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Xanthomatous hypophysitis

R D Folkerth1, D L Price, M Schwartz

  • 1Department of Pathology (Neuropathology), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.

The American Journal of Surgical Pathology
|June 18, 1998
PubMed
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Inflammatory hypophyseal lesions can mimic pituitary tumors. This study identifies a new inflammatory condition, "xanthomatous hypophysitis," characterized by lipid-laden macrophages in the pituitary gland.

Area of Science:

  • Endocrinology
  • Neuropathology
  • Oncology

Background:

  • Inflammatory lesions of the hypophysis (pituitary gland) can present as pituitary neoplasms.
  • Common inflammatory conditions include lymphocytic hypophysitis, pituitary abscess, and granulomatous inflammation.

Observation:

  • Three patients underwent transsphenoidal resection for presumed pituitary adenoma.
  • Clinical presentations included headache, menstrual irregularity, nausea, and diabetes insipidus.
  • Imaging revealed pituitary masses with varied characteristics, including ring enhancement and cystic changes.

Findings:

  • Histologic examination revealed infiltration of the anterior pituitary by foamy histiocytes (macrophages).
  • Lesions lacked features of granulomas, infections, or epithelial cysts.

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  • Immunohistochemistry confirmed macrophages (CD68+) and ruled out other cell types (S-100, CD1a).

    • Implications:

    • The findings suggest a distinct inflammatory entity, proposed as xanthomatous hypophysitis.
    • Accurate diagnosis is crucial as this condition can be mistaken for pituitary adenoma.
    • Understanding this inflammatory process may guide future treatment strategies for pituitary lesions.