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.
Sabel MC, Hans VHJ, Reifenberger G. Mixed Gangliocytoma/Pituitary Adenoma. Arch Neurol. 2000;57(4):587-588. doi:10.1001/archneur.57.4.587