title: ACTH- and prolactin-producing pituitary gland microadenoma with biphasic features of atypia and intermediate filament expression.
abstract: Herein, we report the case of a 28-year old woman clinically presenting with unclear weight gain over the last years. The patient displayed facial and neck edema in combination with unobtrusive striae distensae. Endocrinological examinations led to the diagnosis of Cushing's disease. Neuroradiological examination revealed an intrasellar tumor mass of 7 mm in diameter. Subsequently, transsphenoidal tumor resection was performed. Histological and immunohistochemical investigations revealed a pituitary gland adenoma showing a biphasic tumor growth pattern with two morphologically different tumor areas producing ACTH and prolactin respectively. Co-expression of ACTH and prolactin is exceedingly rare in pituitary adenoma. To our surprise, both tumor areas exhibited features of atypia consisting in elevated MIB-1 proliferation index in the ACTH-producing portion as well as p53 expression selectively in the prolactin-producing tumor parts. To our knowledge, this is the first case of an ACTH- and prolactin-producing pituitary gland adenoma exhibiting biphasic features of atypia.
authors.affiliation: Institute of Brain Research, University of Tuebingen, Germany. michel-guy-andr.mittelbronn@med.uni-tuebin
authors.forename: Michel
authors.initials: M
authors.lastname: Mittelbronn
authors.forename: Tsambika
authors.initials: T
authors.lastname: Psaras
authors.forename: David
authors.initials: D
authors.lastname: Capper
authors.forename: Richard
authors.initials: R
authors.lastname: Meyermann
authors.forename: Jürgen
authors.initials: J
authors.lastname: Honegger
mesh_terms: D000236:Adenoma / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D000324:Adrenocorticotropic Hormone / Q000096:biosynthesis*; D000328:Adult; D049109:Cell Proliferation; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007381:Intermediate Filament Proteins / Q000096:biosynthesis*; D019394:Ki-67 Antigen / Q000378:metabolism; D010907:Pituitary Hormones / Q000737:chemistry / Q000378:metabolism; D010911:Pituitary Neoplasms / Q000378:metabolism* / Q000601:surgery; D011388:Prolactin / Q000096:biosynthesis*; D016159:Tumor Suppressor Protein p53 / Q000096:biosynthesis
chemical_list: D007381:Intermediate Filament Proteins; D019394:Ki-67 Antigen; D010907:Pituitary Hormones; D016159:Tumor Suppressor Protein p53; D000324:Adrenocorticotropic Hormone; D011388:Prolactin