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Mixed Gangliocytoma-Pituitary Adenoma: Insights on the Pathogenesis of a Rare Sellar Tumor

Lopes, M. Beatriz S. MD, PhD; Sloan, Emily MD, PhD; Polder, Julie HT (ASCP), QIHC

The American Journal of Surgical Pathology: May 2017 - Volume 41 - Issue 5 - p 586–595
doi: 10.1097/PAS.0000000000000806
Original Articles

Gangliocytomas originating in the sellar region are rare; most are tumors composed of gangliocytic and pituitary adenomatous elements, forming the so-called mixed gangliocytoma-pituitary adenoma. The majority of mixed gangliocytoma adenomas are associated with endocrinopathies, mainly acromegaly and less often Cushing disease and hyperprolactinemia. In the present study, 10 cases of mixed gangliocytoma and somatotroph adenomas were evaluated for patterns of cellular differentiation and expression of lineage-specific transcription factors. The tumors were characterized by immunohistochemistry for pituitary hormones, cytokeratins, Pit-1, and the neuronal markers NeuN, neurofilaments (NFP), and MAP2. Double-labeling immunohistochemistry for Pit-1/GH, Pit-1/NFP, Pit-1/MAP2, and NeuN/GH was performed in 9/10 tumors. Our data demonstrate that both adenomatous and ganglionic cells express the acidophilic lineage transcription factor Pit-1. Although mixed gangliocytomas and somatotroph adenomas show histologically distinct cellular populations, there is at least a small population of cells that coexpress the Pit-1 transcription factor and neuronal-associated cytoskeletal proteins favoring the theory of transdifferentiation of neuroendocrine cells into neuronal elements of these mixed tumors.

Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA

Supported by University of Virginia Department of Pathology Research Fund.

Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: M. Beatriz S. Lopes, MD, PhD, Department of Pathology, University of Virginia School of Medicine, 1215 Lee Street, Room 3060, HEP, Charlottesville, VA 22908-0214 (e-mail:

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