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Spectrum of different types of hypophysitis: A clinicopathologic study of hypophysitis in 31 cases

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Abstract

Hypophysitis has been histologically classified into five types: lymphocytic hypophysitis (LYH), granulomatous hypophysitis (GRH), xanthogranulomatous hypophysitis (XGH), xanthomatous hypophysitis (XH), and necrotizing hypophysitis. The present study evaluated 31 cases of hypophysitis to clarify their characteristic clinicopathologic features. The lesions were histologically classified into four groups: LYH (22 cases) including lymphocytic adenohypophysitis (LAH) (19 cases) and lymphocytic infundibuloneurohypophysitis (LINH) (3 cases), GRH (5 cases), XGH (2 cases), and XH (2 cases). In each group, the pituitary gland showed lymphocytic infiltration associated with focal or diffuse hypophysial destruction of variable severity and fibrosis. Histologic and clinical overlap among different types of hypophysitis, especially between LAH and LINH, suggest that these entities may have similar etiologic background and/or represent different stages of the same lesion. Considering the sampling sites and clinical manifestations, LAH may not usually involve the neurohypophysis, but LINH may often extend to the adenohypophysitis. A selective loss of adrenocorticotropic hormone-positive cells was seen in two patients with LAH despite only very slight lymphoplasmacytic infiltration. This suggests that there may be at least two causative mechanisms for hypopituitarism in hypophysitis: nonspecific destruction of all types of adenohypophysical cells by severe inflammation and selective destruction of specific adenohypophysial cells.

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Authors and Affiliations

  1. Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan

    Hiroshi Nishioka MD, PhD

  2. Department of Neurosurgery, Toranomon Hospital, Tokyo, Japan

    Shozo Yamada MD, PhD

  3. Department of Pathology, St. Michael’s Hospital, University of Toronto, Ontario, Canada

    Kalman Kovacs MD, PhD

  4. Department of Pathology, University of Tokushima School of Medicine, 3-18-15 Kuramoto-cho, 770-8503, Tokushima, Japan

    Takashi Tashiro MD,  Toshiaki Sano MD, PhD, Bing Xu MD, PhD, Shingo Wakatsuki MD & Noriko Kagawa MD, PhD

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  1. Takashi Tashiro MD
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  2. Toshiaki Sano MD, PhD
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  3. Bing Xu MD, PhD
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  4. Shingo Wakatsuki MD
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  5. Noriko Kagawa MD, PhD
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Correspondence to Toshiaki Sano MD, PhD.

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Tashiro, T., Sano, T., Xu, B. et al. Spectrum of different types of hypophysitis: A clinicopathologic study of hypophysitis in 31 cases. Endocr Pathol 13, 183–195 (2002). https://doi.org/10.1385/EP:13:3:183

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