Concomitant pituitary adenoma and Rathke's cleft cyst
ABSTRACT We reviewed the clinical, radiological and surgical findings in patients with both pituitary adenoma and Rathke's cleft cyst.
We retrospectively selected patients with both lesions from the 374 patients in whom a sellar/juxtasellar lesion was detected
on MRI at 1.5 tesla. All patients received intravenous contrast medium. Concomitant pituitary adenoma and Rathke's cleft cyst
were found in eight patients (2.1 %). The frequency of the combination was 3.5 % of pituitary adenomas and 11 % of Rathke's
cleft cysts. Symptoms were always due to the adenoma, secreting adrenocorticotrophin in two patients and growth hormone in
six. The adenoma was larger in five patients, and the cyst in three. The cysts gave variable signal. The adenoma was adjacent
to the cyst in seven patients, and enclosed it in the other patient. As a result of experience with MRI, concomitant pituitary
adenoma and Rathke's cleft cyst are now known not to be as rare as thought previously. When a nonenhancing cyst-like structure
is demonstrated in a patient with pituitary adenoma, the possibility of a coexisting Rathke's cleft cyst should be considered.
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ABSTRACT: The concomitant presence of a pituitary adenoma with a second sellar lesion in patients operated upon for pituitary adenoma is an uncommon entity. Although rare, quite a great variety of lesions have been indentified coexisting with pituitary adenomas. In fact, most combinations have been described before, but an overview with information on the frequency of combined pathologies in a large series has not been published. We present a series of eight collision sellar lesions indentified among 548 transsphenoidally resected pituitary adenomas in two Neurosurgical Departments. The histological studies confirmed a case of sarcoidosis within a non-functioning pituitary adenoma, a case of intrasellar schwannoma coexisting with growth hormone (GH) secreting adenoma, two Rathke's cleft cysts combined with pituitary adenomas, three gangliocytomas associated with GH-secreting adenomas, and a case of a double pituitary adenoma. The pertinent literature is discussed with emphasis on pathogenetic theories of dual sellar lesions. Although there is no direct evidence to confirm the pathogenetic relationship of collision sellar lesions, the number of cases presented in literature makes the theory of an incidental occurrence rather doubtful. Suggested hypotheses about a common embryonic origin or a potential interaction between pituitary adenomas and the immune system are presented.Pituitary 07/2009; 13(1):8-17. · 1.83 Impact Factor
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ABSTRACT: Pituitary necrosis is mostly a result of pituitary haemorrhage or infarct. The frequency of pituitary necrosis in the Polish population has not yet been investigated. Hence, the aim of this study was to estimate the incidence of pituitary necrotic lesions in forensic autopsy material and to assess possible correlations of pituitary necrosis with sex, age, other pituitary pathologies, endocrine disorders and atherosclerosis. Serial sections of 100 human pituitary glands stained with hematoxylin-eosin were examined microscopically. Pituitary necrosis was found in 19 cases (19%), all of them in persons aged > 40 years. The majority of the lesions had relatively large size, occupying 10-50% of the gland. According to family interviews, none of the subjects manifested any clinical symptoms related to pituitary insufficiency, hence al the detected cases can be regarded as subclinical. There was no association of pituitary necrosis occurrence with sex, other pituitary pathologies found upon autopsy, endocrine diseases or cause of death. Only correlations with age and atherosclerosis were statistically significant. This study has shown that subclinical pituitary necrosis is a relatively frequent phenomenon in elderly persons, probably resulting from age-related deterioration in the vascular status.Polish journal of pathology: official journal of the Polish Society of Pathologists 01/2008; 59(2):97-100. · 0.35 Impact Factor