Date post: | 31-Dec-2015 |
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Clinical history:
36 year old female with a 5 year history of panhypopituitarism and increasing visual deficits.
Describe the lesion on the following MRI scan.
Question 1
Question 2What is your differential diagnosis based on the radiologic appearance and location of the lesion?
Answer Pituitary adenoma
Craniopharyngioma
Pituicytoma
Granular cell tumor
Meningioma
Pilocytic astrocytoma
Germ cell tumor
Question 3
An endoscopic endonasal resection was performed. An intraoperative consultation was requested. What is your interpretation of the following touch prep?
According to the surgeon, the mass appears to be arising from the infundibulum.
Click here to view slide.
AnswerHypocellular touch prep consisting
predominantly of blood
No evidence of pituitary adenoma
Rare large polygonal cells with abundant granular cytoplasm (macrophages vs granular cells)
Overall, a granular cell tumor is favored
AnswerModerately cellular neoplasm composed of elongated to large polygonal cells with abundant coarsely granular cytoplasm and eccentric nuclei with inconspicuous nucleoli.
Question 6
What is your interpretation of the following stains?
Click here to view PAS-D slide.Click here to view S100 slide (red chromogen).Click here to view GFAP slide (brown chromogen).
AnswerPAS-D strongly stains the cytoplasmic
granules
S100 is patchy weakly to moderately positive
GFAP is negative in the tumor cells; highlights rare glial processes at the edge of the tumor
Answer
Yes
PAS and PAS-D strongly stain the cytoplasmic lysosomal granules
S100 is usually positive, but may be variable
GFAP is usually negative
Question 10
Name a lesion that is related to infundibular granular cell tumors and can be seen incidentally in ~10% of autopsy pituitaries?