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Washington University Experience | NEOPLASM (SELLAR) | Pituitary Adenoma - Pituitary Neuroendocrine Neoplasm | MRI | 7A0 Case 7 History
Case 7 History ---- The patient is a 41 year old woman who presented in 2009 with headaches and decreased vision in the right visual field. She was found to have a 2.8 cm sellar/suprasellar lesion consistent with a pituitary adenoma and had markedly elevated prolactin. She was treated medically for 1 year but did not continue (due to insurance issues). She developed a CSF leak that was repaired. A biopsy was taken in 8/2010 shown here. Since that time the lesion has undergone considerable growth. ---- Sections show a cellular neoplasm composed of a largely monotonous population of cells in a large lobulated to sheet-like arrangement. In some areas these cells are apposed to fragments of ciliated epithelium and underlying basement membrane. Hemosiderin pigment is focally present. The tumor cell nuclei have finely stippled chromatin and inconspicuous nucleoli. Mitoses are not identified in the sections examined. A stain for reticulin shows disruption of the normal acinar architecture of the pituitary gland. ---- Immunohistochemistry provided from the outside institution for synaptophysin and cytokeratins (AE1/AE3 & CK18) shows widespread staining and prolactin is present in a high percentage of tumor cells. Growth hormone (GH), follicle stimulating hormone (FSH), and adrenocorticotrophic hormone (ACTH) are negative. Immunohistochemistry was performed on material obtained from the outside institution for p53 which was negative as well as Ki67 which showed a proliferation index of 0.8% (7/887 total cell counted). ---- Comment: The morphological and immunohistochemical features are consistent with a pituitary adenoma secreting prolactin (prolactinoma).