Advertisement

Endocrine Pathology

, Volume 13, Issue 2, pp 157–165 | Cite as

Prolactin-producing pituitary adenoma associated with prolactin cell hyperplasia

  • Sergio Vidal
  • Eva Horvath
  • Luis V. Syro
  • Humberto Uribe
  • Sandy Cohen
  • Kalman Kovacs
Case Report

Abstract

A 24-yr-old woman with amenorrhea, galactorrhea, hyperprolactinemia, and sellar mass underwent transsphenoidal surgery. Histologic, immunohistochemical, and electron microscopic investigation revealed a well-differentiated, sparsely granulated prolactin (PRL) cell adenoma of the pituitary showing conclusive PRL immunoreactivity. In the nontumorous adenohypophysis PRL cell hyperplasia was noted. Marked differences were evident between the neoplastic and hyperplastic areas. The tumor consisted of sparsely granulated PRL cells immunoreactive only for PRL. As demonstrated by immunoelectron microscopy, the hyperplastic are a comprised monohormonal sparsely granulated PRL cells as well as bihormonal mammosomatotrophs immunoreactive for both PRL and growth hormone. The MIB-1 index was higher whereas microvessel density was lower in the adenoma as compared with the hyperplastic area. In addition, the nontumorous area showed lymphocytic infiltration whereas inflammatory reaction was not seen in the adenoma. This case represents a rare association of a PRL cell adenoma and PRL cell hyperplasia. The fact that these two lesions were contiguous in the surgically removed material raises the possibility that hyperplasia can precede and transform into adenoma.

Key Words

Prolactin adenoma pituitary hyperplasia human electron microscopy immunohistochemistry 

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. The World Health Organization classification of adenohypophysial neoplasms: a proposed five-tier scheme. Cancer 78:502–510, 1996.PubMedCrossRefGoogle Scholar
  2. 2.
    Kovacs K. The pathology of Cushing’s disease. J Steroid Biochem Mol Biol 45:179–182, 1993.PubMedCrossRefGoogle Scholar
  3. 3.
    Horvath E, Kovacs K. The adenohypophysis. In: Kovacs K, Asa SL, eds. Functional endocrine pathology. 2nd ed. Malden, MA: Blackwell Science, 1998; 247–281.Google Scholar
  4. 4.
    Kovacs K, Stefaneanu L, Horvath E, Lloyd RV, Lancranjan I, Buchfelder M, Fahlbusch R. Effect of dopamine agonist medication on prolactin producing pituitary adenomas: a morphological study including immunocytochemistry, electron microscopy and in situ hybridization. Virchows Arch A Pathol Anat Histopathol 418:439–446, 1991.PubMedCrossRefGoogle Scholar
  5. 5.
    Kovacs K, Lloyd R, Horvath E, Asa SL, Stefaneanu L, Killinger DW, Smyth HS. Silent somatotroph adenomas of the human pituitary: a morphologic study of three cases including immunocytochemistry, electron microscopy, in vitro examination, and in situ hybridization. Am J Pathol 134:345–353, 1989.PubMedGoogle Scholar
  6. 6.
    Vidal S, Kovacs K, Horvath E, Scheithauer BW, Kuroki T, Lloyd RV. Microvessel density in pituitary adenomas and carcinomas. Virchows Arch 438:595–602, 2001.PubMedCrossRefGoogle Scholar
  7. 7.
    Bendayan M. Double immunocytochemical labeling applying the protein A-gold technique. J Histochem Cytochem 30:81–85, 1982.PubMedGoogle Scholar
  8. 8.
    Vidal S, Horvath E, Kovacs K. Ultrastructural immunohistochemistry. In: Lloyd RV, ed. Morphology methods: cell and molecular biology techniques. Totowa, NJ: Humana, 2001; 375–402.Google Scholar
  9. 9.
    McConnon JK, Smyth HS, Horvath E. A case of sparsely granulated growth hormone cell adenoma associated with lymphocytic hypophysitis. J Endocr Invest 14:691–696, 1991.PubMedGoogle Scholar
  10. 10.
    Heshmati HM, Kujas M, Casanova S, Wollan PC, Racadot J, van Effenterre R, Derome PJ, Turpin G. Prevalence of lymphocytic infiltrate in 1400 pituitary adenomas. Endocr J 45:357–361, 1998.PubMedGoogle Scholar
  11. 11.
    Kovacs K, Corenblum B, Sirek AM, Penz G, Ezrin C. Localization of prolactin in chromophobe pituitary adenomas: study of human necropsy material by immunoperoxidase technique. J Clin Pathol 29:250–258, 1976.PubMedGoogle Scholar
  12. 12.
    Scheithauer BW, Kovacs KT, Young WF Jr, Randall RV. The pituitary gland in hyperthyroidism. Mayo Clin Proc 67:22–26, 1992.PubMedGoogle Scholar
  13. 13.
    Scheithauer BW, Kovacs K, Randall RV, Ryan N. Pituitary gland in hypothyroidism: histologic and immunocytologic study. Arch Pathol Lab Med 109:499–504, 1985.PubMedGoogle Scholar
  14. 14.
    Scheithauer BW, Kovacs K, Randall RV. The pituitary gland in untreated Addison’s disease: a histologic and immunocytologic study of 18 adenohypophyses. Arch Pathol Lab Med 107:484–487, 1983.PubMedGoogle Scholar
  15. 15.
    Carey RM, Varma SK, Drake CR Jr, Thorner MO, Kovacs K, Rivier J, Vale W. Ectopic secretion of corticotropin-releasing factor as a cause of Cushing’s syndrome: a clinical, morphologic, and biochemical study. N Engl J Med 311:13–20, 1984.PubMedCrossRefGoogle Scholar
  16. 16.
    Ezzat S, Asa SL, Stefaneanu L, Whittom R, Smyth HS, Horvath E, Kovacs K, Frohman LA. Somatotroph hyperplasia without pituitary adenoma associated with a long standing growth hormone-releasing hormone-producing bronchial carcinoid. J Clin Endocrinol Metab 78:555–560, 1994.PubMedCrossRefGoogle Scholar
  17. 17.
    Horvath E, Kovacs K, Scheithauer BW. Pituitary hyperplasia. Pituitary 1:169–179, 1999.PubMedCrossRefGoogle Scholar
  18. 18.
    Vidal S, Horvath E, Kovacs K, Lloyd RV, Smyth HS. Reversible transdifferentiation: interconversion of somatotrophs and lactotrophs in pituitary hyperplasia. Mod Pathol 14:20–28, 2001.PubMedCrossRefGoogle Scholar
  19. 19.
    Cusimano MD, Kovacs K, Bilbao JM, Tucker WS, Singer W. Suprasellar craniopharyngioma associated with hyperprolactinemia, pituitary lactotroph hyperplasia, and microprolactinoma: case report. J Neurosurg 69:620–623, 1988.PubMedCrossRefGoogle Scholar
  20. 20.
    Khalil A, Kovacs K, Sima AA, Burrow GN, Horvath E. Pituitary thyrotroph hyperplasia mimicking prolactin-secreting adenoma. J Endocrinol Invest 7:399–404, 1984.PubMedGoogle Scholar
  21. 21.
    Kovacs K, Stefaneanu L, Ezzat S, Smyth HS. Prolactin-producing pituitary adenoma in a male-to-female transsexual patient with protracted estrogen administration: a morphologic study. Arch Pathol Lab Med 118:562–565, 1994.PubMedGoogle Scholar
  22. 22.
    van Nesselrooij JH, Szeverenyi NM, Ritter-Hrncirik C, Tillapaugh-Fay GM, Feron VJ. Rat pituitary changes observed with magnetic resonance imaging following removal of estrogen stimulus: correlation with histopathology and immunohistology. Carcinogenesis 13:277–282, 1992.PubMedCrossRefGoogle Scholar
  23. 23.
    Asa SL, Kelly MA, Grandy DK, Low MJ. Pituitary lactotroph adenomas develop after prolonged lactotroph hyperplasia in dopamine D2 receptor-deficient mice. Endocrinology 140:5348–5355, 1999.PubMedCrossRefGoogle Scholar
  24. 24.
    Schulte HM, Oldfield EH, Allolio B, Katz DA, Berkman RA, Ali IU. Clonal composition of pituitary adenomas in patients with Cushing’s disease: determination by X-chromosome inactivation analysis. J Clin Endocrinol Metab 73:1302–1308, 1991.PubMedCrossRefGoogle Scholar
  25. 25.
    Suhardja A, Kovacs K, Rutka J. Genetic basis of pituitary adenoma invasiveness: a review. J Neurooncol 52:195–204, 2001.PubMedCrossRefGoogle Scholar
  26. 26.
    Suhardja AS, Kovacs KT, Rutka JT. Molecular pathogenesis of pituitary adenomas: a review. Acta Neurochir (Wien) 141:729–736, 1999.CrossRefGoogle Scholar
  27. 27.
    Pal S, Claffey KP, Dvorak HF, Mukhopadhyay D. The von Hippel-Lindau gene product inhibits vascular permeability factor/vascular endothelial growth factor expression in renal cell carcinoma by blocking protein kinase C pathways. J Biol Chem 272:27,509–27,512, 1997.CrossRefGoogle Scholar
  28. 28.
    Missale C, Fiorentini C, Finardi A, Spano P. Growth factors in pituitary tumors. Pituitary 1:153–158, 1999.PubMedCrossRefGoogle Scholar
  29. 29.
    Derwahl M, Studer H. Hyperplasia versus adenoma in endocrine tissues: are they different? Trends Endocr Metab 13:23–28, 2002.CrossRefGoogle Scholar
  30. 30.
    Horvath E, Kovacs K, Lloyd RV. Pars intermedia of the human pituitary revisited: morphologic aspects and frequency of hyperplasia of POMC-peptide immunoreactive cells. Endocr Pathol 10:55–64, 1999.Google Scholar

Copyright information

© Humana Press Inc 2002

Authors and Affiliations

  • Sergio Vidal
    • 1
    • 2
  • Eva Horvath
    • 1
  • Luis V. Syro
    • 3
  • Humberto Uribe
    • 4
  • Sandy Cohen
    • 1
  • Kalman Kovacs
    • 1
  1. 1.Department of Laboratory Medicine, Division of PathologySt. Michael’s HospitalTorontoCanada
  2. 2.Department of Anatomy, Laboratory of HistologyUniversity of Santiago de CompostelaLugoSpain
  3. 3.Departments of Neurosurgery Clinica MedellinHospital Pablo Tobon UribeMedellinColombia
  4. 4.Universidad de AntioquiaMedellinColombia

Personalised recommendations