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Pituitary carcinoma diagnosed on fine needle aspiration: Report of a case and review of pathogenesis.

Yakoushina TV, Lavi E, Hoda RS - Cytojournal (2010)

Bottom Line: To date, only three cases of PC have been reportedly diagnosed on fine needle aspiration (FNA).Two of the reported cases were diagnosed on FNA of the cervical lymph nodes and one on FNA of the vertebral bone lesion.Herein, we present a case of PC, diagnosed on FNA of the liver lesion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York.

ABSTRACT
Pituitary carcinoma (PC) is a very rare entity (0.2% of all pituitary tumors), with only about 140 cases reported in English literature. There are no reliable histological, immunohistochemical or ultrastructural features distinguishing pituitary adenoma (PA) from PC. By definition, a diagnosis of PC is made after a patient with PA develops non-contiguous central nervous system (CNS) or systemic metastases. To date, only three cases of PC have been reportedly diagnosed on fine needle aspiration (FNA). Two of the reported cases were diagnosed on FNA of the cervical lymph nodes and one on FNA of the vertebral bone lesion. Herein, we present a case of PC, diagnosed on FNA of the liver lesion. In this case, we describe cytologic features of PC and compare them to histologic features of the tumor in the pituitary. Clinical behavior of tumor, pathogenesis of metastasis and immunochemical and prognostic markers will also be described.

No MeSH data available.


Related in: MedlinePlus

a-c). Histology of recurrent pituitary neoplasm. Dense, highly cellular sheets and nests of monotonous cells with ovoid nuclei and focal clear cell features. Tumor is highly vascular. Areas of necrosis; d-f) Cytology of pituitary carcinoma. FNA of the liver lesion. d, e) 20x; F. 40x: Loose clusters and microacini of monotonous, moderate size cells with eccentrically located, round to oval, mildly pleomorphic nuclei with coarsely granular chromatin and small nucleoli. Cytoplasm is ill-defined due to its fragility
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Figure 0002: a-c). Histology of recurrent pituitary neoplasm. Dense, highly cellular sheets and nests of monotonous cells with ovoid nuclei and focal clear cell features. Tumor is highly vascular. Areas of necrosis; d-f) Cytology of pituitary carcinoma. FNA of the liver lesion. d, e) 20x; F. 40x: Loose clusters and microacini of monotonous, moderate size cells with eccentrically located, round to oval, mildly pleomorphic nuclei with coarsely granular chromatin and small nucleoli. Cytoplasm is ill-defined due to its fragility

Mentions: A 51 -year-old woman, married with two children, smoker, presented with visual impairment and headache in November 2005. She recalls remote history of amenorrhea with galactorrhea from age 26 to age 36. MRI showed a pituitary macroadenoma. She underwent transnasal trassphenoidal resection at another institution. Because her tumor had extended into the cavernous sinus, it was not removed completely. Initial pathological diagnosis revealed the disease as PA. Two months later, she presented at our institution with recurrent symptoms. MRI revealed a 4.0 cm recurrent pituitary lesion [Figure 1a], extending into the cavernous sinus, which was resected. Histology showed dense, highly cellular sheets and nests of monotonous cells with ovoid nuclei and focal clear-cell features [Figures 1c, 2a–b]. The tumor exhibited increased vascularity and was surrounded by fibrosis and fat necrosis, consistent with previous surgery. Immunohistochemical stains for Synaptophysin [Figure 1e] and CD31 [Figure 1d] were positive, and all pituitary hormones, including prolactin (PRL), were negative [Figure 1f]. Ki- 67 labeling index (LI) was <3% [Figure 3a] and p53 [Figure 3d] showed rare positivity. Pathologic diagnosis at this time was -cell PA. Small fraction of the tumor extending into cavernous sinus was left behind. Therefore, the patient underwent six months of radiation therapy.


Pituitary carcinoma diagnosed on fine needle aspiration: Report of a case and review of pathogenesis.

Yakoushina TV, Lavi E, Hoda RS - Cytojournal (2010)

a-c). Histology of recurrent pituitary neoplasm. Dense, highly cellular sheets and nests of monotonous cells with ovoid nuclei and focal clear cell features. Tumor is highly vascular. Areas of necrosis; d-f) Cytology of pituitary carcinoma. FNA of the liver lesion. d, e) 20x; F. 40x: Loose clusters and microacini of monotonous, moderate size cells with eccentrically located, round to oval, mildly pleomorphic nuclei with coarsely granular chromatin and small nucleoli. Cytoplasm is ill-defined due to its fragility
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2926927&req=5

Figure 0002: a-c). Histology of recurrent pituitary neoplasm. Dense, highly cellular sheets and nests of monotonous cells with ovoid nuclei and focal clear cell features. Tumor is highly vascular. Areas of necrosis; d-f) Cytology of pituitary carcinoma. FNA of the liver lesion. d, e) 20x; F. 40x: Loose clusters and microacini of monotonous, moderate size cells with eccentrically located, round to oval, mildly pleomorphic nuclei with coarsely granular chromatin and small nucleoli. Cytoplasm is ill-defined due to its fragility
Mentions: A 51 -year-old woman, married with two children, smoker, presented with visual impairment and headache in November 2005. She recalls remote history of amenorrhea with galactorrhea from age 26 to age 36. MRI showed a pituitary macroadenoma. She underwent transnasal trassphenoidal resection at another institution. Because her tumor had extended into the cavernous sinus, it was not removed completely. Initial pathological diagnosis revealed the disease as PA. Two months later, she presented at our institution with recurrent symptoms. MRI revealed a 4.0 cm recurrent pituitary lesion [Figure 1a], extending into the cavernous sinus, which was resected. Histology showed dense, highly cellular sheets and nests of monotonous cells with ovoid nuclei and focal clear-cell features [Figures 1c, 2a–b]. The tumor exhibited increased vascularity and was surrounded by fibrosis and fat necrosis, consistent with previous surgery. Immunohistochemical stains for Synaptophysin [Figure 1e] and CD31 [Figure 1d] were positive, and all pituitary hormones, including prolactin (PRL), were negative [Figure 1f]. Ki- 67 labeling index (LI) was <3% [Figure 3a] and p53 [Figure 3d] showed rare positivity. Pathologic diagnosis at this time was -cell PA. Small fraction of the tumor extending into cavernous sinus was left behind. Therefore, the patient underwent six months of radiation therapy.

Bottom Line: To date, only three cases of PC have been reportedly diagnosed on fine needle aspiration (FNA).Two of the reported cases were diagnosed on FNA of the cervical lymph nodes and one on FNA of the vertebral bone lesion.Herein, we present a case of PC, diagnosed on FNA of the liver lesion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York.

ABSTRACT
Pituitary carcinoma (PC) is a very rare entity (0.2% of all pituitary tumors), with only about 140 cases reported in English literature. There are no reliable histological, immunohistochemical or ultrastructural features distinguishing pituitary adenoma (PA) from PC. By definition, a diagnosis of PC is made after a patient with PA develops non-contiguous central nervous system (CNS) or systemic metastases. To date, only three cases of PC have been reportedly diagnosed on fine needle aspiration (FNA). Two of the reported cases were diagnosed on FNA of the cervical lymph nodes and one on FNA of the vertebral bone lesion. Herein, we present a case of PC, diagnosed on FNA of the liver lesion. In this case, we describe cytologic features of PC and compare them to histologic features of the tumor in the pituitary. Clinical behavior of tumor, pathogenesis of metastasis and immunochemical and prognostic markers will also be described.

No MeSH data available.


Related in: MedlinePlus