Advertisement

Hormones

, Volume 11, Issue 1, pp 94–100 | Cite as

Atypical, invasive, recurring Crooke cell adenoma of the pituitary

  • Fabio Rotondo
  • Michael Cusimano
  • Bernd W. Scheithauer
  • Claire Coire
  • Eva Horvath
  • Kalman Kovacs
Case report

Abstract

We report the case of a 49-year-old woman presenting with Cushing disease and visual disturbance. An atypical, aggressive, invasive pituitary tumor regrew despite several surgeries. Detailed morphologic investigation by histology, immunohistochemistry and electron microscopy documented a Crooke cell adenoma, a rare form of ACTH-producing pituitary tumor. Recognition of such adenomas is of importance given their aggressive behavior and tendency to recur. More studies are needed to explain the pathobiology of this not invariably functional pituitary adenoma.

Key words

Crooke cell adenoma Histology Immunohistochemistry Neoplasm Ultrastructure 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kovacs K, Scheithauer BW, Horvath E, Lloyd RV, 1996 The World Health organization classification of adenohypophysial neoplasms. A proposed five-tier scheme. Cancer 78: 502–510.PubMedGoogle Scholar
  2. 2.
    Kovacs K, Horvath E 1986 Tumors of the pituitary gland. In: Hartmann WH, Sobin LH (eds) Atlas of tumor pathology, 2nd series, Fascicle 21. Armed Forces Institute of Pathology, Washington, DC.Google Scholar
  3. 3.
    Horvath E, Kovacs K, Killinger DW, Smyth HS, Platts ME, Singer W, 1980 Silent corticotropic adenomas of the human pituitary gland: a histologic, immunologic, and ultrastructural study. Am J Pathol 98: 617–638.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Horvath E, Kovacs K, Smyth HS, et al, 1988 A novel type of pituitary adenoma: morphological features and clinical correlations. J Clin Endocrinol Metab 66: 1111–1118.CrossRefGoogle Scholar
  5. 5.
    Hassoun J, Charpin C, Jaquet P, Lissitzky JC, Grisoli F, Toga M, 1982 Corticolipotropin immunoreactivity in silent chromophobe adenomas: A light and electron microscopic study. Arch Pathol Lab Med 106: 25–30.PubMedGoogle Scholar
  6. 6.
    Ezzat S, Asa SL, Couldwell WT, et al, 2004 The prevalence of pituitary adenomas: a systematic review. Cancer 101: 613–619.CrossRefGoogle Scholar
  7. 7.
    Asa SL, Ezzat S, 1998 The cytogenesis and pathogenesis of pituitary adenomas. Endocr Rev 19: 798–827.PubMedGoogle Scholar
  8. 8.
    Terada T, Kovacs K, Stefaneanu L, Horvath E, 1995 Incidence, pathology, and recurrence of pituitary adenomas: study of 647 unselected surgical cases. Endocr Pathol 6: 301–310.CrossRefGoogle Scholar
  9. 9.
    Thapar K, Kovacs K, Scheithauer BW, et al, 1996 Proliferative activity and invasiveness among pituitary adenomas and carcinomas: an analysis using the MIB-1 antibody. Neurosurgery 38: 99–106.CrossRefGoogle Scholar
  10. 10.
    Hsu DW, Hakim F, Biller BM, et al, 1993 Significance of proliferating cell nuclear antigen index in predicting pituitary adenoma recurrence. J Neurosurg 78: 753–761.CrossRefGoogle Scholar
  11. 11.
    Minematsu T, Miyai S, Kajiya H, et al, 2005 Recent progress in studies of pituitary tumor pathogenesis. Endocrine 28: 37–41.CrossRefGoogle Scholar
  12. 12.
    Levy A, 2004 Pituitary disease: presentation, diagnosis, and management. J Neurol Neurosurg Psychiatry 75: iii47–52.CrossRefGoogle Scholar
  13. 13.
    Arafah BM, Nasrallah MP, 2001 Pituitary tumors: pathophysiology, clinical manifestations and management. Endocr Relat Cancer 8: 287–305.CrossRefGoogle Scholar
  14. 14.
    Kovacs K, Hovath E, Kerenyi NA, Sheppard RH, 1976 Light and electron microscopic features of a pituitary adenoma in Nelson’s syndrome. Am J Clin Pathol 65: 337–343.CrossRefGoogle Scholar
  15. 15.
    Kovacs K, Horvath E, Coire C, et al, 2006 Pituitary corticotroph hyperplasia preceding adenoma in a patient with Nelson’s syndrome. Clin Neuropathol 25: 74–80.PubMedGoogle Scholar
  16. 16.
    Scheithauer BW, Kovacs K, Horvath E, et al, 2008 Pituitary blastoma. Acta Neuropathol 116: 657–666.CrossRefGoogle Scholar
  17. 17.
    Pernicone PJ, Scheithauer BW, Sebo TJ, et al, 1997 Pituitary carcinoma: a clinicopathologic study of 15 cases. Cancer 79: 804–812.CrossRefGoogle Scholar
  18. 18.
    Zafar MS, Mellinger RC, Chason JL, 1984 Cushing’s disease due to pituitary carcinoma. Henry Ford Hosp Med J 32: 61–65.PubMedGoogle Scholar
  19. 19.
    Holthouse DJ, Robbins PD, Kahler R, Knuckey N, Pullan P, 2001 Corticotroph pituitary carcinoma: case report and literature review. Endocr Pathol 12: 329–341.CrossRefGoogle Scholar
  20. 20.
    Scheithauer BW, Jaap AJ, Horvath E, et al, 2002 Clinically silent corticotroph tumors of the pituitary gland. Neurosurgery 47: 723–729.Google Scholar
  21. 21.
    Kovacs K, Stefaneanu L, Ezzat S, Smyth HS, 1994 Prolactin-producing pituitary adenoma in a male-to-female transsexual patient with protracted estrogen administration: a morphologic study. Arch Pathol Lab Med 118: 562–566.PubMedGoogle Scholar
  22. 22.
    Rotondo F, Kovacs K, Horvath E, Bell CD, Lloyd RV, Scheithauer BW, 2006 Immunohistochemical expression of nestin in the non-tumorous hypophysis and in pituitary neoplasms. Acta Neuropathol 111: 272–277.CrossRefGoogle Scholar
  23. 23.
    Crooke AC, 1935 A change in the basophil cells of the pituitary gland common to conditions which exhibit the syndrome attributed to basophil adenoma. J Pathol Bacteriol 41: 339–349.CrossRefGoogle Scholar
  24. 24.
    Felix UA, Horvath E, Kovacs K, 1981 Massive Crooke’s hyalinization in corticotroph cell adenomas of the human pituitary: a histological, immunocytological and electron microscopic study of three cases. Acta Neurochir (Wien) 58: 235–243.CrossRefGoogle Scholar
  25. 25.
    Neumann PE, Horoupian DS, Goldman JE, et al, 1984 Cytoplasmic filaments of Crooke’s hyaline change belong to the cytokeratin class: an immunocytochemical and ultrastructural study. Am J Pathol 116: 214–222.PubMedPubMedCentralGoogle Scholar
  26. 26.
    George DH, Scheithauer BW, Kovacs K, et al, 2003 Crooke’s cell adenoma of the pituitary: an aggressive variant of corticotroph adenoma. Am J Surg Pathol 27: 1330–1336.CrossRefGoogle Scholar
  27. 27.
    Horvath E, Kovacs K, Josse R, 1983 Pituitary corticotroph cell adenoma with marked abundance of microfilaments. Ultrastruct Pathol 5: 249–255.CrossRefGoogle Scholar
  28. 28.
    Eschbacher JM, Coons SW, 2006 Cytokeratin CK20 is a sensitive marker for Crooke’s cells and the early cytoskeletal changes associated with hypercortisolism within pituitary corticotrophs. Endocr Pathol 17: 365–376.CrossRefGoogle Scholar
  29. 29.
    Horvath E, Scheithauer BW, Kovacs K, Lloyd RV 2002 Hypothalamus and pituitary. In: Graham DI, Lantos PL (Eds). Greenfield’s Neuropathology Vol 1, New York, Arnold Publishers, NY; pp, 983–1062.Google Scholar
  30. 30.
    Ikeda H, Yoshimoto T, Ogawa Y, Mizoi K, Murakami O, 1997 Clinico-pathological study of Cushing’s disease with large pituitary adenoma. Clin Endocrinol 46: 669–679.CrossRefGoogle Scholar
  31. 31.
    Saeger W, Lüdecke DK, Geisler F 1990 The anterior lobe in Cushing’s disease/syndrome. In Cushing’s Syndrome, and Other Hypercortisolemic States. Progress on Endocrine Research and Surgery, vol 5, pp, 147–156. DK Lüdecke, G Chrousos, G Tolis (eds), New York: Raven Press.Google Scholar
  32. 32.
    Lüdecke DK, Flitsch J, Knappe UJ, Saeger W, 2001 Cushing’s disease: a surgical view. J Neuro-Oncol 54: 151–166.CrossRefGoogle Scholar
  33. 33.
    Thapar K, Scheithauer BE, Kovacs K, Pernicone PJ, Laws ER Jr, 1996 P-53 expression in pituitary adenomas and carcinomas. Correlation with invasiveness and tumor growth fractions. Neurosurgery 38: 765–770.PubMedGoogle Scholar
  34. 34.
    Scheithauer BW, Kovacs KT, Laws ER, Randall RV, 1986 Pathology of invasive pituitary tumors with special reference to functional classification. Neurosurgery 65: 733–744.CrossRefGoogle Scholar
  35. 35.
    Gaffey TA, Scheithauer BW, Lloyd RV, et al, 2002 Corticotroph carcinoma of the pituitary: a clinicopatho-logical study. J Neurosurg 96: 352–360.CrossRefGoogle Scholar
  36. 36.
    Scheithauer BW, Gaffey TA, Lloyd RV, et al, 2006 Pathobiology of pituitary adenomas and carcinomas. Neurosurgery 59: 341–53.CrossRefGoogle Scholar
  37. 37.
    Kovacs K, Diep CC, Horvath E, et al, 2005 Prognostic indicators in an aggressive pituitary Crooke’s cell adenoma. Can J Neurol Sci 32: 540–545.CrossRefGoogle Scholar
  38. 38.
    Takeshita A, Inoshita N, Taguchi M, et al, 2009 High incidence of low O6-methylguanine DNA methyl-transferase expression in invasive macroadenomas of Cushing’s disease. Europ J Endocrinol 161: 553–559.CrossRefGoogle Scholar
  39. 39.
    Grossman AB, 2005 Clinical review: diagnosis and management of pituitary carcinomas. J Clin Endocrinol Metab 90: 3089–3099.CrossRefGoogle Scholar
  40. 40.
    Scheithauer BW, Kurtkaya-Yapicier O, Kovacs KT, Young WF Jr, Lloyd RV, 2005 Pituitary carcinoma: a clinicopathological review. Neurosurgery 56: 1066–1074.PubMedGoogle Scholar
  41. 41.
    Pernicone PJ, Scheithauer BW 1993 Invasive pituitary adenomas and pituitary carcinomas. In Lloyd RV (eds), Surgical pathology of the pituitary gland. Philadelphia, WB Sanders, Co, pp, 121–136.Google Scholar
  42. 42.
    Levine AJ, 1997 the cellular gatekeeper for growth and division. Cell 88: 323–331.CrossRefGoogle Scholar
  43. 43.
    Lidhar R, Korbonits M, Jordan S, et al, 1999 Low expression of the cell cycle inhibitor p27Kip1 in normal corticotroph cells, corticotroph tumors, and malignant pituitary tumors. J Clin Endocrinol Metab 84: 3823–3830.CrossRefGoogle Scholar
  44. 44.
    Vidal S, Kovacs K, Horvath E, et al, 2002 Topoisomerase II alpha expression in pituitary adenomas and carcinomas: relationship to tumor behavior. Mod Pathol 15: 1205–1212.CrossRefGoogle Scholar
  45. 45.
    Lloyd RV, Jin L, Qian X, Kulig E, 1997 Aberrqant p27kip1 expression in endocrine and other tumors. Amer J Pathol 150: 401–407.Google Scholar
  46. 46.
    Serres MP, Zlotek-Klotkiewicz E, Concha C, et al, 2011 Cytoplasmic p27 is oncogenic and cooperates with Ras both in vivo and in vitro. Oncogene 30: 2846–2858.CrossRefGoogle Scholar
  47. 47.
    Sumi T, Stefaneanu L, Kovacs K, Asa S, Rindi, 1993 Immunohistochemical study of p53 protein in human and animal pituitary tumors. Endocr Pathol 4: 95–99.CrossRefGoogle Scholar
  48. 48.
    Kontogeorgos G, 2006 Predictive markers of pituitary adenoma behavior. Neuroendocrinology 83: 179–188.CrossRefGoogle Scholar
  49. 49.
    Saeger W, 2004 Proliferation markers and cell cycle inhibitors in pituitary adenomas. Front Horm Res 32: 110–126.CrossRefGoogle Scholar
  50. 50.
    Wolfsberger S, Wunderer J, Zachenhofer I, et al, 2004 Expression of cell proliferation markers in pituitary adenomas- correlation and clinical relevance of MIB-1 and anti-topoisomerase-II alpha. Acta Neurochir (Wien) 146: 831–839.Google Scholar

Copyright information

© Hellenic Endocrine Society 2012

Authors and Affiliations

  • Fabio Rotondo
    • 1
  • Michael Cusimano
    • 2
  • Bernd W. Scheithauer
    • 3
  • Claire Coire
    • 4
  • Eva Horvath
    • 1
  • Kalman Kovacs
    • 1
  1. 1.Department of Laboratory Medicine, Division of Pathology, St. Michael’s HospitalUniversity of TorontoTorontoCanada
  2. 2.Department of Neurosurgery, St. Michael’s HospitalUniversity of TorontoTorontoCanada
  3. 3.Department of PathologyMayo ClinicRochesterUSA
  4. 4.Department of PathologyTrillium Health CentreMississaugaCanada

Personalised recommendations