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Case Report
Mixed somatotroph adenoma-gangliocytoma: A rare sellar combined tumor
1 Endocrine Unit, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
2 Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), UERJ, Rio de Janeiro, Brazil
3 Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Ana Beatriz Winter Tavares
Hospital Universitário Pedro Ernesto, UERJ, Boulevard 28 de setembro, 77/4° andar (Endocrinologia), Vila Isabel, Rio de Janeiro, RJ 20551-030,
Brazil
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Article ID: 101154Z01AT2020
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Tavares ABW, Tomaz GA, Leão LMCSM, Tabet A, Kraemer-Aguiar LG. Mixed somatotroph adenoma-gangliocytoma: A rare sellar combined tumor. Int J Case Rep Images 2020;11:101154Z01AT2020.ABSTRACT
Introduction: Gangliocytomas are rare entities that correspond to less than 1% of the brain tumors, and can be present in the sellar region or more frequently in association with a pituitary adenoma. Hormonal overexpression has also been described in this tumor association leading to endocrine syndromes.
Case Report: We report a case of a 23-year-old female diagnosed with a pituitary macroadenoma. The first symptoms were unilateral amaurosis and contralateral reduced visual acuity. On physical examination, she had unilateral amaurosis and galactorrhea, while the laboratory showed hyperprolactinemia and hypogonadotropic hypogonadism. Eight months after starting cabergoline and without any follow-up visit, the patient was subject to an emergency transsphenoidal surgery due to pituitary apoplexy. At this moment, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) previously collected were checked and acromegaly was diagnosed [GH 10.68 μg/dL; IGF-1 2.25 ULN (the upper limit of normality)]. Histopathology revealed a mixed somatotroph adenoma-gangliocytoma with areas of apoplexy. Unfortunately, surgery did not cure acromegaly, and clinical treatment was started but without hormonal control. A new surgery was scheduled.
Conclusion: Mixed pituitary adenoma-gangliocytoma is a rare entity. The diagnosis is only possible after surgery and immunohistochemistry of the mass, once radiologically, it is indistinguishable from other sellar masses.
Keywords: Acromegaly, Gangliocytoma, Hyperprolactinemia, Pituitary adenoma
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Acknowledgments
We acknowledge Dr. Ellington Simões and Dr. Felipe Carvalho, neurosurgeons (from Neurosurgery Service, Faculty of Medical Sciences, State University of Rio de Janeiro) who realized the surgical procedure of the patient.
Author ContributionsAna Beatriz Winter Tavares - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Geísa Antony Tomaz - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Lenora Maria Camarate Silveira Martins Leão - Substantial contributions to conception and design, Interpretation of data, Final approval of the version to be published
Ana Tabet - Acquisition of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Luiz Guilherme Kraemer-Aguiar - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Ana Beatriz Winter Tavares et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
