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Gangliocytoma masquerading as a prolactinoma. Case report
K C McCowen1, J N Glickman, P M Black
1Harvard Vanguard Medical Associates, Boston, Massachusetts, USA. karen.mccowen@joslin.harvard.edu
Journal of Neurosurgery
|September 2, 1999
Summary
A rare prolactin-secreting gangliocytoma mimicked a pituitary adenoma, showing no shrinkage with bromocriptine therapy. This diagnosis is crucial for patients with unexplained tumor growth despite declining prolactin levels.
Area of Science:
- Neuroendocrinology
- Pituitary Pathology
Background:
- Pituitary macroadenomas are common tumors, often presenting with visual disturbances and hyperprolactinemia.
- Bromocriptine is a standard treatment for prolactin-secreting adenomas (prolactinomas), typically causing tumor shrinkage.
Observation:
- A 36-year-old man presented with bitemporal hemianopsia and markedly elevated prolactin levels.
- Despite bromocriptine therapy, his pituitary mass did not shrink, and visual defects progressed.
- Hemorrhage into the mass occurred years later, revealing dysplastic neurons immunoreactive for prolactin and neural markers.
Findings:
- The resected mass was diagnosed as a prolactin-secreting gangliocytoma, a rare tumor of neuronal origin.
- Immunocytochemistry confirmed prolactin production by dysplastic neurons, not pituitary cells.
- The tumor exhibited resistance to bromocriptine therapy, unlike typical prolactinomas.
Implications:
- Prolactin-secreting gangliocytoma should be considered in the differential diagnosis of pituitary macroadenomas when bromocriptine fails to induce tumor shrinkage.
- Biopsy prior to radiotherapy may be warranted in atypical cases to confirm diagnosis and guide treatment.
- This case highlights the importance of comprehensive histopathological evaluation for rare pituitary region tumors.
