Abstract
Corticotroph adenomas rarely show Crooke’s hyaline change in neoplastic cells, a feature similar to that of normal corticotroph cells exposed to excess cortisol. Crooke’s cell adenomas are usually associated with Cushing’s disease. Nonfunctioning examples are uncommon. We report two clinically silent corticotroph adenomas featuring extensive Crooke’s hyalinization in neoplastic cells. The two patients were 49 and 59 yr of age and neither had Cushing’s disease. Serum and urinary cortisol were normal. One patient had elevated serum adrenocorticotropic hormone. In our experience, the two patients accounted for 0.4% of pituitary adenomas operated on from January 1992 to December 2001 and 3.5% of all corticotroph adenomas. The two lesions had features of the subtype 1 silent corticotroph adenoma. Cytogenetic analysis performed on one lesion showed a normal karyotype (46;XY). Hyalinization in clinically silent Crooke’s cell adenoma indicates that hyaline changes do not always relate to excess cortisol. It is known that neoplastic Crooke’s cells show immunoreactivity for glucocorticoid receptors stronger than nontumorous Crooke’s corticotrophs. This fact suggests that receptor overexpression or lack of receptor downregulation may result in hypersensitivity of neoplastic Crooke’s cells to physiologic cortisol plasma levels.
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References
Robert F, Pelletier G, Hardy J. Pituitary adenomas in Cushing’s disease: A histological, immunocytological and ultrastructural study. Arch Pathol Lab Med 102:448–455, 1978.
Felix IA, Horvath E, Kovacs K. Massive Crooke’s hyalinization in corticotroph cell adenomas of the human pituitary. Acta Neurochirur 58:235–243, 1981.
Horvath E, Kovacs K, Josse R. Pituitary corticotroph cell adenoma with marked abundance of microfilaments. Ultrastruct Pathol 5:249–255, 1983.
Kamijo K, Sato M, Saito T, Yachi A, Minase T, Noro H, Kawahara T. An ACTH and FSH producing invasive pituitary adenoma with Crooke’s hyalinization. Pathol Res Pract 187:637–641, 1991.
Neumann PE, Horoupian DS, Goldman JE, Hess MA. Cytoplasmic filaments of Crooke’s hyaline change belong to the cytokeratin class. Am J Pathol 116:214–222, 1984.
Uei Y, Kanzaki M, Yabana T. Further immunohistochemical study of Crooke’s hyaline. Pathol Res Pract 187:539, 540, 1991.
Kovacs K, Horvath E, Stefanescu L, BilbaO JM, Singer W, Muller P, Scheithauer BW. Two cases of pituitary Crooke’s cell adenoma without Cushing’s disease: a histologic, immunohistochemical, electron microscopic and in situ hybridization study. Endocr Pathol 10:65–72, 1999.
George DH, Scheithauer BW, Kovacs K, Horvath E, Young WF, Lloyd RV, Meyer FB, Smyne H. Crooke’s cell adenoma of the pituitary: an aggressive variant of corticotroph adenoma. In: Proceedings of the United States and Canadian Academy of Pathology, 2001;76.
Horvath E, Kovacs K, Killinger DW, Smyth HS, Platts ME, Singer W. Silent corticotropic adenomas of the human pituitary gland. Am J Pathol 98:617–638, 1980.
Scheithauer BW, Jaap AJ, Horvath E, Kovacs K, Lloyd RV, Meyer FB, Laws ER, Young WF. Clinically silent corticotroph tumors of the pituitary. Neurosurgery 47:723–730, 2000.
Reinke M, Allolio B, Saeger D, Kaulen D, Winkelmann W. A pituitary adenoma secreting high molecular weight adenocorticotropin without evidence of Cushing’s disease. J Clin Endocrinol Metab 65:1296–1300, 1987.
Ueyama T, Tamaki N, Kondoh T, Kurata H. Large and invasive silent corticotroph-cell adenoma with elevated ACTH: a case report. Surg Neurol 50:30–32, 1998.
Kontogeorgos G, Kapranos N, Orphanidis G, Rologis D, Kokka E. Molecular cytogenetics of chromosome 11 in pituitary adenomas: a comparison of fluorescence in situ hybridization and DNA ploidy study. Hum Pathol 30:1377–1382, 1999.
Capra E, Rindi G, Santi G, Pompei Spina M, Scappatici S. Chromosome abnormalities in a case of pituitary adenoma. Cancer Genet Cytogenet 68:140–142, 1993.
Bello MJ, de Campos JM, Kusak ME, Vaquero J, Sarasa JL, Rey JA. Chromosomal abnormalities in pituitary adenomas. Cancer Genet Cytogenet 124:76–79, 2001.
Finelli P, Giardino D, Rizzi N, Buiatiotis S, Virducci T, Franzin A, Losa M, Larizza M. Non-random trisomies of the chromosomes 5, 8 and 12 in the prolactinoma sub-type pituitary adenomas: conventional cytogenetics and interphase fish study. Int J Cancer 86:344–350, 2000.
Fan X, Paetau A, Aalto Y, Valimaki M, Sane T, Poranen A, Castresana JS, Knuutila S. Gain of chromosome 3 and loss of 13q are frequent alterations in pituitary adenomas. Cancer Genet Cytogenet 128:97–103, 2001.
Rickert CH, Scheithauer BW, Paulus W. Chromosomal aberrations in pituitary carcinoma. Acta Neuropathol 102:117–120, 2001.
Kovacs K, Rotondo F, Stefanescu L, Fereidooni F, Horvath E, Lloyd R, Scheithauer BW. Glucocorticoid receptor expression in nontumorous human pituitaries and pituitary adenomas. Endocr Pathol 3:267–275, 2000.
Hague K, Post KD, Morgello S. Absence of peritumoral Crooke’s change is associated with recurrence in surgically treated Cushing’s disease. Surg Neurol 53:77–81, 2000.
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Roncaroli, F., Faustini-Fustini, M., Mauri, F. et al. Crooke’s hyalinization in silent corticotroph adenoma: Report of two cases. Endocr Pathol 13, 245–249 (2002). https://doi.org/10.1385/EP:13:3:245
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DOI: https://doi.org/10.1385/EP:13:3:245