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Endocr Pathol. 2019 Mar;30(1):74-80. doi: 10.1007/s12022-018-9562-3.

Plurihormonal Pituitary Tumor of Pit-1 and SF-1 Lineages, with Synchronous Collision Corticotroph Tumor: a Possible Stem Cell Phenomenon.

Author information

1
Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel. karent@tlvmc.gov.il.
2
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. karent@tlvmc.gov.il.
3
Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
4
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
5
Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
6
Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
7
Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
8
Maccabi Health Services, Tel Aviv, Israel.
9
Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.
10
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.

Abstract

Thyrotropin (TSH)-secreting pituitary tumors are the rarest functioning pituitary tumors. Nonetheless, they are not infrequently plurihormonal, as they may express/secrete hormones made by other pituitary cells derived from the Pit-1 lineage such as growth hormone (GH), prolactin (PRL), and α-subunit (αSU). However, adrenocorticotropin (ACTH) or gonadotropin secretion by such a tumor is exceptional. Although double pituitary tumors are rare, they often combine ACTH and GH secretion. A 41-year-old presented almost 2 years after delivering her 10th child; she had thyrotoxicosis (goiter and palpitations) masquerading as autoimmune postpartum thyroiditis. She was still breastfeeding and amenorrheic. She proved to have TSH, GH, PRL, and ACTH hypersecretion. Imaging revealed an invasive pituitary macrotumor. She had stigmata neither of Cushing's disease nor of acromegaly. Prior to surgery, hormonal control was achieved for close to 1 year by combined octreotide and cabergoline treatment with significant shrinking of the tumor. Following surgery, pathology revealed a collision tumor; the dominant lesion was positive for GH, βTSH, βFSH, and αSU and expressed both Pit-1 and SF-1.The smaller lesion was a corticotroph tumor. We report an unusual plurihormonal tumor co-expressing Pit-1 and SF-1 along with hormones made by cells of both lineages. Its simultaneous occurrence adjacent to a corticotroph tumor raises questions regarding the pathogenesis of these tumors. We propose the possibility of a stem cell tumor with multiple lineage differentiation. We hypothesize that pregnancy might have played a permissive role in tumorigenesis.

KEYWORDS:

Collision; Double tumor; Pit-1; Pituitary tumor; Plurihormonal; SF-1; Stem cell

PMID:
30610567
DOI:
10.1007/s12022-018-9562-3

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