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April 2000, Vol 57, No. 4 >

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Images in Neurology | April 2000

Mixed Gangliocytoma/Pituitary Adenoma

Michael C. Sabel, MD; Volkmar H. J. Hans, MD; Guido Reifenberger, MD, PhD
Arch Neurol. 2000;57(4):587-588. doi:10.1001/archneur.57.4.587.
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A 60-YEAR-OLD woman presented with a 10-year history of gradual enlargement of her hands and feet and progressive acromegalic changes of her face (Figure 1). Six months prior to presentation, she suffered from persistent frontal headaches. She had neither visual field defects nor papilledema. Growth hormone (GH) serum concentrations were increased (31.6 mU/L; normal, <10 mU/L). Serum levels of the other pituitary hormones were normal. Neuroimaging showed a large intrasellar tumor (Figure 2), which was almost completely removed via a transsphenoidal approach. The postoperative course was uneventful. Findings from neuropathological evaluation revealed a mixture of 2 different tumor tissues: a GH-producing adenoma and a benign ganglion cell tumor with dysplastic and occasionally binucleated ganglion cells in a neuropil-like matrix (Figure 3). The histological diagnosis was mixed gangliocytoma/GH-producing adenoma.
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Figure 1.

The patient showed marked acromegalic changes that included macroglossia.

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Figure 2.

Frontal T1-weighted magnetic resonance imaging scan after administration of gadolinium-diethylenetriamine-pentaacetic acid revealed a homogeneous intrasellar mass lesion (arrow).

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Figure 3.

On histologic examination, the tumor contained dysplastic and occasionally binucleated ganglion cells (left) (hematoxylin-eosin, original magnification ×120), as well as strongly growth hormone–producing adenoma (right) (immunostaining for growth hormone, original magnification ×120).

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