Adenoma acidófilo de células madre: reporte de un caso atípico / Stem cells acidopylic adenoma: report of an atypical case

ABSTRACT

Objective. We developed a bibliographic research of this rarely and highly aggressive entity, showing our experience and taking into account the special case of one patient, who developed an extremely aggressive disease. Description. Patient of 71 years that consults our department for left cavernous syndrome associated with moderate headache and bilateral visual accuracy diminish. Pituitary IRM was performed showing a homogeneous selar tumor that causes slight mass effect towards optic quiasm. Both cavernous sinuses were compromised. Intervention.Trasfenoidal surgery was performed, reaching the diagnosis of acidophil stem cell adenoma. The patient is dismissed. One week later and because of the development of sudden visual loss she was admitted once again. Pituitary IRM was performed showing a massive growth of the known lesion, requiring transcranial approach. Important mass reduction was achieved but our patient evolution was erratic. Three weeks after surgery we decided to repeat the IRM where we discovered the great mass reduction achieved in the second surgery did not reflect the voluminous lesion shown. One week later the patient died. Conclusion. Acidophil stem cell adenomas of the pituitary gland are mixed PRL/GH lesions, but because its immaturity non functional secreting hormones are produced; this is why these patients do not express physiognomic changes. We should think of this pathology in any pituitary tumor with low PRL-GH expression and few physiognomic changes, and aggressive natural evolution.