Prevalence of Post-Mortem Incidental Pituitary Pathology - A Pathological Study

Harsha Moosakoya Shahida; Aparna Govindan; Sujith Sreenivas

doi:10.21276/apalm.3923

Authors

Harsha Moosakoya Shahida Department of Pathology, Government Medical College, Kozhikode, Kerala, India
Aparna Govindan Department of Pathology, Government Medical College, Kozhikode, Kerala, India
Sujith Sreenivas Department of Forensic Medicine, Government Medical College, Kozhikode, Kerala, India

DOI:

https://doi.org/10.21276/apalm.3923

Keywords:

pituitary adenoma, hyperplasia of adenohypophysis, histology of pituitary gland, lymphocytic hypophysitis, infarction

Abstract

Background: Disorders of pituitary gland can results in dysfunction of the endocrine system. The normal and variations in histology need to be studied in order to find the abnormalities in the pituitary gland. This study is to asses prevalence of normal variations in histology and incidental pathologies of pituitary gland. The primary objective is to find out the prevalence of pituitary pathologies and variations in normal histology.

Methods: Present study is a prospective study conducted in the department of Pathology, from 2020 to 2022. 104 pituitary glands were collected from consecutive autopsies. Histopathological examinations are done and findings are evaluated and categorized. Prevalence is calculated statistically.

Results: 104 glands are studied in this study. 83.6% of glands had no abnormalities which are histologically significant. Most common findings were fibrosis (33.6%), cyst in the intermediate lobe (16.4%), amyloid deposition (7.6%), congestion (22.1%) and basophil invasion (18.2%). 3.8% glands had microadenoma and 4.8% had pituitary hyperplasia.

Conclusion: The prevalence of pituitary histological variations in this study is comparable with other autopsy-based populations. However, the prevalence of incidental microadenoma (3.8%, 4/104) was significantly lower than reported by Fernandez et al. (11.5%, 19/165; p = 0.028) and the Aljabri et al (46.4%, n = 537; p < 0.0001). Similarly, the prevalence of pituitary hyperplasia (4.8%, 5/104) was significantly lower than reported by Fernandez et al. (26.3%, 44/167; p < 0.0001).

References

1. Kumar V, Abbas AK, Aster JC. Robbins Basic Pathology. 10th ed. Philadelphia: Elsevier; 2017.

2. Scolding NJ. Greenfield's Neuropathology. 6th ed. London: Arnold; 1999.

3. Mills SE. Histology for Pathologists. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2012.

4. Vallecillos FJT, Fernández SO. Histopathological features of post-mortem pituitaries: a retrospective analysis. Rev Assoc Med Bras. 2016 Aug;62(5):399-406.

5. Lloyd RV, D'Amato CJ, Thiny MT, Jin L, Hicks SP, Chandler WF. Corticotroph (basophil) invasion of the pars nervosa in the human pituitary: localization of proopiomelanocortin peptides, galanin and peptidylglycine α-amidating monooxygenase-like immunoreactivities. Endocr Pathol. 1993 Jun;4(2):86-94.

6. Johnson MD, Blitman J. Basophilic invasion in the neurohypophysis is increased in patients with Alzheimer's disease. Clin Neuropathol. 2020 Nov;39(11):271-4.

7. Chen CH, Hsu SS, Lai PH, Lo YS. Intrasellar symptomatic salivary gland rest. J Chin Med Assoc. 2007 May;70(5):215-7.

8. Asa SL. Practical pituitary pathology: what does the pathologist need to know? Arch Pathol Lab Med. 2008 Aug;132(8):1231-40.

9. Kobalka PJ, Huntoon K, Becker AP. Neuropathology of pituitary adenomas and sellar lesions. Neurosurgery. 2021 May;88(5):900-18.

10. Mao J, Huang H, Liu F, Mai Y, Liao X, Qiu B, et al. Activation of age-related nuclear factor-κB signaling pathway leads to chronic inflammation and pituitary fibrosis. World Neurosurg. 2022 Jan;157:e417-23.

11. Röcken C, Saeger W. Amyloid deposits of the pituitary in old age: correlation with histopathological alterations. Endocr Pathol. 1994 Sep;5(3):183-90.

12. Terada T, Stefaneanu L, Kovacs K, Scheithauer BW. Vanishing psammoma bodies in the anterior pituitary of the human newborn: an immunohistochemical and histometric study. Endocr Pathol. 1996 May;7(2):151-7.

13. Kusumi E, Yuji K, Miyakoshi S, Matsumura T, Kami M, Taniguchi S. Extramedullary haematopoiesis surrounding the pituitary gland after cord blood transplantation. Neuropathol Appl Neurobiol. 2007;33(2):243-5.

14. Folkerth RD, Price DL, Schwartz M, Black PM, De Girolami U. Xanthomatous hypophysitis. Am J Surg Pathol. 1998 Jun;22(6):736-41.

15. Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, et al. The prevalence of pituitary adenomas: a systematic review. Cancer. 2004 Aug;101(3):613-9.

16. Mete O, Lopes MB. Overview of the 2017 WHO classification of pituitary tumors. Endocr Pathol. 2017 Sep;28(3):228-43.

17. Nishioka H, Inoshita N. New WHO classification of pituitary adenomas (4th edition): assessment of pituitary transcription factors and the prognostic histological factors. Brain Tumor Pathol. 2018 Apr;35(2):57-61.

18. Heaney AP. Pituitary carcinoma: difficult diagnosis and treatment. J Clin Endocrinol Metab. 2011 Dec;96(12):3649-60.

19. Saeger W, Lüdecke DK, Buchfelder M, Fahlbusch R, Quabbe HJ, Petersenn S. Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol. 2007 Feb;156(2):203-16.

20. Müller HL. Risk-adapted, long-term management in childhood-onset craniopharyngioma. Pituitary. 2017 Apr;20(2):267-81.

21. Jeong TS, Yee GT, Kim NR. Malignant transformation of craniopharyngioma without radiation therapy: case report and review of the literature. J Korean Neurosurg Soc. 2017 Jan;60(1):108-13.

22. Pekmezci M, Louie J, Gupta N, Bloomer MM, Tihan T. Clinicopathological characteristics of adamantinomatous and papillary craniopharyngiomas: University of California, San Francisco experience 1985-2005. Neurosurgery. 2010 Nov;67(5):1341-9.

23. Aljabri KS, Bokhari SA, Assiri FY, Alshareef MA, Khan PM. The epidemiology of pituitary adenomas in a community-based hospital: a retrospective single center study in Saudi Arabia. Ann Saudi Med. 2016 Sep-Oct;36(5):341-345.

24. Borg A, Jaunmuktane Z, Dorward N. Tumors of the neurohypophysis: one unit's experience and literature review. World Neurosurg. 2020 Feb;134:e968-78.

25. Guerrero-Pérez F, Vidal N, Marengo AP, Pozo CD, Blanco C, Rivero-Celada D, et al. Posterior pituitary tumours: the spectrum of a unique entity. A clinical and histological study of a large case series. Endocrine. 2019 Jan;63(1):36-43.

26. Mu Q, Yu J, Qu L, Hu X, Gao H, Liu P, et al. Spindle cell oncocytoma of the adenohypophysis: two case reports and a review of the literature. Mol Med Rep. 2015 Jul;12(1):871-6.

27. Vajtai I, Sahli R, Kappeler A. Spindle cell oncocytoma of the adenohypophysis: report of a case with a 16-year follow-up. Pathol Res Pract. 2006 Oct;202(10):745-50.

28. Takami H, Perry A, Graffeo CS, Giannini C, Narita Y, Nakazato Y, et al. Comparison on epidemiology, tumor location, histology, and prognosis of intracranial germ cell tumors between Mayo Clinic and Japanese consortium cohorts. J Neurosurg. 2021 Feb;134(2):446-56.

29. Sav A, Rotondo F, Syro LV, Serna CA, Kovacs K. Pituitary pathology in traumatic brain injury: a review. Pituitary. 2019 Jun;22(3):201-11.

30. Ward M, Kamal N, Majmundar N, De Leon AB, Eloy JA, Liu JK. Post-traumatic pituitary tumor apoplexy after closed head injury: case report and review of the literature. World Neurosurg. 2018;120:331-5.