title: [A case of pleomorphic TSH-producing pituitary adenoma with calcification].
abstract: We reported a rare case of pleomorphic TSH-producing pituitary adenoma with calcification and reviewed the literature. A 25-year-old female was admitted to our hospital with a complaint of anterior neck swelling. An endocrinological examination demonstrated elevated serum levels of free triiodothyronine (FT3: 5.6 pg/ml), free thyroxin (FT4: 2.2 ng/dl), TSH (5.85 microIU/ml), and TSH a-subunit (5.9 ng/ml), whereas a physical examination revealed no goiter. CT scan showed a suprasellar isodensity mass with dense calcification. Contrast-enhanced T1-weighted images revealed a less enhancing tumor extending from the left upper portion of pituitary fossa into suprasellar cistern. The patient underwent gross total removal of the tumor via the right pterional approach. Microscopically, medium-sized to enlarged tumor cells with marked pleomorphism and prominent calcification were observed. The tumor cells displayed positive reaction for TSH (beta-subunit). The MIB-1 index averaged 2.9%. The histological diagnosis was a pleomorphic TSH-producing pituitary adenoma. Postoperatively, the serum levels of FT3, FT4, TSH, and TSH alpha-subunit decreased to normal range. Follow-up MR images showed no evidence of recurrent tumor 3 years after the resection. All of six patients with densely calcified TSH-producing pituitary adenoma, previously reported in the literature, remained well without tumor recurrence. We suggest that this type of TSH-producing pituitary adenoma may be associated with favorable prognosis despite histologically pleomorphic appearance.
authors.affiliation: Department of Neurosurgery, Akita University School of Medicine, 1-1-1 Hondo, Akita-shi, Akita 010-8567, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Toshio
authors.initials: T
authors.lastname: Sasajima
authors.forename: Masataka
authors.initials: M
authors.lastname: Takahashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kinouchi
authors.forename: Akira
authors.initials: A
authors.lastname: Suzuki
authors.forename: Naomi
authors.initials: N
authors.lastname: Yoshioka
authors.forename: Seiki
authors.initials: S
authors.lastname: Itoh
authors.forename: Kazuo
authors.initials: K
authors.lastname: Mizoi
mesh_terms: D008949:Adenoma, Pleomorphic / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D000328:Adult; D002114:Calcinosis / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D007016:Hypophysectomy; D010900:Pituitary Diseases / Q000150:complications* / Q000473:pathology; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D013972:Thyrotropin / Q000096:biosynthesis*
chemical_list: D013972:Thyrotropin