title: Anterior Gray Matter Pituicytic Heterotopia with Monomorphic Anterior Pituitary Cells: A Variant of Nonsecretory Pituitary Adenoma Neuronal Choristoma? Report of a Rare Case and Review of the Literature.
abstract: BACKGROUND
  Mixed tumors of adenomatous and neuronal cells in the sellar region are an uncommon finding. The origins of these heterogeneous tumors are unknown, and management remains unsettled. We report a very rare case of anterior gray matter pituicytic heterotopia with monomorphic anterior pituitary cells that likely represents a variant of nonsecreting pituitary adenoma neuronal choristoma (PANCH) with no ganglion cells. We also review the current literature for the various clinical presentations of PANCH.
  
  
  METHODS
  A 49-year-old female complaining of headache, blurred vision, and hair loss was found to have a nonsecretory sellar mass with compression of the optic chiasm on magnetic resonance imaging (MRI). The mass was excised via a transsphenoidal procedure. Histological analysis of tissue sections revealed heterotopic gray matter with reactive gliosis without ganglion cells or Herring bodies. Only 1 smear exhibited characteristics of a pituitary adenoma.
  
  
  CONCLUSIONS
  The overall findings were most consistent with a variant of PANCH. At a postoperative follow-up of 4.5 years, there was resolution of visual symptoms, and the residual sellar mass was stable on MRI. Neuronal choristoma is hypothesized to originate from embryonal pituitary or hypothalamus, or by differentiation from pituitary adenoma cells. Surgery is the cornerstone of management, and the clinical course appears to be similar to that of nonfunctioning pituitary adenoma in reported cases.
authors.affiliation: Department of Neurosurgery, Augusta University, Augusta, Georgia, USA. Electronic address: jyowtak@augusta.edu.
authors.forename: June
authors.initials: J
authors.lastname: Yowtak
authors.affiliation: Department of Pathology, Augusta University, Augusta, Georgia, USA.
authors.forename: Suash
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Radiology, Augusta University, Augusta, Georgia, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Forseen
authors.affiliation: Department of Neurosurgery, Augusta University, Augusta, Georgia, USA.
authors.forename: Cargill H
authors.initials: CH
authors.lastname: Alleyne
mesh_terms: D000236:Adenoma / Q000473:pathology* / Q000601:surgery*; D002828:Choristoma / Q000473:pathology* / Q000601:surgery*; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D005260:Female; D066128:Gray Matter / Q000473:pathology / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010902:Pituitary Gland; D010911:Pituitary Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Adenoma; Choristoma; Heterotopia; Pituitary