Tumefactive Postmenopausal Gonadotroph Cell Hyperplasia
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Tumefactive Postmenopausal Gonadotroph Cell Hyperplasia Mark Jentoft & Bernd W. Scheithauer & Olga Moshkin & Eva Horvath & Phillip C. Collins & Luis V. Syro & Kalman Kovacs
Published online: 4 March 2012 # Springer Science+Business Media, LLC 2012
Introduction Pituitary hyperplasia, an infrequent finding, varies in morphologic appearance and can be difficult to diagnose in surgical specimens. The normal histology and immunotype of the anterior pituitary are more complex than generally assumed. Many adenohypophysial cells produce and secrete only a single hormone, while others are plurihormonal [1]. The regional distribution and densities of some cell types vary within the gland, while others are distributed evenly throughout. The patterns of cell distribution are well documented in several publications [1–3]. When a particular cell type undergoes hyperplasia, variation in cell distribution M. Jentoft : B. W. Scheithauer Department of Pathology, Mayo Clinic, Rochester, MN, USA O. Moshkin Peterborough Regional Health Center, Peterborough, ON, Canada E. Horvath : K. Kovacs St. Michael’s Hospital, Toronto, ON, Canada P. C. Collins North Austin Medical Center, Austin, TX, USA L. V. Syro Neurosurgery, Hospital Pablo Tobon Uribe and Clinica Medellin, Medellin, Colombia M. Jentoft (*) Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA e-mail: [email protected]
assumes three basic histologic patterns. These include focal, nodular, and diffuse [4]. The focal pattern consists of a small circumscribed accumulation of a single pituitary cell type, often as an incidental autopsy finding. It is thought to be of no clinical relevance. The nodular pattern consists of multifocal expansion of nearly monomorphous acini but is not monomorphous in cellular makeup as adenoma. The diffuse pattern of hyperplasia consists of an evenly distributed increase in the number of cells. It results in only slight expansion of acinar architecture. This form of hyperplasia poses a particular diagnostic challenge in that it is often undetectable in the intact pituitary, much less in fragmented surgical specimens [4]. All cell types are capable of hyperplasia, but gonadotroph cell hyperplasia is rare. In the setting of early-onset gonadal failure, it is characterized by a diffuse increase in vacuolated gonadotroph cells, so-called gonadal deficiency cells or “castration cells” [4]. In the combined experience of the authors in addition to a review of the literature, no similar case of tumefactive gonadotroph cell hyperplasia in the setting of a normal physiologic decline of gonadal function, such as menopause, has been previously reported. Herein, we document the first example.
Case Report A 49-year-old female with a history of daily “hot flashes” had ceased menses 1 year prior. Otherwise considered to be in normal health, her only prescribed medication was Tramadol for headaches. Pituitary hormonal levels were remarkable for FSH >400 mIU/ml (maximal postmenopausal level, 114 mIU/mL), LH 110
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