Ultrastructure of Human Sella Tumors: Correlations of Clinical Findings and Morphology

174 Pages·1975·6.176 MB·English

by  Alex M. Landolt M.D. (auth.)

ACTA NEUROCHIRURGICA
SUPPLEMENTUM 22
Alex M. Landolt
Ultrastructure
of Human Sella Tumors
Correlations of Clinical Findings
and Morphology
SPRINGER-VERLAG
WIEN NEWYORK
ALEX M. LANDOLT, M.D.
Neurosurgical Clinic, Kantonsspital, University of Zurich
(Head: Prof. Dr. M. G. YA§ARGIL)
With 94 Figures
This work is subject to copyright.
All rights are reserved, whether the whole or part of the material is concerned, specifically
those of translation, reprinting, re·use of illustrations, broadcasting, reproduction by
photocopying machine or similar means, and storage in data banks.
© 1975 by Springer·Verlag/Wien
Softcover reprint of the hardcover 1st edition 1975
Library of Congress Cataloging in Publication Data. Landolt, Alex M 1935 -. Ultrastructure of
human sella tumors. (Acta neurochirurgica: Supplementum, 22.) Bibliography: p.1. Pituitary
body-Tumors. I. Title. II. Series. RC280.P5L36. 616.9'92'47. 75-23233.
ISBN-13:978-3-211-81326-3 e-ISBN-13:978-3-7091-8420-2
DOl: 10_1007/978-3-7091-8420-2
Foreword
This monograph on the "Ultrastructure of Human Sella Tumors"
is in fact a study of the correlations of clinical findings and morphology.
It is a timely and eagerly awaited publication because of the increasing
interest of the endocrinologist in pituitary disorders and of the neuro
surgeon in the newest aspects of surgery on pituitary tumors, and
also because of the unsatisfactory but still widely accepted classification
into eosinophil, basophil and chromophobe pituitary adenomas. This
old classification has been mainly based on granule color as seen after
hematoxylin-eosin staining, but it does not, after extensive clinical
observations, reflect in many instances the type of clinical picture
observed.
The author has brilliantly succeeded in demonstrating in a convinc
ing way, by an extensive study of the relevant literature and by his
own histological work, that further insight into the biology of the
hypophysis and of the pituitary tumor can be obtained only by newer
methods of light microscopic staining, immuno-histochemistry and
electron microscopy combined with radio-immunological blood hormone
determination.
Therefore an earlier diagnosis of primary and recurrent tumors
may be obtained which is favoured by the attitude of the electron
microscopist who tries to use a functional nomenclature. The basis
of the nomenclature is derived mainly from the hormones produced
by each cell type. A detailed description of the ultrastructure and
reports on special features of the different types of tumors are given,
and the correlation between the several histological and ultrastructural
features and the secretory activity of the different pituitary adenomas
is amply discussed. Under these assumptions, for instance, the old
term of chromophobe adenoma as equivalent to "without signs of
endocrine activity" is not correct and should be replaced by "endocrine
inactive adenoma". In this respect special attention is given to the
ultrastructural types of endocrine inactive adenomas such as the onco
cytoma and endocrine inactive adenomas with secretory granules.
Also the special features of the cranio-pharyngiomas and of the granular
cell tumors of the neurohypophysis are considered in detail.
VI Foreword
On the whole, it may be stated that this publication is a landmark
in research into correlations of clinical findings and the morphology
of the pituitary gland and provides new insights into the biology of
the pituitary disorders. Therefore it will be of great benefit to the
endocrinologist and neurosurgeon.
HUGO KRAYENBUm.
Honorary Professor and Former Director
of the Neurosurgical Clinic
of the University of ZUrich
Contents
List of Abbreviations Used ...................................... VIII
1. Introduction .............................................. 1
2. Material and Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3. mtrastructure of the Normal Pituitary. . . . . . . . . . . . . . . . . . . . . . . . 8
4. Pituitary Adenomas Associated with Signs of Endocrine Activity 31
a) Acromegaly ............................................ 31
b) Amenorrhea-Galactorrhea Syndrome (Forbes-Albright) ....... 51
c) Corticotropic Adenomas of the Pituitary Gland. . . . . . . . . . . . . . 57
d) Thyrotropic Adenomas of the Pituitary Gland .............. 69
5. Pituitary Adenomas without Signs of Endocrine Activity: The
So-called "Chromophobe Adenomas" ...................... 71
a) Oncocytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
b) Endocrine Inactive Adenomas with Secretory Granules. . . . . . . 78
6. Malignant Pituitary Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
7. Craniopharyngiomas........................................ 104
8. Granular Cell Tumors of the Neurohypophysis ................. 120
9. Meningiomas .............................................. 129
10. Summary................................................. 134
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 138
List of Abbreviations Used
ACTH Adrenocorticotrophic hormone
AMP Adenosine monophosphate
CRL Crown rump length
FSH Follicle stimulating hormone
GH Growth hormone
HGH Human growth hormone
LH Luteinizing hormone
LTH Luteotrophic hormone, prolactin
RER Rough surfaced endoplasmic reticulum
-RF Releasing factor
TSH Thyroid stimulating hormone
1. Introduction
The tumors of the sella region in man always have been a challenge
to pathologists, endocrinologists, and surgeons since the first successful
operations for pituitary adenomas performed by Horsley in 1889 (Hors
ley, 1906), who used the transfrontal and transtemporal approaches and
by Schloffer in 1907, who performed the first transnasal intervention.
The challenge has been manyfold. For the surgeon it was mainly the
formidable localization of the tumors surrounded by a number of im
portant and delicate structures including the cavernous sinus, optic
nerves, circle of Willis, and hypothalamus whose damage could mean
death or invalidism to the patient. For the clinician it was the bifold
symptomatology: 1. neurological signs caused by damage to the cranial
nerves located above and lateral to the sella or by compression of the
cerebrospinal fluid pathways and 2. signs of increased or decreased
endocrinological activity of the adenohypophysis and neurohypophysis.
For the pathologist the origin of the neoplasms from all three germinal
layers (neuro-ectoderm, entoderm and mesoderm) resulted in a large
variety of basically different histological pictures: pituitary adenomas,
craniopharyngiomas, meningiomas, and granular cell tumors of the
posterior lobe.
Much is known about the biology and classification of the cranio
pharyngiomas and meningiomas. In spite of an enormous bulk of knowl
edge concerning the pituitary adenomas, we have to admit that their
present classification, which is mainly based on the granule color as seen
after hematoxylin-eosin staining, does not reflect the type of clinical
picture observed. Acromegaly can be produced by chromophobe as well
as by eosinophilic adenomas. The eosinophilic oncocytomas do not show
any signs of hormone production.-We will demonstrate in the following
chapters that newer methods of light microscopic staining, immuno
histochemistry, and electron microscopy present an entirely different
picture concerning the relationship of the adenomas with the different
endocrinological syndromes observed. These new methods will have to
be used in the future to allow further insight into the biology of these
tumors. This knowledge, combined with today's methods of radioimmu
nological blood hormone determination, ultimately will be used for the
benefit of the patient by allowing an earlier diagnosis of primary and
Landolt, Ultrastructure
2 Introduction
recurrent tumors of the adenohypophysis.-The problem of malignant
adenohypophysial tumors is still unsolved since conventional histology
often has failed to demonstrate the characteristics of a pituitary cancer.
The present knowledge of the granular cell tumors of the neurohypophy
sis and pituitary stalk is even less advanced. There are still no definite
indications as to whether or not this is a true neoplasm or a thesauris
mOSlS.
The following chapters will deal with the results of the ultrastructural
examination of 111 tumors of the sella region. We will try to find rela
tionships between the morphological findings, the results of the clinical
and endocrinological evaluation and subsequent operative findings. The
literature concerning the ultrastructure of the normal human hypophysis
as well as of the human hypophysial tumors will be reviewed thoroughly.
Reports concerning the light microscopy of human pathological material,
clinical descriptions, and electron microscopy of experimental material
of laboratory animals will be used where necessary. On occasion we will
present the literature concerning light and electron microscopy of the
normal pituitary in mammalians. Material originating from other verte
brates and invertebrates will not be mentioned.
This monograph could not have been written without the most
generous help of my inspiring teachers and chiefs Prof. Dr. H. Krayen
buhl and Prof. Dr. M. G. Yai;!argil. They operated on a large number of
the patients presented and focused my interest on the unsolved problems
of pituitary pathology. I thank both for their continuing interest and
support. I also wish to express my gratitude to Prof. Dr. A. Labhart
and Prof. Dr. R. E. Froesch, Department of Internal Medicine, Kan
tonsspital Zurich, Prof. Dr. A. Prader, Children's Hospital, Zurich, and
numerous internists and ophthalmologists in the vicinity of Zurich for
referring the patients and supplying the clinical data. Prof. Dr. Ch.
Hedinger and Dr. E. Pfenninger, Institute of Pathology, Kantonsspital
Zurich performed the light microscopical examinations and allowed me
to review the slides. Prof. Dr. U. Fisch, Department of Otorhinolaryn
gology, Kantonsspital Zurich and his collegues participated actively in
the transnasal operations of numerous pituitary tumors. The data of
the radioimmunological hormone determinations were supplied by PD
Dr. R. Illig, Children's Hospital Zurich (HGH), PD Dr. G. Zahnd,
Department of Medicine, Hopital Cantonal Geneve (HGH), Dr. E. del
Pozo, Sandoz AG, Basel (LTH), and PD Dr. J. Girard, Children's Hospi
tal, Basel (ACTH). Dr. O. Friedman and Dr. P. Kelly, Collaborative
Research Inc., Waltham, Mass., USA performed the tissue culture
experiments with some of our pituitary adenomas and supplied the data
concerning the hormone production of these tumors. PD Dr. W. Weg
mann, Department of Pathology, Kantonsspital Zurich performed the
Introduction 3
electron micrographs of one granular cell tumor. The radiological ex
aminations were done by Prof. Dr. J. Wellauer, Department of Diagnos
tic Radiology, Kantonsspital Zurich and Dr. H. Etter, Department of
Radiology, Kantonsspital Luzem (Fig. 92). Prof. Dr. K. Bauknecht
and Dipl. math. A. Leuzinger, Institute for Informatics, University of
Zurich performed the mathematical evaluation of the granule size
distribution curves.
The book could not have been written without the continuous help
of Dr. B. Zumstein, Mrs. H. U. Hosbach-Zust Dipl. zool., and Mrs. U.
Ryffel-Gysin Dipl. zool. who did the largest part of the technical work
presented. I thank them for their cooperation as well as Dr. J. L. Fox,
Washington D.C., USA, Dr. Sidney S. Schochet, Galveston, Texas, USA,
Mrs. M. Steiner, and Miss A. Stutz, for their inestimable help in trans
lating and editing the manuscript.
1·