Prolactin-Producing Pituitary Adenoma With Abundant Spherical Amyloid Deposition Masquerading as Extensive Calcification -Case Report-

Abstract

A 53-year-old male presented with a case of prolactin-producing pituitary adenoma with abundant spherical amyloid depositions masquerading as extensive calcification and manifesting as visual disturbance. Computed tomography revealed a large high density mass suggesting calcified tumor in the intra-and supra-sellar regions. Magnetic resonance imaging revealed a heterogeneously enhanced large pituitary tumor reaching lateral ventricle. Blood prolactin level was elevated to 5971 ng/ml. Cabergoline treatment for 3 months provided considerable shrinkage of the tumor but failed to improve the visual symptoms. Transcranial surgery revealed that the tumor was fibrous and included abundant grayish translucent spherical granules with diameter of 0.5-1.5 mm. Immunohistochemically, the tumor was strongly positive for prolactin. Congo red stain and polarized light showed that these spherical bodies were amyloid depositions. No calcification was noted.

Pituitary Stone or Calcified Pituitary Tumor? Three Cases and Literature Review

“…In clinical practice, most common causes of pituitary calcifications are related to craniopharyngiomas. In other cases, it may be a Rathke’s cleft cyst calcification ( 4 ) or a calcified pituitary adenoma ( 2 , 3 , 5 - 10 ). Nevertheless, calcified chordomas, meningiomas, and pituitary aneurisms should be considered too.…”

“…This anomaly can be discovered accidentally ( 1 ) or in a person with endocrine and/or neurological abnormalities ( 2 ). The mechanism of the pituitary calcification remains totally obscure and controversial although many authors believe it results from a calcified pituitary tumor, an inflammatory or hemorrhagic process, and/or amyloidal deposits ( 1 , 3 ). The true pituitary stone may be idiopathic or “de novo”, but this situation remains exceptional ( 1 - 10 ).…”

Corticotroph Pituitary Stone

“…The spherical presentation appears almost exclusively in prolactin adenoma, and can appear as high density spots on CT, simulating an extensive calcified pituitary adenoma. 10 The treatment of choice of pituitary adenoma is surgery. Transsphenoidal approach showed excellent results regarding safety and efficacy.…”

Osteochondroma Presenting as a Calcified Mass in the Sellar Region and Review of the Literature

“…A total of 21 English-language articles documenting calcified lesions of the sellar region, published from 1961 to 2015, were retrieved from the database. 4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Pathologies included cerebral aneurysm, 16 chondroid chordoma, 20 chondroma, 13 craniopharyngiomas, 19,22 OCs, [6][7][8][9][10][11] odontome, 18 osteoma, 17 pituitary adenomas, 15,21 pituitary stone, 25 Rathke cleft cyst, 23 retinoblastoma, 14 schwannoma, 24 and xanthogranuloma. 12 Among them, six patients were documented as OC cases.…”

“…Besides OCs, diverse pathologies have been reported as calcified lesions in the sellar region. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] These are, except for craniopharyngiomas, reports of extremely rare instances, and each case is ranked at a lower probability than OCs among the differential diagnoses. OCs comprised 29% (6/21) of all the reported calcified masses of the sellar region.…”