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Neurosurgery Oct 2007Ectopic pituitary adenomas are rare. We present an unusual case of an ectopic growth hormone-secreting pituitary adenoma in the suprasellar space. (Review)
Review
OBJECTIVE
Ectopic pituitary adenomas are rare. We present an unusual case of an ectopic growth hormone-secreting pituitary adenoma in the suprasellar space.
CLINICAL PRESENTATION
A 31-year-old man presented with a history of chronic headache and typical clinical signs of acromegaly. Magnetic resonance imaging scans revealed a suprasellar mass not arising from the normal looking pituitary gland.
INTERVENTION
The patient underwent gross total removal of the tumor through a pterional approach. At the time of follow-up, he met the criteria of endocrinological cure. Histological examination showed a growth hormone-secreting pituitary adenoma
CONCLUSION
Although uncommon, growth hormone-secreting pituitary adenomas are encountered in the suprasellar region. They should be added to the differential diagnosis of tumors in this location.
Topics: Adenoma; Adult; Choristoma; Growth Hormone-Secreting Pituitary Adenoma; Humans; Male; Radiography; Sella Turcica
PubMed: 17986925
DOI: 10.1227/01.NEU.0000298921.47495.42 -
Virchows Archiv : An International... Feb 1997Alveolar adenomas of the lung may be a rare cause of solitary coin lesions on chest radiographs. We report a case of this neoplasm, describe its morphological and... (Review)
Review
Alveolar adenomas of the lung may be a rare cause of solitary coin lesions on chest radiographs. We report a case of this neoplasm, describe its morphological and immunohistochemical characteristics and give further evidence that alveolar adenomas of the lung represent a benign proliferation of both the alveolar epithelium and the septal mesenchyme.
Topics: Adenoma; Anatomy, Cross-Sectional; Female; Humans; Immunohistochemistry; Lung Neoplasms; Middle Aged; Pulmonary Alveoli; Solitary Pulmonary Nodule; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 9083522
DOI: 10.1007/BF01008040 -
Clinical Journal of Gastroenterology Apr 2021Sessile serrated adenomas/polyps (SSA/Ps), recently called sessile serrated lesions, have a neoplastic pathway in the large intestine and are treated as lesions with...
Sessile serrated adenomas/polyps (SSA/Ps), recently called sessile serrated lesions, have a neoplastic pathway in the large intestine and are treated as lesions with malignant potential. There are a few reports of traditional serrated adenomas in the duodenum but no reports of duodenal SSA/Ps. A 66-year-old man underwent screening upper gastrointestinal endoscopy and was found to have a white elevated lesion in the second portion of the duodenum. Magnifying blue laser imaging showed various sized villous-like structures with dilated crypt openings in the white surface mucosa, similar to a SSA/P. Based on these images, a duodenal adenoma was suspected at the time of endoscopic resection. Pathological findings of the resected specimen showed a saw-tooth structure corresponding to basal crypt dilatation and branching with mucus and positive immunostaining for MUC6 and MUC2, similar to a colonic SSA/P. MUC5AC did not stain the glandular crypt cells. KRAS mutation was detected. Immunohistochemical expression of Annexin A10 was clearly identified in the lesion. Although not all of molecular biological features were satisfied, these findings were similar to a colonic SSA/P which has malignant potential. This is the first report of a duodenal SSA/P which should be considered when evaluating elevated duodenal lesions.
Topics: Adenoma; Aged; Colon; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Duodenum; Humans; Male
PubMed: 33646513
DOI: 10.1007/s12328-021-01358-x -
British Journal of Hospital MedicineAdenoma of the nipple can pose a diagnostic problem for both clinicians and pathologists. It can be confused clinically with Paget's disease of the nipple and... (Review)
Review
Adenoma of the nipple can pose a diagnostic problem for both clinicians and pathologists. It can be confused clinically with Paget's disease of the nipple and histologically with carcinoma. The majority of nipple adenomas are entirely benign although rare examples have shown malignant changes. Limited surgical excision is the appropriate treatment.
Topics: Adenoma; Adult; Biopsy; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Nipples
PubMed: 8124544
DOI: No ID Found -
Neurosurgical Focus Feb 2015Ectopic pituitary adenomas are exceedingly rare entities that are often misdiagnosed. The resulting delay in diagnosis may be particularly concerning in the case of... (Review)
Review
Ectopic pituitary adenomas are exceedingly rare entities that are often misdiagnosed. The resulting delay in diagnosis may be particularly concerning in the case of Cushing syndrome caused by an ectopic adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma. Although the total resection of ectopic adenomas results in rapid and durable remission, persistent Cushing syndrome is often associated with permanently damaging invasive procedures and significantly higher risk of mortality. The authors report the case of a 48-year-old man with ACTH-dependent Cushing syndrome. On the morning before surgery, his serum cortisol measured 51 μg/dl, his ACTH level was 195.7 pg/ml, and his urinary free cortisol level was 2109 μg/day. Serum cortisol was not suppressed with the administration of high-dose dexamethasone. Imaging showed separate masses in both the sphenoid sinus and the pituitary gland, complicating the diagnostic process and requiring pathological assessment of both masses. No other abnormalities were found on thoracic, abdominal, or pelvic scans. Gross-total resection of both lesions was accomplished via an endoscopic endonasal transsphenoidal approach. Pathology confirmed an ectopic ACTH pituitary adenoma of the sphenoid sinus and a Crooke hyaline change of the pituitary gland. The patient achieved stable hormonal remission without significant postoperative complications, returned to full activity within 3 months, and remained disease free nearly 1 year after tumor resection. In a systematic literature review, the authors identified 41 cases of ectopic ACTH-secreting pituitary adenomas, including 18 arising in the sphenoid sinus without direct involvement of the sella. Including the case described here, the total number of ectopic ACTH pituitary adenomas arising in the sphenoid sinus was 19, and the total number of ectopic ACTH pituitary adenomas without regard to location was 42. For the 19 patients with adenomas found in the sphenoid sinus, ages ranged from 16 to 76 years, and there were 15 women and 4 men. The mean and median diameters of the resected sphenoid masses were 13.9 and 8 mm, respectively, with a range of 3-55 mm. Seven were microadenomas (< 1 cm). Fifteen of the 19 cases reported serum ACTH and morning cortisol levels, the means of which were 106.7 pg/ml and 32.5 μg/dl, respectively. Gross-total tumor resection was achieved in all patients except one, and in all of them durable hormonal remission of Cushing syndrome was achieved (mean follow-up time 20 months). Ectopic pituitary adenomas are rare but important causes of Cushing syndrome and related endocrinopathies, particularly because of the rapid onset and severity of symptoms with atypical presentation. Ectopic pituitary adenomas, especially those in the nasal cavity, nasopharynx, or paranasal sinuses, are easily misidentified. Any patient presenting with signs and symptoms of Cushing syndrome without any obvious pituitary adenoma or other sources of hypercortisolemia should be thoroughly screened for an ectopic adenoma. However, as with the case presented here, the coincident existence of a sellar mass should not preclude the possibility of an ectopic source. There should be a high degree of clinical suspicion for any mass in the general area surrounding the sella when evaluating Cushing syndrome.
Topics: ACTH-Secreting Pituitary Adenoma; Adenoma; Adolescent; Adult; Aged; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Cavity; Sphenoid Sinus; Young Adult
PubMed: 25639312
DOI: 10.3171/2014.10.FOCUS14685 -
Endocrinology and Metabolism Clinics of... Mar 2015Pituitary adenomas are frequently silent. Among silent adenomas, some are clinically silent but can be detected on the basis of the excessive secretion of hormonal... (Review)
Review
Pituitary adenomas are frequently silent. Among silent adenomas, some are clinically silent but can be detected on the basis of the excessive secretion of hormonal products, whereas others are totally silent and cannot be detected by hormonal measurements. Treatment of a silent pituitary adenoma depends on its size and extent. Silent adenomas that are associated with neurologic compromise should be treated by surgery. Postoperative radiation therapy may be used to prevent or treat recurrences. Only occasional silent pituitary adenomas respond to treatment with dopamine agonists or somatostatin analogs.
Topics: Adenoma; Humans; Pituitary Neoplasms
PubMed: 25732644
DOI: 10.1016/j.ecl.2014.11.001 -
Abdominal Radiology (New York) Mar 2022To assess whether heterogeneous adrenal adenomas can be distinguished from heterogeneous non-adenomas with Computed Tomography (CT) and/or Magnetic Resonance Imaging...
PURPOSE
To assess whether heterogeneous adrenal adenomas can be distinguished from heterogeneous non-adenomas with Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI).
METHOD
From 2009 to 2019, 980 consecutive adrenalectomies were retrospectively identified. Patients without adequate CT/MRI, with homogeneous and/or < 1 cm lesions were excluded. Differences between adenomas and non-adenomas were analyzed using Chi-square, Student t or Fischer tests, and interobserver agreement using weighted kappa test or intraclass correlation coefficient. Independent variables associated with adenomas were searched for using multivariable analysis. Area under the receiver operating characteristic curve (AUC) of the final model and its diagnostic performances were calculated.
RESULTS
Final population comprised 183 patients (106 women, 77 men, mean age 53.2 ± 14.4 years) with 124 non-adenomas and 59 heterogeneous adenomas. Macroscopic or microscopic fat on CT/MRI allowed diagnosis of adenoma with 98% specificity and 63% sensitivity. Interobserver agreement was almost perfect for macroscopic fat (k = 0.82; 95% CI 0.66; 0.94) and substantial for microscopic fat (k = 0.75; 95% CI 0.62; 0.86). A multivariable model including micro- or macroscopic fat [Odds ratio (OR) 81.19; 95% CI 20.17; 572.27], diameter < 5.5 cm (OR 7.32; 95% CI 2.17; 31.28), calcifications (OR 5.68; 95% CI 2.08; 16.18), and hemorrhage (OR 3.10; 95% CI 0.70; 15.35) had an AUC of 0.91 (95% CI 0.86; 0.96), 71% (42/59, 95% CI 58; 82) sensitivity, 93% (115/124; 95% CI 87; 97) specificity, and 86% (157/183; 95% CI 79; 90) accuracy for the diagnosis of adenoma.
CONCLUSION
A multivariable model enables CT/MR diagnosis of heterogeneous adenomas. Presence of microscopic fat, even if partial, in a heterogeneous mass is highly specific of adenoma.
Topics: Adenoma; Adrenal Gland Neoplasms; Adult; Aged; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 35037990
DOI: 10.1007/s00261-022-03409-4 -
Der Nervenarzt Jun 2019Despite characteristic symptoms the diagnosis of clinically relevant pituitary adenomas is often delayed until an advanced stage due to the rarity of the disease. The... (Review)
Review
Despite characteristic symptoms the diagnosis of clinically relevant pituitary adenomas is often delayed until an advanced stage due to the rarity of the disease. The typical clinical manifestations are presented in this review article. The recent discovery of the USP8 mutation in Cushing's disease and of X‑linked acrogigantism (X-LAG) syndrome in early onset gigantism were milestones in the search for the molecular etiology of pituitary adenomas. The triad of endocrinological, radiological and ophthalmological diagnostics are the main pillars for the diagnostic work-up of pituitary adenomas. The standard treatment modalities, which include surgery, medical treatment and irradiation, have been further developed and refined. For transsphenoidal excision of pituitary adenomas, microsurgery and endoscopy are two equivalent surgical techniques with relatively few complications. Surgery represents the first-line treatment of pituitary adenomas. Prolactinomas are an exception as the medical treatment with dopamine agonists is highly efficient. Nowadays, new medical treatment options are available for acromegaly and Cushing's disease and are used for second-line treatment. The alkylating chemotherapeutic agent temozolomide is used for the first-line chemotherapy of rare aggressively growing pituitary adenomas. Irradiation is indicated if surgical and medical treatment options are insufficiently successful. Stereotactic one-stage irradiation (radiosurgery) is especially suitable for well-demarcated invasive residual or recurrent adenomas in the cavernous sinus. A new development is hypofractionated radiosurgery for protection of structures at risk. Fractionated irradiation is necessary with large radiation volumes and for pituitary adenomas with a close proximity to the optic tract.
Topics: Adenoma; Humans; Pituitary Neoplasms; Prolactinoma; Radiosurgery
PubMed: 30997549
DOI: 10.1007/s00115-019-0708-4 -
Histology and Histopathology Jan 2003The concept of metanephric adenoma has become established in recent years. Metanephric adenoma is a rare neoplasm. Macroscopically, the cut surface of the tumor displays... (Review)
Review
The concept of metanephric adenoma has become established in recent years. Metanephric adenoma is a rare neoplasm. Macroscopically, the cut surface of the tumor displays a tan to gray or yellow color, and tumors generally form well-circumscribed masses. Histologically, tumors are composed of small epithelial cells that form small acini. Glomeruloid bodies, which are composed of lobulated papillary projections, are occasionally seen. Although there have been few studies using chromosomal analysis, two recent studies have shown partial monosomy or LOH of 2p. On the other hand, the concept of metanephric tumors has recently become broadened. These tumors include metanephric adenomas, adenofibromas and stromal tumors, and they compose a continuous histological spectrum. Therefore, further studies on various aspects are needed to identify the gene responsible for the occurrence of metanephric tumors and, furthermore, to clarify the association among the three types of metanephric tumors.
Topics: Adenoma; Chromosome Aberrations; Humans; Kidney Neoplasms
PubMed: 12507304
DOI: 10.14670/HH-18.253 -
Cancer Medicine Jun 2013Measures shown to improve the adenoma detection during colonoscopy (excellent bowel preparation, cecal intubation, cap fitted colonoscope to examine behind folds,...
Measures shown to improve the adenoma detection during colonoscopy (excellent bowel preparation, cecal intubation, cap fitted colonoscope to examine behind folds, patient position change to optimize colon distention, trained endoscopy team focusing on detection of subtle flat lesions, and incorporation of optimum endoscopic examination with adequate withdrawal time) are applicable to clinical practice and, if incorporated are projected to facilitate comprehensive colonoscopy screening program for colon cancer prevention. To determine adenoma and serrated polyp detection rate under conditions designed to optimize quality parameters for comprehensive screening colonoscopy. Retrospective analysis of data obtained from a comprehensive colon cancer screening program designed to optimize quality parameters. Academic medical center. Three hundred and forty-three patients between the ages of 50 years and 75 years who underwent first screening colonoscopy between 2009 and 2011 among 535 consecutive patients undergoing colonoscopy. Comprehensive colonoscopy screening program was utilized to screen all patients. Cecal intubation was successful in 98.8% of patients. The Boston Bowel Preparation Scale for quality of colonoscopy was 8.97 (95% confidence interval [CI]; 8.94, 9.00). The rate of adenoma detection was 60% and serrated lesion (defined as serrated adenomas or hyperplastic polyps proximal to the splenic flexure) detection was 23%. The rate of precancerous lesion detection (adenomas and serrated lesions) was 66%. The mean number of adenomas per screening procedure was 1.4 (1.2, 1.6) and the mean number of precancerous lesions (adenomas or serrated lesions) per screening procedure was 1.6 (1.4, 1.8). Retrospective study and single endoscopist experience. A comprehensive colonoscopy screening program results in high-quality screening with high detection of adenomas, advanced adenomas, serrated adenomas, and multiple adenomas.
Topics: Adenoma; Aged; Colonoscopy; Early Detection of Cancer; Female; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 23930215
DOI: 10.1002/cam4.73