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A Case of Pleomorphic TSH-producing Pituitary Adenoma with Calcification Suguru YAMAGUCHI 1 , Toshio SASAJIMA 1 , Masataka TAKAHASHI 1 , Hiroyuki KINOUCHI 1 , Akira SUZUKI 1 , Naomi YOSHIOKA 2 , Seiki ITOH 2 , Kazuo MIZOI 1 1Department of Neurosurgery,Akita University School of Medcine 2Department of Geriatric Medicine,Akita University School of Medicine Keyword: pituitary adenoma , TSH , pleomorphism , calcification pp.961-967
Published Date 2004/9/1
DOI https://doi.org/10.11477/mf.1436100484
  • Abstract
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 We reported a rare case of pleomorphic TSH-producing pituitary adenoma with calcification and reviewed the literature.

 A 25-year-old female was admitted to our hospital with a complaint of anterior neck swelling. An endocrinological examination demonstrated elevated serum levels of free triiodothyronine (FT3 : 5.6 pg/ml),free thyroxin (FT4 : 2.2 ng/dl),TSH (5.85 mIU/ml),and TSH a-subunit (5.9 ng/ml),whereas a physical examination revealed no goiter. CT scan showed a suprasellar isodensity mass with dense calcification. Contrast-enhanced T1-weighted images revealed a less enhancing tumor extending from the left upper portion of pituitary fossa into suprasellar cistern. The patient underwent gross total removal of the tumor via the right pterional approach. Microscopically,medium-sized to enlarged tumor cells with marked pleomorphism and prominent calcification were observed.The tumor cells displayed positive reaction for TSH (β-subunit). The MIB-1 index averaged 2.9%. The histological diagnosis was a pleomorphic TSH-producing pituitary adenoma. Postoperatively,the serum levels of FT3,FT4,TSH,and TSH α-subunit decreased to normal range. Follow-up MR images showed no evidence of recurrent tumor 3 years after the resection. All of six patients with densely calcified TSH-producing pituitary adenoma,previously reported in the literature,remained well without tumor recurrence. We suggest that this type of TSH-producing pituitary adenoma may be associated with favorable prognosis despite histologically pleomorphic appearance.


Copyright © 2004, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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