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Hypothalamic Vasopressin-Producing Tumors

Often Inappropriate Diuresis But Occasionally Cushing Disease

Asa, Sylvia L., MD, PhD*; Ezzat, Shereen, MD*; Kelly, Daniel F., MD; Cohan, Pejman, MD; Takasumi, Yuki, MD; Barkhoudarian, Garni, MD; Heaney, Anthony P., MD; Ridout, Rowena, MD*; Chik, Constance L., MD, PhD§; Thompson, Lester D.R., MD; Gentili, Fred, MD*; Mete, Ozgur, MD*

The American Journal of Surgical Pathology: February 2019 - Volume 43 - Issue 2 - p 251–260
doi: 10.1097/PAS.0000000000001185
Original Articles
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Tumors of hypothalamic neurons that produce vasopressin are rare. We retrieved all cases of vasopressin-positive tumors in the sellar region from the database of the Department of Pathology. Five cases fulfilled the selection criteria, representing the first series of such tumors. Clinical, radiologic, and pathologic features were reviewed. Four tumors classified as neurocytomas were identified in 3 females and 1 male patient; the ages at onset of symptoms ranged from 17 to 40 years. All were large sellar masses with suprasellar extension and/or invasion of the parasellar sinuses. Three patients had the syndrome of inappropriate antidiuresis; in one of these, a 6-year history was initially considered to be idiopathic. One patient died of progressive disease; 3 had incomplete resections and are being followed. In contrast to these patients with neurocytoma, a 65-year-old woman had Cushing disease and a 0.8 cm mass that was completely resected at transsphenoidal surgery; this tumor was a gangliocytoma producing vasopressin associated with corticotroph hyperplasia. We postulate that the small amount of vasopressin secreted by this mature gangliocytic tumor was locally bound to corticotrophs, resulting in hyperplasia and Cushing disease, without sufficient overproduction to cause systemic effects of vasopressin excess. Hypothalamic neurocytoma is a tumor that can mimic pituitary neuroendocrine tumors and olfactory neuroblastoma but is distinguished by positivity for neurofilaments, NeuN, and TTF-1 and negative staining for adenohypophysial biomarkers. Our cases illustrate that neurocytoma and gangliocytoma are 2 variants of tumors of hypothalamic neurons that can produce vasopressin. The morphologic and proliferative features of these 2 tumor types represent 2 ends of a spectrum; their function also can result in divergent clinical manifestations, one characterized by reduced urine output and the other by the more insidious features of glucocorticoid excess.

*Endocrine Oncology Site Group, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

§Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB

Pacific Brain Tumor Center & Pituitary Disorders, John Wayne Cancer Institute at Providence Saint John’s Health Center

Department of Endocrinology, University of California, Los Angeles

Department of Pathology, Southern California Permanente Medical Group, Woodland Hills, CA

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: Sylvia L. Asa, MD, PhD, Department of Pathology, University Health Network, Laboratory Medicine & Pathobiology, University of Toronto, 200 Elizabeth Street, 11th floor, Toronto, ON, Canada M5G 2S3 (e-mail: sylvia.asa@utoronto.ca).

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