Pituitary macroadenoma - TSH - paediatric

Case contributed by RMH Neuropathology

Presentation

Visual failure.

Patient Data

Age: 13 years
Gender: Female
MRI

MRI pituitary

A large relatively homogeneous mass expands the pituitary fossa, bulges into the left cavernous sinus, as extends into the suprasellar cistern elevating and compressing the optic chiasm. The mass demonstrates homogeneous contrast enhancement. 

The patient went on to have the tumour resected. 

MICROSCOPIC DESCRIPTION:

The sections show fragments of a moderately hypercellular adenoma.  The tumour cells have moderately pleomorphic round and oval hyperchromatic nuclei and a variable amount of pale cytoplasm.  These are arranged in diffuse sheets intersected by thin walled capillaries. An occasional mitotic figure is identified.  No areas of necrosis are seen.  A narrow rim of normal anterior pituitary tissue is seen at one edge of the tumour.  Immunohistochemistry shows strong cytoplasmic staining in tumour cells for TSH.  There is also moderate staining for cytokeratin CAM 5.2.  No staining for growth hormone, prolactin, ACTH, FSH or LH is seen in tumour cells.  The features are of a thyrotroph cell adenoma.  The topoisomerase labelling index is approximately 3%. 

FINAL DIAGNOSIS:

Pituitary tumour:  Thyrotroph cell adenoma.

Case Discussion

TSH secreting macroadenomas are rare. Macroadenomas in children are also rare. A TSH secreting macroadenoma in a 13 year old is therefore very rare indeed. 

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Case information

rID: 24392
Case created: 12th Aug 2013
Last edited: 9th Jun 2016
Inclusion in quiz mode: Included

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