Abstract
Histologically, cholesterol clefts are often observed in craniopharyngioma, Rathke’s cleft cyst, and various granulomas. However, pituitary adenomas with cholesterol clefts are rare. A 46-year-old woman developed visual field disturbance. She had no history of severe headache that would suggest pituitary apoplexy. She presented with homonymous bitemporal hemianopsia and galactorrhea. Blood prolactin level was 63.1 ng/mL. Other hypophysial hormone levels were within normal range. Magnetic resonance imaging revealed a pituitary tumor with intratumoral cyst. The cyst showed high intensity on T1- and T2-weighted images. The tumor was demonstrated with iso intensity on T1-weighted image and with high intensity on T2-weighted image.
She underwent trans-sphenoidal surgery. The tumor was soft, with yellowish, oily fluid, probably the cyst content. By light microscopy with hematoxylin and eosin staining, a typical chromophobic adenoma of the pituitary was identified. Immunostaining revealed immunoreactivity for ACTH in several cells. Many cholesterol clefts and several hemosiderin pigment containing macrophages were observed. Electron microscopy demonstrated a pituitary adenoma with sparse and small secretory granules and numerous lysosomes. The cyst was most likely caused by focal hemorrhagic infarction, followed by the formation of cholesterol crystals, the appearance of hemosiderin containing macrophages, foreign body product cells, and accumulation of lysosomes.
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References
Ostrov SG, Quencer RM, Hoffman JC, Davis PC, Hasso AN, David NJ. Hernorrhage within pituitary adenomas: how often associated with pituitaery apoplexy syndrome? AJR 153:153–160, 1989.
Findling JW, Tyrrell JB, Aron DC, Fitzgerald PA, Wilson CB, Forsham PH. Silent pituitary apoplexy: subclinical infarction of an adreno-corticotropin-producing pituitary adenoma. J Clin Endocrinol Metab 52:95–97, 1981.
Mohanty S, Tandon PN, Banerju AK, Prakash B. Hemorrhage into pituitary adenomas. J Neurol Neurosurg Psychiatry 40:987–991, 1977.
Nager GT, Vanderveen TS. Cholesterol granuloma involving the temporal bone. Ann Otol 85:204–209, 1976.
Brodkey JA, Robertson JH, Shea JJ, Gardener G. Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management. J Neurosurg 85:625–633, 1996.
Yokoyama S, Goto M, Asakura T, Hirahara K, Tsuyama S, Murata F. Histopathological study on the effect of octreotide. Brain Tumor Pathol 12:7–13, 1995.
Kovacs K, Horvath E, Bayley TA, Hassaram ST, Ezrin C. Silent corticotroph cell adenoma with lysosomal accumulation and crinophagy. Am J Med 64:492–499, 1978.
Glick RP, Tiesi JA. Subacute pituitary apoplexy: clinical and magnetic resonance imaging characteristics. Neurosurgery 27: 214–219, 1990.
Uhuillier F, Combes C, Martin N, Leclerc X, Pruvo JP, Gaston A. MRI in the diagnosis of so-called pituitary apoplexy: seven cases. J Neuroradiol 16:221–237, 1989.
Pusey E, Kottman KE, Flanningan RD, Tsuruda J, Bradley WG. MR of craniopharyngiomas: tumor delineation and characterization. AJNR 8:439–444, 1987.
Oka H, Kawano N, Suwa T, Yada K, Kan S, Kameya T. Radiological study of symptomatic Rathke's cleft cysts. Neurosurgery 35:632–637, 1994.
Greenberg JJ, Oot RF, Wismer GL, Davis KR, Goodman ML, Weber AK, Montgomery WW. Cholesterol granuloma of the petrous apex: MR and CT evaluation. AJNR 9:1205–1214, 1988.
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Yokoyama, S., Goto, M., Hirano, H. et al. Pituitary adenoma with cholesterol clefts. Endocr Pathol 9, 91–95 (1998). https://doi.org/10.1007/BF02739956
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DOI: https://doi.org/10.1007/BF02739956