Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 2369
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size


 
  Table of Contents    
ORIGINAL ARTICLE  
Year : 2011  |  Volume : 54  |  Issue : 4  |  Page : 692-694
Prevalence of pituitary incidentaloma in the Iranian cadavers


1 Department of Forensic Medicine and Toxicology, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Pathology, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Forensic Medicine and Toxicology, Shaheed-Beheshti University of Medical Sciences, Tehran, Iran

Click here for correspondence address and email

Date of Web Publication6-Jan-2012
 

   Abstract 

Aim: Although one-fourth of the pituitary tumors are inactive and silent, increased total volume of the pituitary gland exerts pressure on sella turcica and corrodes the clinoid processes, resulting in several problems. Therefore, determination of the prevalence of the concealed pituitary tumors is of major concern among clinical practitioners. This study was performed to determine the prevalence of these tumors in cadavers referred to the Iranian Legal Medicine Organization (Kahrizak, Tehran). Materials and Methods: This cross-sectional descriptive study was performed between June 2007 and February 2008. A total of 485 cadavers were selected by simple random sampling method. Pituitary glands were removed and then horizontally cut and four slides were prepared from each of them, stained by hematoxylin and eosin, and evaluated by a light microscope. For statistical analysis, SPSS software (version 16), Mann-Whitney U test, Kolmogorov-Smirnov nonparametric test (K-S test), and Chi-square test were used. Results: Of the 485 investigated cadavers, 365 (75.3%) were males with an average age of 42 ± 20.5 years and 120 (24.7%) were females with an average age of 44 ± 22 years. A total of 61 (12.6%) had concealed pituitary masses. No statistically significant difference was found between the mean age, sex, and body mass index (BMI) of the cadavers with and without concealed tumors (P=0.380 P=0.450, and P=0.884, respectively). Conclusions: In the present study, the prevalence of the concealed pituitary adenomas was 12.6%. There was no correlation between age, sex, and BMI and the prevalence of the concealed masses.

Keywords: Autopsy, concealed tumors, pituitary gland, prevalence, Iranian cadavers

How to cite this article:
Aghakhani K, Kadivar M, Kazemi-Esfeh S, Zamani N, Moradi M, Sanaei-Zadeh H. Prevalence of pituitary incidentaloma in the Iranian cadavers. Indian J Pathol Microbiol 2011;54:692-4

How to cite this URL:
Aghakhani K, Kadivar M, Kazemi-Esfeh S, Zamani N, Moradi M, Sanaei-Zadeh H. Prevalence of pituitary incidentaloma in the Iranian cadavers. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Apr 26];54:692-4. Available from: http://www.ijpmonline.org/text.asp?2011/54/4/692/91493



   Introduction Top


Sellar and para-sellar masses present with clinical and radiological features ranging from asymptomatic incidental presentations/hormonal effects to compressive local mass effects. One-fourth of these tumors are endocrinologically inactive and silent. In the active ones, hyperprolactinemia or hypogonadism are the most common signs. [1] Several pathological lesions have been detected in the pituitary gland; adenoma is the most common among them that almost specifically arises in the anterior lobe of the gland. [2],[3],[4] In addition, epithelial neoplasms are the most common neoplasms in the pituitary gland with their origin from adenohypophysis cells which constitute about 15-20% of the neoplasms inside the skull. [5],[6],[7] However, pituitary tumors lead to dilatation of the sella turcica and corrosion of the clinoid edges and damage the chiasm or optic nerve resulting in reduced vision. [8],[9],[10],[11] Determining the prevalence of pituitary tumors in the general population is of major concern among the clinical specialists. [12],[13],[14],[15] Davis and his colleagues [16] showed that pituitary tumors were less prevalent compared to tumors in other parts of the body including tumors of the lungs, breasts, and colon. However, a meta-analysis on radiologic studies and autopsies, performed by Ezzat and his colleagues, [17] showed that one of each six persons is suffering from the pituitary tumors. Due to the controversial results in the literature and lack of accurate estimation of the prevalence of the concealed tumors of the pituitary gland in our country, this study was performed to determine the prevalence of these tumors in cadavers.


   Materials and Methods Top


This cross-sectional descriptive study was performed between June 2007 and February 2008 in the Iranian Legal Medicine Organization (Kahrizak, Tehran), and 485 cadavers were selected by simple random sampling method. After opening the skull and removing the brain and cerebellum, pituitary gland was removed and put into 10% formalin solution. Samples were horizontally cut to prepare four slides form each sample, stained by hematoxylin and eosin (H and E) and evaluated by a light microscope. We did not perform the reticulin stain and immunohistochemistry and the diagnosis was based on the conventional H and E stain. Specifications of the cadavers including age, gender, body mass index (BMI), and pathologic changes such as presence or absence of concealed tumors were recorded in the above-mentioned checklist.

Statistical Analysis

For analyzing the data, SPSS software (version 16), Mann-Whitney U test, Kolmogorov-Smirnov nonparametric test (K-S test), and Chi-square test were used and a P value less than 0.05 was considered to be statistically significant.

Ethics

Information of the cadavers, such as the identity specifications, were kept completely secured and only codes were used for the review and analysis of the data. Our study was approved by the regional ethics committee.


   Results Top


Of the 485 investigated cadavers, 365 (75.3%) were males with the average age of 42 ± 20.5 years and 120 (24.7%) were females with the average age of 44 ± 22 years. After calculating the cadavers' body mass index (BMI; BMI of 20-25 indicates optimal weight), they were divided into three groups: underweight (BMI < 20), normal range (20 < BMI < 25), and overweight (BMI > 25) groups. A total of 194 (40%), 187 (38.5%), and 104 (21.5%) cadavers were in underweight, normal range, and overweight groups, respectively. Of the 485 pathologic samples, 424 (87.4%) had no evidence (group I), while 61 (12.6%) had concealed pituitary masses (adenoma) (group II) [Figure 1]. No significant statistical difference was detected between the mean age of these two groups (P=0.380). Also, there were no significant statistical differences between three BMI groups regarding the prevalence of pituitary masses (P=0.884). Furthermore, the prevalence of the adenoma was not different between male and female cadavers (P=0.450).
Figure 1: Concealed pituitary adenoma in a 65-year-old female (a and b) and a 72-year-old male (c and d), stained by hematoxylin and eosin (H and E; ×40 in a and c; ×10 in b and d)

Click here to view



   Discussion Top


Pituitary adenomas diagnosed by methods such as computed tomography (CT) scan and magnetic resonance imaging (MRI) have a frequency of about 3.7-37%; while in studies performed on cadavers, it is about 1.4-27%. [18],[19],[20],[21],[22] Different statistical results are due to the different methods of histology sampling. [23],[24] Number and thickness of the samples may affect the prevalence of malignancy; however, this subject has not yet been proven. [19],[20],[21] In this study, diagnosis of adenoma was made based on the proliferation of the endocrine cells with diffused, sinusoidal, or papillary growth pattern, loss of normal structure of acinar and stromal cells, and compression of the parenchymal tissues adjacent to the pituitary gland [Figure 1]. Additionally, the prevalence of the concealed pituitary adenomas was 12.6% which is less than the results obtained by the previous studies and may be justified based on the method of detection of the adenomas. Unlike other studies showing a relation between age and prevalence of the concealed pituitary masses, the present study showed no correlation between these two variables. [25],[26],[27] In addition, in this study, no association was detected between the gender of the cadavers and prevalence of the concealed masses, which is in accordance with the previous studies. [21],[22],[23],[24],[28]

However, in studies performed using diagnostic radiologic procedures and surgery, the prevalence of the concealed pituitary masses was more in women. [22] On the basis of the results obtained in this study, there was no statistically significant correlation between BMI and the prevalence of the concealed pituitary tumors. Other studies are warranted to survey the type of adenoma, such as functional and non-functional adenomas, and its subtypes, which could not be evaluated in this survey.


   Acknowledgment Top


This study was supported by a grant from the Iranian Legal Medicine Organization.

 
   References Top

1.Famini P, Maya MM, Melmed S. Pituitary Magnetic Resonance Imaging for Sellar and Parasellar Masses: Ten-Year Experience in 2598 Patients. J Clin Endocrinol Metab 2011;96:1633-41.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Krikorian A, Aron D. Evaluation and management of pituitary incidentalomas- revisiting an acquaintance. Nat Clin Pract Endocrinol Metab 2006;2:138-45.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Aron DC, Howlett TA. Pituitary incidentalomas. Endocrinol Metab Clin North Am 2000;29:205-21.  Back to cited text no. 3
[PUBMED]    
4.Sanno N, Oyama K, Tahara S, Teramoto A, Kato Y. A survey of pituitary incidentaloma in Japan. Eur J Endocrinol 2003;149:123-7.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Rosai J. Ackerman's Surgical Pathology. 8 th ed. New York: Mosby; 1996.  Back to cited text no. 5
    
6.Silverberg SG. Principles and practice of surgical pathology and cytopathology. 3 rd ed. New York: Churchill livingstone; 1997.  Back to cited text no. 6
    
7.Fletcher CD. Diagnostic histopathology of tumors. 2 nd ed. London: Churchill Livingstone; 2000.  Back to cited text no. 7
    
8.Tsang RW, Brierley JD. Radiation therapy for pituitary adenoma: Treatment outcome and prognostic factors. Int J Radiat Oncol Biol Phys 1994;30:557-65.  Back to cited text no. 8
    
9.Zierhut D, Flentje M, Adolph J, Erdmann J, Raue F, Wannenmacher M. External radiation therapy of pituitary adenoma. Int J Radiation Oncol Biol Phys 1995;33:307-14.  Back to cited text no. 9
    
10.Kovalic JJ, Grigsby PW, Fineberg BB. Recurrent pituitary adenoma after surgical resection. Radiology 1990;177:273-5.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  
11.DeVita VT, Hellman S, Rosenberg SA. Cancer: Principles and Practices of Oncology. 6 th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2001.  Back to cited text no. 11
    
12.Nammour GM, Ybarra J, Naheedy MH, Romeo JH, Aron DC. Incidental pituitary macroadenoma: A population-based study. Am J Med Sci 1997;314:287-91.  Back to cited text no. 12
[PUBMED]  [FULLTEXT]  
13.Asa SL. Tumors of the pituitary gland. In: Rosai J. Atlas of tumor pathology, 3 rd series Fascicle 22. Washington DC: Armed Forces Institute of Pathology; 1998.  Back to cited text no. 13
    
14.Muhr C, Bergstrom K, Grimelius L, Larsson SG. A parallel study of the roentgen anatomy of the sella turcica and the histopathology of the pituitary gland in 205 autopsy specimens. Neuroradiology 1981;21:55-65.  Back to cited text no. 14
    
15.Teramoto A, Hirakawa K, Sanno N, Osamura Y. Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology 1994;193:161-4.  Back to cited text no. 15
[PUBMED]  [FULLTEXT]  
16.Davis FG, Kupelian V, Freels S, McCarthy B, Surawicz T. Prevalence estimates for primary brain tumors in the United States by behavior and major histology groups. Neuro Oncol 2001;3:152-8.  Back to cited text no. 16
[PUBMED]  [FULLTEXT]  
17.Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, et al. The prevalence of pituitary adenomas: A systematic review. Cancer 2004;101:613-9.  Back to cited text no. 17
[PUBMED]  [FULLTEXT]  
18.Aron DC, Howlett TA. Pituitary incidentalomas. Endocrinol Metab Clin North Am 2000;29:205-21.  Back to cited text no. 18
[PUBMED]    
19.Camaris C, Balleine R, Little D. Microadenomas of the human pituitary. Pathology 1995;27:8-11.  Back to cited text no. 19
[PUBMED]  [FULLTEXT]  
20.Parent AD, Brown B, Smith EE. Incidental pituitary adenomas: A retrospective study. Surgery 1982;92:880-3.  Back to cited text no. 20
[PUBMED]    
21.Burrow GN, Wortzman G, Rewcastle NB, Holgate RC, Kovacs K. Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N Engl J Med 1981;304:156-8.  Back to cited text no. 21
[PUBMED]  [FULLTEXT]  
22.Fainstein Day P, Guitelman M, Artese R, Fiszledjer L, Chervin A, Vitale NM, et al. Retrospective multicentric study of pituitary incidentalomas. Pituitary 2004;7:145-8.  Back to cited text no. 22
[PUBMED]  [FULLTEXT]  
23.Gorczyca W, Hardy J. Microadenomas of the human pituitary and their vascularization. Neurosurgery 1988;22:1-6.  Back to cited text no. 23
[PUBMED]    
24.Parent AD, Bebin J, Smith RR. Incidental pituitary adenomas. J Neurosurg 1981;54:228-31.  Back to cited text no. 24
[PUBMED]  [FULLTEXT]  
25.Ghorbani M, Kosari F, Mardani F, Saeednejad R, Mohammadi N, Akhlaghi M. Prevalence and distribution study of sella turcica tumors in 20 years and more old cadavers dissected in the legal medicine center of Tehran in 1383-1384. [Article in Persian] Sci J Forensic Med 2006;12:87-9.  Back to cited text no. 25
    
26.Kastelan D, Korsic M. High prevalence rate of pituitary incidentaloma: Is it associated with the age-related decline of the sex hormones levels? Med Hypotheses 2007;69:307-9.  Back to cited text no. 26
[PUBMED]  [FULLTEXT]  
27.Char G, Persaud V. Asymptomatic microadenomas of the pituitary gland in an unselected autopsy series. West Indian Med J 1986;35:275-9.  Back to cited text no. 27
[PUBMED]    
28.Tomita T, Gates E. Pituitary adenomas and granular cell tumors. Incidence, cell type, and location of tumor in 100 pituitary glands at autopsy. Am J Clin Pathol 1999;111:817-25.  Back to cited text no. 28
[PUBMED]    

Top
Correspondence Address:
K Aghakhani
Department of Forensic Medicine and Toxicology, Tehran University of Medical Sciences, Hazrat Rasoul Akram Hospital, Niayesh Street, Sattar-Khan Ave., 1445613131, Tehran
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.91493

Rights and Permissions


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Acknowledgment
    References
    Article Figures

 Article Access Statistics
    Viewed1985    
    Printed91    
    Emailed6    
    PDF Downloaded71    
    Comments [Add]    

Recommend this journal