Advertisement

Endocrine Pathology

, Volume 15, Issue 4, pp 351–357 | Cite as

Xanthogranulomatous hypophysitis mimicking a pituitary neoplasm

  • Shunichi Yokoyama
  • Toshiaki Sano
  • Kenichiro Tajitsu
  • Kazuhiro Kusumoto
Case Report

Abstract

Hypophysitis is an inflammatory disease of the pituitary gland that clinically and radiologically mimics pituitary tumors. We report here a case of xanthogranulomatous hypophysitis mimicking a pituitary neoplasm.

A 65-yr-old woman presented with weight loss, fatigue, and visual disturbance. Computed tomography demonstrated a round cystic low-density mass with calcification in the sella. A T1-weighted magnetic resonance imaging scan showed most of the mass as hyperintense. The capsule of the mass was strongly enhanced by gadolinium. Endocrinologic examination revealed hypocorticism and hypothyroidism. Diabetes insipidus (DI) developed after the administration of hydrocortisone. The patient also had hallucination and delusions of persecution.

Transsphenoidal surgery was performed. Histologic examination of the removed tissue showed central necrosis surrounded by accumulation of foamy cells and epithelioid cells. Several multinucleated giant cells were also seen. The foamy cells and epithelioid cells were immunopositive for Kp-1, a marker of macrophages. The patient made an uneventful postoperative recovery. Although DI and hypofunction of adenohypophysis persisted, the visual disturbance and psychiatric disorder were resolved.

We have described an unusual inflammatory lesion of the pituitary in the sellar region that was mimicking neoplasm. A high level of clinical suspicion of inflammatory disorders is necessary for correct diagnosis and optimal management.

Key Words

Hypophysitis xanthogranulomatous pituitary 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Deodhare SS, Bilbao JM, Kovacs K, et al. Xanthomatous hypophysitis: a novel entity obscure etiology. Endocr Pathol 10:237–241, 1999.PubMedGoogle Scholar
  2. 2.
    Folkerth RD, Price DL, Jr, Schwartz M, Black PM, De Girolami U. Xanthomatous hypophysitis. Am J Surg Pathol 22:736–741, 1998.PubMedCrossRefGoogle Scholar
  3. 3.
    Scanarini M, d’Avella D, Rotilio A, Kitromilis N, Mingrino S. Giant-cell granulomatous hypophysitis: a distinct clinicopathological entity. J Neurosurg 71:681–686, 1989.PubMedCrossRefGoogle Scholar
  4. 4.
    Cheung CC, Ezzat S, Smyth HS, Asa SL. The spectrum and significance of primary hypophysitis. J Clin Endocrinol Metab 86:1048–1053, 2001.PubMedCrossRefGoogle Scholar
  5. 5.
    Hashimoto K, Takao T, Makino S. Lymphocytic adenohypophysitis and lymphocytic infundibuloneurohypophysitis. Endocr J 44:1–10, 1997.PubMedGoogle Scholar
  6. 6.
    Honegger J, Fahlbusch R, Bornemann A, et al. Lymphocytic and granulomatous hypophysitis: experience with nine cases. Neurosurgery 40:713–722, 1997.PubMedCrossRefGoogle Scholar
  7. 7.
    Tashiro T, Sano T, Xu B, et al. Spectrum of different types of hypophysitis: a clinicopathologic study of hypophysitis in 31 cases. Endocr Pathol 13:183–195, 2002.PubMedCrossRefGoogle Scholar
  8. 8.
    Saeger W. Tumor-like lesions of the sellar region. In: Thapar K, Kovacs K, Scheithauer BW, Lloyd RV, eds. Diagnosis and management of pituitary tumors. Totowa, NJ: Humana Press, 2001; 449–460.Google Scholar
  9. 9.
    Goudie RB, Pinkerton PH. Anterior hypophysitis and Hashimoto’s disease in a young woman. J Pathol Bacteriol 83:584–585, 1962.PubMedCrossRefGoogle Scholar
  10. 10.
    Imura H, Nakao K, Shimatsu A, et al. Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus. N Engl J Med 329:683–689, 1993.PubMedCrossRefGoogle Scholar
  11. 11.
    Hama S, Arita K, Tominaga A, et al. Symptomatic Rathke’s cleft cyst coexisting with central diabetes insipidus and hypophysitis: case report. Endocr J 46:187–192, 1999.PubMedGoogle Scholar
  12. 12.
    Emery D, Kucharczyk W. Imaging of pituitary tumors. In: Thapar K, Kovacs K, Scheithauer BW, Lloyd RV, eds. Diagnosis and management of pituitary tumors. Totowa, NJ: Humana Press, 2001; 201–217.Google Scholar
  13. 13.
    Asa SL. Tumor-like lesions of the sella turcica. In: Tumors of the pituitary gland. Washington, DC: Armed Forces Institute of Pathology, 1998; 191–210.Google Scholar

Copyright information

© Humana Press Inc. 2004

Authors and Affiliations

  • Shunichi Yokoyama
    • 1
  • Toshiaki Sano
    • 2
  • Kenichiro Tajitsu
    • 1
  • Kazuhiro Kusumoto
    • 1
  1. 1.Division of NeurosurgeryNanpuh HospitalKagoshimaJapan
  2. 2.Department of PathologyUniversity of Tokushima School of MedicineTokushimaJapan

Personalised recommendations