and lateral deviation of the pituitary stalk. The second patient had a 1.1-cm "cystic" mass seen during magnetic resonance imaging with adjacent bony changes seen during computed tomography. In the third, computed tomography showed a hypodense pituitary mass that enlarged during 1-month observation. At surgery, abnormal soft tissue surrounded liquefied material in the anterior pituitary in all cases. Histologic studies showed fragments of intact normal anterior pituitary with preserved vascular and reticulin network and regions of anterior pituitary infiltrated by foamy histiocytes. Other fragments resembled granulation tissue, and some consisted of acellular debris. Histiocytes were immunoreactive for the macrophage marker CD68 and negative for S-100 and CD1a. Ultrastructurally, the normal adenohypophysis was permeated by lipid-laden macrophages. There were no well-formed granulomas or giant cells, hemosiderin, acid-fast bacilli, or fungi. Serial sections and keratin immunostains failed to identify an epithelial cyst lining or keratin among the debris. We propose the term "xanthomatous hypophysitis" for this lesion.</description><identifier>ISSN: 0147-5185</identifier><identifier>EISSN: 1532-0979</identifier><identifier>DOI: 10.1097/00000478-199806000-00011</identifier><identifier>PMID: 9630181</identifier><identifier>CODEN: AJSPDX</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Antigens, CD - metabolism ; Antigens, Differentiation, Myelomonocytic - metabolism ; Biological and medical sciences ; Child ; Diagnosis, Differential ; Endocrine System Diseases - diagnosis ; Endocrine System Diseases - metabolism ; Endocrine System Diseases - pathology ; Endocrinopathies ; Female ; Humans ; Hypothalamus. Hypophysis. Epiphysis (diseases) ; Immunohistochemistry ; Magnetic Resonance Imaging ; Medical sciences ; Microscopy, Electron ; Non tumoral diseases. Target tissue resistance. 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D</creatorcontrib><creatorcontrib>PRICE, D. L</creatorcontrib><creatorcontrib>SCHWARTZ, M</creatorcontrib><creatorcontrib>BLACK, P. M</creatorcontrib><creatorcontrib>DE GIROLAMI, U</creatorcontrib><title>Xanthomatous hypophysitis</title><title>The American journal of surgical pathology</title><addtitle>Am J Surg Pathol</addtitle><description>Inflammatory lesions of the hypophysis include lymphocytic hypophysitis, pituitary abscess, and granulomatous inflammation, with or without specific infections (i.e., sarcoidosis, mycobacteria). These lesions are known to mimic pituitary neoplasms. We report the clinical and pathologic findings in three patients who underwent transsphenoidal resection for presumed pituitary adenoma. Two were women aged 30 years (one with a 5-month history of headache, the other with a 1-year history of menstrual irregularity) and one was a 12-year-old girl with headache, nausea, and diabetes insipidus. Preoperative endocrinologic studies showed increased prolactin in one patient and normal serum thyroid stimulating hormone and prolactin levels in another. By magnetic resonance imaging (MRI), the first case had a 1.2-cm mass with increased signal on T1 and isointensity on T2, ring enhancement after gadolinium, and lateral deviation of the pituitary stalk. The second patient had a 1.1-cm "cystic" mass seen during magnetic resonance imaging with adjacent bony changes seen during computed tomography. In the third, computed tomography showed a hypodense pituitary mass that enlarged during 1-month observation. At surgery, abnormal soft tissue surrounded liquefied material in the anterior pituitary in all cases. Histologic studies showed fragments of intact normal anterior pituitary with preserved vascular and reticulin network and regions of anterior pituitary infiltrated by foamy histiocytes. Other fragments resembled granulation tissue, and some consisted of acellular debris. Histiocytes were immunoreactive for the macrophage marker CD68 and negative for S-100 and CD1a. Ultrastructurally, the normal adenohypophysis was permeated by lipid-laden macrophages. There were no well-formed granulomas or giant cells, hemosiderin, acid-fast bacilli, or fungi. Serial sections and keratin immunostains failed to identify an epithelial cyst lining or keratin among the debris. We propose the term "xanthomatous hypophysitis" for this lesion.</description><subject>Adult</subject><subject>Antigens, CD - metabolism</subject><subject>Antigens, Differentiation, Myelomonocytic - metabolism</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Diagnosis, Differential</subject><subject>Endocrine System Diseases - diagnosis</subject><subject>Endocrine System Diseases - metabolism</subject><subject>Endocrine System Diseases - pathology</subject><subject>Endocrinopathies</subject><subject>Female</subject><subject>Humans</subject><subject>Hypothalamus. Hypophysis. Epiphysis (diseases)</subject><subject>Immunohistochemistry</subject><subject>Magnetic Resonance Imaging</subject><subject>Medical sciences</subject><subject>Microscopy, Electron</subject><subject>Non tumoral diseases. Target tissue resistance. Benign neoplasms</subject><subject>Pituitary Diseases - diagnosis</subject><subject>Pituitary Diseases - metabolism</subject><subject>Pituitary Diseases - pathology</subject><subject>Pituitary Neoplasms - diagnosis</subject><subject>Pituitary Neoplasms - metabolism</subject><subject>Pituitary Neoplasms - pathology</subject><subject>Pituitary Neoplasms - ultrastructure</subject><issn>0147-5185</issn><issn>1532-0979</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kE1LxDAQQIMo67r6AzwIexBv0ZkkbTJHWfyCBS8K3kLapmyl3dame9h_b9atHRiGMG8yyWNsiXCPQPoBDqG04UhkII0HHhPxhM0xkYJHhk7ZHFBpnqBJztlFCN-REAbFjM0olYAG5-z6y22HTdu4od2F5Wbftd1mH6qhCpfsrHR18FdjXbDP56eP1Stfv7-8rR7XPJeSBo6-zAxIlFqRElRqR4XUiTBFXKYy0KRMDgIVFJJKBQqlMQlmkOaQZkRywe6O93Z9-7PzYbBNFXJf127r45usJlLxbzqC5gjmfRtC70vb9VXj-r1FsAcr9t-KnazYPytx9GbcscsaX0yDo4bYvx37LuSuLnu3zaswYUKkIGP8AiJ9Zk4</recordid><startdate>19980601</startdate><enddate>19980601</enddate><creator>FOLKERTH, R. D</creator><creator>PRICE, D. L</creator><creator>SCHWARTZ, M</creator><creator>BLACK, P. M</creator><creator>DE GIROLAMI, U</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19980601</creationdate><title>Xanthomatous hypophysitis</title><author>FOLKERTH, R. D ; PRICE, D. L ; SCHWARTZ, M ; BLACK, P. M ; DE GIROLAMI, U</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c339t-1efb80313749429f7a9d37528d0124b07948c02140d39f404138851b06c06b993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Adult</topic><topic>Antigens, CD - metabolism</topic><topic>Antigens, Differentiation, Myelomonocytic - metabolism</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Diagnosis, Differential</topic><topic>Endocrine System Diseases - diagnosis</topic><topic>Endocrine System Diseases - metabolism</topic><topic>Endocrine System Diseases - pathology</topic><topic>Endocrinopathies</topic><topic>Female</topic><topic>Humans</topic><topic>Hypothalamus. Hypophysis. Epiphysis (diseases)</topic><topic>Immunohistochemistry</topic><topic>Magnetic Resonance Imaging</topic><topic>Medical sciences</topic><topic>Microscopy, Electron</topic><topic>Non tumoral diseases. Target tissue resistance. Benign neoplasms</topic><topic>Pituitary Diseases - diagnosis</topic><topic>Pituitary Diseases - metabolism</topic><topic>Pituitary Diseases - pathology</topic><topic>Pituitary Neoplasms - diagnosis</topic><topic>Pituitary Neoplasms - metabolism</topic><topic>Pituitary Neoplasms - pathology</topic><topic>Pituitary Neoplasms - ultrastructure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>FOLKERTH, R. D</creatorcontrib><creatorcontrib>PRICE, D. L</creatorcontrib><creatorcontrib>SCHWARTZ, M</creatorcontrib><creatorcontrib>BLACK, P. M</creatorcontrib><creatorcontrib>DE GIROLAMI, U</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgical pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>FOLKERTH, R. D</au><au>PRICE, D. L</au><au>SCHWARTZ, M</au><au>BLACK, P. M</au><au>DE GIROLAMI, U</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Xanthomatous hypophysitis</atitle><jtitle>The American journal of surgical pathology</jtitle><addtitle>Am J Surg Pathol</addtitle><date>1998-06-01</date><risdate>1998</risdate><volume>22</volume><issue>6</issue><spage>736</spage><epage>741</epage><pages>736-741</pages><issn>0147-5185</issn><eissn>1532-0979</eissn><coden>AJSPDX</coden><abstract>Inflammatory lesions of the hypophysis include lymphocytic hypophysitis, pituitary abscess, and granulomatous inflammation, with or without specific infections (i.e., sarcoidosis, mycobacteria). These lesions are known to mimic pituitary neoplasms. We report the clinical and pathologic findings in three patients who underwent transsphenoidal resection for presumed pituitary adenoma. Two were women aged 30 years (one with a 5-month history of headache, the other with a 1-year history of menstrual irregularity) and one was a 12-year-old girl with headache, nausea, and diabetes insipidus. Preoperative endocrinologic studies showed increased prolactin in one patient and normal serum thyroid stimulating hormone and prolactin levels in another. By magnetic resonance imaging (MRI), the first case had a 1.2-cm mass with increased signal on T1 and isointensity on T2, ring enhancement after gadolinium, and lateral deviation of the pituitary stalk. The second patient had a 1.1-cm "cystic" mass seen during magnetic resonance imaging with adjacent bony changes seen during computed tomography. In the third, computed tomography showed a hypodense pituitary mass that enlarged during 1-month observation. At surgery, abnormal soft tissue surrounded liquefied material in the anterior pituitary in all cases. Histologic studies showed fragments of intact normal anterior pituitary with preserved vascular and reticulin network and regions of anterior pituitary infiltrated by foamy histiocytes. Other fragments resembled granulation tissue, and some consisted of acellular debris. Histiocytes were immunoreactive for the macrophage marker CD68 and negative for S-100 and CD1a. Ultrastructurally, the normal adenohypophysis was permeated by lipid-laden macrophages. There were no well-formed granulomas or giant cells, hemosiderin, acid-fast bacilli, or fungi. Serial sections and keratin immunostains failed to identify an epithelial cyst lining or keratin among the debris. We propose the term "xanthomatous hypophysitis" for this lesion.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>9630181</pmid><doi>10.1097/00000478-199806000-00011</doi><tpages>6</tpages></addata></record> |
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| ispartof | The American journal of surgical pathology, 1998-06, Vol.22 (6), p.736-741 |
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| language | eng |
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| subjects | Adult Antigens, CD - metabolism Antigens, Differentiation, Myelomonocytic - metabolism Biological and medical sciences Child Diagnosis, Differential Endocrine System Diseases - diagnosis Endocrine System Diseases - metabolism Endocrine System Diseases - pathology Endocrinopathies Female Humans Hypothalamus. Hypophysis. Epiphysis (diseases) Immunohistochemistry Magnetic Resonance Imaging Medical sciences Microscopy, Electron Non tumoral diseases. Target tissue resistance. Benign neoplasms Pituitary Diseases - diagnosis Pituitary Diseases - metabolism Pituitary Diseases - pathology Pituitary Neoplasms - diagnosis Pituitary Neoplasms - metabolism Pituitary Neoplasms - pathology Pituitary Neoplasms - ultrastructure |
| title | Xanthomatous hypophysitis |
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