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Mixed pituitary adenoma/craniopharyngioma: clinical, morphological, immunohistochemical and ultrastructural study of a case, review of the literature, and pathogenetic and nosological considerations

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Abstract

Mixed pituitary adenoma/craniopharyngiomas are very rare tumors. Their pathogenesis is still unclear and it is not known whether they are collision tumors derived from independent stem cells or whether they originate from a single stem cell undergoing divergent differentiation. The latter hypothesis is supported by the close commixture between the two tumor components with transition areas that has been previously described. However, “hybrid” cells with both pituitary adenoma and craniopharyngioma features have never been described. In this paper we report a case of mixed pituitary adenoma/craniopharyngioma observed in a 75-year-old woman presenting with diplopia and slight increase of serum prolactin, who underwent endoscopic endonasal trans-sphenoidal tumor resection. Histologically, the tumor was composed of a typical pituitary silent subtype 2 ACTH cell adenoma admixed with islands of adamantinomatous craniopharyngioma. Electron microscopy showed that, in addition to distinct silent subtype 2 ACTH and craniopharyngioma cells, there were “hybrid” cells, showing characteristics of both pituitary adenoma and craniopharyngioma, consisting of small dense secretory granules, bundles of cytoplasmic filaments, and desmosomes. This ultrastructural finding was also confirmed by the presence of cells showing nuclear p40 expression and chromogranin A immunoreactivity. The close commixture between the two components and the ultrastructural and immunohistochemical findings demonstrate a common histogenesis of the two components and support the classification of the neoplasm as a mixed tumor. The patient completely recovered and, 10 months after surgery, head MR confirmed the complete resection of the lesion.

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Conflict of interest

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Authors and Affiliations

  1. Department of Pathology, Ospedale di Circolo, Viale Borri 57, 21100, Varese, Italy

    Giovanna Finzi, Michele Cerati & Stefano La Rosa

  2. Department of Surgical and Morphologic Sciences, University of Insubria, Viale Borri 57, 21100, Varese, Italy

    Alessandro Marando & Carlo Capella

  3. Neurosurgical Clinic, University of Insubria, Viale Borri 57, 21100, Varese, Italy

    Cesare Zoia & Giustino Tomei

  4. Department of Otorhinolaryngology, University of Insubria, Viale Borri 57, 21100, Varese, Italy

    Fabio Ferreli & Paolo Castelnuovo

Authors
  1. Giovanna Finzi
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  2. Michele Cerati
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  3. Alessandro Marando
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  4. Cesare Zoia
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  5. Fabio Ferreli
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  6. Giustino Tomei
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  7. Paolo Castelnuovo
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  8. Stefano La Rosa
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  9. Carlo Capella
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Correspondence to Stefano La Rosa.

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Finzi, G., Cerati, M., Marando, A. et al. Mixed pituitary adenoma/craniopharyngioma: clinical, morphological, immunohistochemical and ultrastructural study of a case, review of the literature, and pathogenetic and nosological considerations. Pituitary 17, 53–59 (2014). https://doi.org/10.1007/s11102-013-0465-5

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  • DOI: https://doi.org/10.1007/s11102-013-0465-5

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