PATHOLOGICAL CORRELATES OF PITUITARY-ADENOMAS PRESENTING WITH APOPLEXY

Pituitary adenomas presenting de novo with apoplectic symptoms are unc ommon, Several series on pituitary adenomas with apoplexy have been re ported but have emphasized clinical aspects, incidence, or radiographi c appearance by computed tomography (CT) scan. We reviewed our 13 year s' experience, focusing on pathological appearance. We identified 15 p atients with pituitary adenomas whose first presentation to our instit ution was with apoplexy By combining histological and intraoperative f indings with more sensitive magnetic resonance imaging (MRI) scans, we were able to attribute 5 of 15 cases to bland infarction, five cases to hemorrhagic infarction, four cases to pure clot, and one to a remot e hemorrhagic infarction leaving extensive residual fibrosis and hemos iderin, Despite extensive tumor necrosis, reticulin staining still all owed identification of specimens as adenomas, Immunohistochemical stai ning was informative in 13 of 15 cases and endocrine-inactive, weak go nadotroph and null cell adenomas predominated. Cases with the greatest interval between symptom onset and surgery showed peripheral rim enha ncement by MRI. Pathologically, this corresponded to granulation tissu e, T cell lymphocytic infiltration, and atrophic pituicytes at the edg e of the infarction or hemorrhage, Occasionally this reaction overshad owed the necrotic adenoma and contributed to diagnostic confusion. Our Ending of lymphocytic inflammation in pituitary adenomas that have un dergone an apoplectic event may suggest at least a modest immune-media ted response to damaged anterior pituitary tissue. Copyright (C) 1998 by W.B. Saunders Company.