3 cases of pituitary adenomas, two hormone-secreting adenomas, and one non-secreting chromophobe adenoma, were treated surgically by the sublabial transsphenoidal approach with use of surgical microscope and radiofluroscopic image intensification at the Dept. of Neurosurgery, Yonsei University Medical College. The 2 cases of hormone secreting adenomas were an eosinophilic microadenoma manifestating gigantism and a prolaction secreting adenoma with amenorrhea and galactorrhea. The simplicity of this technique, criteria for the treatment of the hormone secreting and non-secreting adenomas and their biologic behaviors were described and discussed with review of literatures.
Adenoma ; Adenoma, Chromophobe ; Amenorrhea ; Eosinophils ; Female ; Galactorrhea ; Gigantism ; Neurosurgery ; Pituitary Neoplasms ; Pregnancy

3 cases of pituitary adenomas, two hormone-secreting adenomas, and one non-secreting chromophobe adenoma, were treated surgically by the sublabial transsphenoidal approach with use of surgical microscope and radiofluroscopic image intensification at the Dept. of Neurosurgery, Yonsei University Medical College. The 2 cases of hormone secreting adenomas were an eosinophilic microadenoma manifestating gigantism and a prolaction secreting adenoma with amenorrhea and galactorrhea. The simplicity of this technique, criteria for the treatment of the hormone secreting and non-secreting adenomas and their biologic behaviors were described and discussed with review of literatures.
Adenoma ; Adenoma, Chromophobe ; Amenorrhea ; Eosinophils ; Female ; Galactorrhea ; Gigantism ; Neurosurgery ; Pituitary Neoplasms ; Pregnancy

Intrasellar or pituitary abscess was first reported about a century ago, after then once relatively common but now is rare. Since 1925, about 50 cases have been reported in the literatures, of which characters were variable, but clinical very similar to one of pituitary tumor. So they were often diagnosed preoperatively as pituitary tumor. Several pathogenic factors were postulated in relation to clinical aspects. We had recently experienced a case of pituitary abscess combined with chromophobe adenoma. A 28 years old clerkman was admitted to our hospital with complaints of impared ejaculation and visual disturbance. Clinical aspects and diagnostic studies gave us a strong impression of pituitary tumor. Upon surgery we found a cystic mass in pituitary region, of which aspiration showed whitish-gray, tenacious and liquid material. Many polymorphous leukocytes were noted by direct smear, but no microorganisms were detected in culture. He had postoperatively suffered from transient polyuria and polydipsia, which soon disappeared under the medication of Esidrex. He was discharged from this hospital with recommendation of radiation therapy. Clinical features and treatment were also discussed with review of ever reported cases.
Abscess* ; Adenoma, Chromophobe ; Adult ; Ejaculation ; Humans ; Hydrochlorothiazide ; Leukocytes ; Male ; Pituitary Neoplasms ; Polydipsia ; Polyuria

A case of postirradiation necrosis of the brain, clinically simulating neoplasm, is reported. A 29 years old male underwent a surgery with a partial removal of chromophobe adenoma of the pituitary gland postoperatively received deep radiation therapy with CO60. A total dose of 4,500 r. was given in 35 days. Approximately six months after the irradiation, the patient became confused and complained of frontal headache in association with signs of increased intracranial pressure and of intracranial dynamic mass lesion. Cerebral angiography and C-T scanning demonstrated findings of a large mass in the right temporal region. At operation done nine months after his initial craniotomy, tissue of the mass appeared to be a glioma and large blocks of tissue were resected. Histologically it was verified to be necrosis of the brain.
Adenoma, Chromophobe ; Adult ; Brain* ; Cerebral Angiography ; Craniotomy ; Glioma ; Headache ; Humans ; Intracranial Pressure ; Male ; Necrosis* ; Pituitary Gland

Attention has been called to the sudden expansion of a pituitary tumor by hemorrhage within it, causing sudden loss of vision. Management of the pituitary apoplexy should be regarded as a neurological emergency. The outstanding clinical features of acute pituitary apoplexy were sudden headache, depressed consciousness, opthalmoplegia, meningismus and signs of compression of the optic nerve or chiasm. The authors report two cases of pituitary apoplexy, one was chromophobe adenoma and pathological diagnosis was not obtained in the other. The first case was 45-year-old man admitted to the Department of Neurosurgery, Catholic Medical Center on June 20, 1977, with headache, double vision and impared left side visual acuity. On April 26, 1977, he experienced sudden severe headache and diplopia then became drowsy. The headache and impairment of consciousness improved subsequently. He was admitted to a university hospital following the onset. The work up at the hospital revealed an enlarged sella with hazy dorsum sellae on plain skull films. The carotid angiogram revealed an elevation of the A1 segments bilaterally and cisternal pneumogram revealed an evidence of suprasellar extension of the pituitary tumor. He was advised to have immediate surgery. The patient, however, refused the surgery and noticed the impaired visual acuity and diplopia were persisting. The studies in this hospital revealed marked impairment of left side vision and oculomotor nerve palsy of the left eye. The carotid angiogram and cisternal pneumogram revealed the no evidence of sellar mass or suprasellar extension of the tumor. The second case was 59-year-old woman admitted to the neurosurgical ward on September 30, 1977, after a sudden onset of severe bifrontal headache, vomiting, bilateral ocular pain and drowsy mental state. She was drowsy with panopthalmoplegia of the right side, and spinal fluid was xanthochromic. Skull X-ray, carotid angiogram and air study revealed an evidence of pituitary tumor with minimal suprasellar extension. Removal of pituitary tumor through the trans-sphenoidal approach was performed, and the tumor was proved to be chromophobe adenoma. Panopthalmoplegia was progressively improved postoperatively.
Adenoma, Chromophobe ; Consciousness ; Diagnosis ; Diplopia ; Emergencies ; Female ; Headache ; Hemorrhage ; Humans ; Meningism ; Middle Aged ; Neurosurgery ; Oculomotor Nerve Diseases ; Optic Nerve ; Pituitary Apoplexy* ; Pituitary Neoplasms ; Skull ; Visual Acuity ; Vomiting

There were 11 cases of pituitary tumors and 2 cases of craniopharyngiomas, who were admitted to the Department of Neurosurgery of the Catholic Medical Center from July 1976 to April 1977. The authors analyzed changes of the hormone related with the hypophyses before and after surgery, and radiation using the radioimmunoassay according to Schalch and Parker's double antibody method. The hormonal assays were performed as follows : 5 samplings of growth hormones were given at a fasting state, at 8 AM, 8:30 AM, 10 AM and 11 AM, also the oral glucose tolerance test simulataneously after the patients were given 100 gm of surgar, associated with the insulin tolerance test (0.15 unit/kg). Two specimens of blood for the prolactin were withdrawn at 8 AM and 4 PM on that day. A specimen for LH, FSH, TSH, T3, T4 and cortisol was taken at 8 AM. The 8 surgery cases of the pituitary tumors associated with post-operative radiation underwent 3 transsphenoidal approaches, 3 transfrontal and 2 transtemporal approaches, and all of the surgery cases were alive. The transtemporal approach was for all craniopharyngiomas, and all of them died following surgery. One patient in this chromophile adenoma group had radiation therapy only. Following the clinical improvement after the treatment, the endocrinological symptoms, i. e. diminished libido and amenorrhea, were improved in the acromegalic group. The visual disturbance in the chromophobe adenoma group was markedly improved and the menstruation had started in one case. In inoperative patients, the visual disturbance and the endocrinological disarrangements were aggravated. In the chromophile adenoma group accompanying the acromegaly, the mean value of the plasma growth hormone was markedly increased to 61.3 ng/ml and greatly decreased to 36.8 ng/ml after the surgery and radiation, but increased rather than before radiation in the one case of radiation only. The mean prolactine value was also increased to 60.6 ng/ml and not changed after the therapy. The gonadotropin was within normal limits and tended to decrease slightly after the treatment. The TSH, T3, T4 cortisol were within normal values. In the chromophobe adenoma group, the mean growth hormone values were within normal limits, 7.27 ng/ml, and not altered after the therapy. The mean prolactin value was increased to 57.8 ng/ml and not changed after the treatment. The gonadotropin, TSH, T4 and cortisol were within normal limits before and after the treatment, but the T3 value was slightly higher than normal. In the craniopharyngioma group, the mean growth hormone value was within normal limits, 7.4 ng/ml and not altered after the surgery. The mean prolactin gonadotropin, TSH, T3 and T4 were within normal limits but the cortisol value was increased to 13.7 ng/ml after the surgery.
Acromegaly ; Adenoma ; Adenoma, Chromophobe ; Amenorrhea ; Craniopharyngioma ; Fasting ; Female ; Glucose Tolerance Test ; Gonadotropins ; Growth Hormone ; Humans ; Hydrocortisone ; Insulin ; Libido ; Menstruation ; Neurosurgery ; Pituitary Gland ; Pituitary Neoplasms* ; Plasma ; Prolactin ; Radioimmunoassay* ; Reference Values

Adenocarcinoma, Follicular ; metabolism ; pathology ; Adenoma, Chromophobe ; metabolism ; pathology ; Adenoma, Oxyphilic ; metabolism ; pathology ; Angiomyoma ; metabolism ; pathology ; Biomarkers, Tumor ; metabolism ; Carcinoma, Papillary ; metabolism ; pathology ; Carcinoma, Renal Cell ; classification ; metabolism ; pathology ; ultrastructure ; Diagnosis, Differential ; Humans ; Kidney Neoplasms ; classification ; metabolism ; pathology ; ultrastructure ; Thyroid Neoplasms ; metabolism ; pathology

OBJECTIVETo evaluate the effect of 99Tcm-HYNIC-TOC imaging in localization of somatostatin receptor-positive tumors.

METHODSForty-four patients were involved in this study, including 22 neuroendocrine tumors, 10 non-neuroendrocrine tumors and 12 benign diseases. All patients were confirmed by histopathologic diagnosis, and had clinical laboratory data, or 1-2 other imaging procedures. Regional, whole body and SPECT/CT (in positive cases) imagings were acquired at 1 and 4 hours after an intravenous injection of 370 MBq 99Tcm-HYNIC-TOC. 99Tcm-HYNIC-TOC imaging was compared with 111In-petetreotide imaging in 4 cases, and with 131I-MIBG imaging in 10 cases. 99Tcm-HYNIC-TOC imaging was performed before and after treatment in 1 non-Hodgkins lymphoma (NHL) patient.

RESULTSThe positive imagings were observed in 19 of 32 cases. The sensitivity, specificity, and accuracy of 99Tcm-HYNIC-TOC imaging for somatostatin receptor-positive tumors are 82.6%, 100%, and 87.5%, respectively. The distribution in vivo of 99Tcm-HYNIC-TOC is similar to that of 111In-petetreotide, and showed high physiological uptake in liver, spleen, and kidneys. 99Tcm-HYNIC-TOC imaging demonstrated intense tumor sites uptake at 1 hour after injection, and revealed the lesions first in 6 patients among the imaging modalities, and more lesions that had not been revealed by 131I-MIBG imaging. Compared with imaging before treatment, 99Tcm-HYNIC-TOC imaging confirmed the tumor regression after treatment in 1NHL.

CONCLUSIONS99Tcm-HYNIC-TOC is promising for the diagnosis and localization of somatostatin receptor-positive tumors.

Adenoma, Chromophobe ; diagnostic imaging ; Adult ; Carcinoma, Medullary ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors ; diagnostic imaging ; metabolism ; Octreotide ; analogs & derivatives ; Organotechnetium Compounds ; Pancreatic Neoplasms ; diagnostic imaging ; Pituitary Neoplasms ; diagnostic imaging ; Receptors, Somatostatin ; metabolism ; Thyroid Neoplasms ; diagnostic imaging ; Tomography, Emission-Computed, Single-Photon