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Case History

A 31 year-old man presented with enlarged supraorbital ridges, wide nose, and prognathism. Imaging studies demonstrate a thickened skull, enlarged frontal sinus, and a sella mass. Histopathology: solid neoplasm, interrupted by “pseudoglandular” spaces. Cells had eosinophilic cytoplasm and prominent nucleoli:

Picture1 Picture2

Presumed diagnosis and stains?

  1.       Pituicytoma – TTF-1, S-100.
  2.       Pituitary adenoma – ACTH, Ki-67.
  3.       Craniopharyngioma – Beta-catenin.
  4.       Pituitary adenoma – Growth hormone, Pit-1.

Answer: D. Pituitary adenoma (densely granulated), GH and Pit-1.

Discussion: Densely granulated somatotroph adenomas are eosinophilic and have a solid growth pattern. The pseudoglandular areas and prominent nucleoli are often seen in TSH adenomas. Pit-1 drives both GH and TSH (and Prolactin) producing adenomas. This patient had elevated TSH and GH on his lab studies. GH (left) and TSH (right) are below: 


Case contributed by: Rob Hackney, M.D., Associate Professor, Anatomic Pathology, Neuropathology