Development of a histological pseudocapsule and its use as a surgical capsule in the excision of pituitary tumors

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Object

The presence of a histological pseudocapsule around pituitary tumors was noted in the early 1900s. Since that time there has been no emphasis on the sequence of the stages of its development or on the relationship between these stages and the capacity to identify very small pituitary tumors at surgery in patients in whom preoperative imaging has been nondiagnostic. In addition, limited emphasis has been given to the pseudocapsule’s use for selective and complete resection of pituitary adenomas.

Methods

The development of the pseudocapsule was examined by performing histological analysis of portions of pituitary glands removed during 805 operations for Cushing disease.

Twenty-five adenomas, each measuring between 0.25 and 4 mm in maximum diameter, were detected in the excised specimens; 17 were adenocorticotropic hormone–positive adenomas and eight were incidental tumors (four prolactin-secreting and four nonsecreting lesions). In 16 tumors the size of the adenoma could be established. The distribution of tumor size in relation to the presence of a histological pseudocapsule indicates a transition from the absence of a reticulin capsule (tumor diameter ≤ 1 mm) through the initial compression of surrounding tissue (tumor diameter 1–2 mm) to the presence of a multilayered reticulin capsule observed when adenomas become larger (tumor diameter 2–3 mm).

Conclusions

The absence of a reticulin capsule in cases of very small tumors may contribute to limited localization of these lesions during surgical exploration of the pituitary gland. In this article the authors describe surgical techniques in which the histological pseudocapsule is used as a surgical capsule during pituitary surgery. In their experience, recognition of this surgical capsule and its use at surgery has contributed to the identification of microadenomas buried in the pituitary gland, aided the recognition of subtle invasion of the pituitary capsule and contiguous dura mater, and enhanced the consistency of complete tumor excision with small and large tumors.

Abbreviations used in this paper: ACTH = adrenocorticotropic hormone; MR = magnetic resonance; PRL = prolactin.
Article Information

Contributor Notes

Address reprint requests to: Edward H. Oldfield, M.D., Building 10, Room 5D37, National Institutes of Health, Bethesda, Maryland 20892. email: oldfielde@ninds.nih.gov.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Bergland R: Pathological considerations in pituitary tumors. Prog Neurol Surg 6:62941975

  • 2

    Chacko AGChacko GSeshadri MSChandy MJ: The ‘capsule’ of pituitary macroadenomas represents normal pituitary gland: a histopathological study. Br J Neurosurg 17:2132182003

    • Search Google Scholar
    • Export Citation
  • 3

    Ciric I: On the origin and nature of the pituitary gland capsule. J Neurosurg 46:5966001977

  • 4

    Costello RT: Subclinical adenoma of the pituitary gland. Am J Pathol 12:2052161936

  • 5

    Couldwell WT: Transsphenoidal and transcranial surgery for pituitary adenomas. J Neurooncol 69:2372562004

  • 6

    Das KSpencer WNwagwu CISchaeffer SWenk EWeiss MH: Approaches to the sellar and parasellar region: anatomic comparison of endonasal-transsphenoidal, sublabial-transsphenoidal, and transethmoidal approaches. Neurol Res 23:51542001

    • Search Google Scholar
    • Export Citation
  • 7

    Dickerman RDOldfield EH: Basis of persistent and recurrent Cushing disease: an analysis of findings at repeated pituitary surgery. J Neurosurg 97:134313492002

    • Search Google Scholar
    • Export Citation
  • 8

    Farnoud MRKujas MDerome PRacadot JPeillon FLi JY: Interactions between normal and tumoral tissues at the boundary of human anterior pituitary adenomas. An immunohistochemical study. Virchows Arch 424:75821994

    • Search Google Scholar
    • Export Citation
  • 9

    Grisoli FBrue TGraziani NCosta RTrouillas JBegou D: Enlarged adenomectomy for enclosed prolactinomas: a preliminary study of 26 cases. Acta Neurochir (Wien) 103:92981990

    • Search Google Scholar
    • Export Citation
  • 10

    Hardy JTrans-sphenoidal approach to the pituitary gland. Wilkins RHRengachary SS: Neurosurgery ed 2 New YorkMcGraw-Hill1996. Vol 1:13751384

    • Search Google Scholar
    • Export Citation
  • 11

    Hardy J: Trans-sphenoidal microsurgical removal of pituitary microadenoma. Prog Neurol Surg 6:2002161975

  • 12

    Hashimoto NHanda HYamagami T: Transsphenoidal extracapsular approach to pituitary tumors. J Neurosurg 64:16201986

  • 13

    Herman VFagin JGonsky RKovacs KMelmed S: Clonal origin of pituitary adenomas. J Clin Endocrinol Metab 71:142714331990

  • 14

    Jacoby LBHedley-Whyte ETPulaski KSeizinger BRMartuza RL: Clonal origin of pituitary adenomas. J Neurosurg 73:7317351990

  • 15

    Jane JA JrThapar KKaptain GJMaartens NLaws ER Jr: Pituitary surgery: transsphenoidal approach. Neurosurgery 51:4354442002

  • 16

    Kaptain GJVincent DASheehan JPLaws ER Jr: Transsphenoidal approaches for the extracapsular resection of midline suprasellar and anterior cranial base lesions. Neurosurgery 49:941012001

    • Search Google Scholar
    • Export Citation
  • 17

    Kawamata TKubo OHori T: Surgical removal of growth hormone-secreting pituitary adenomas with intensive microsurgical pseudocapsule resection results in complete remission of acromegaly. Neurosurg Rev 28:2012082005

    • Search Google Scholar
    • Export Citation
  • 18

    Kessel RG: Basic Medical Histology: The Biology of Cells Tissues and Organs New YorkOxford University Press1998

  • 19

    Kuwayama A: [Surgery in endocrine disorders. 1. Pituitary tumors.]. Nippon Geka Gakkai Zasshi 85:101410181984. (Jpn)

  • 20

    Kuwayama A: Treatment and long-term results of Cushing disease. Folia Endocrinol Japon 79:17192003

  • 21

    Landis CAMasters SBSpada APace AMBourne HRVallar L: GTPase inhibiting mutations activate the alpha chain of Gs and stimulate adenylyl cyclase in human pituitary tumours. Nature 340:6926961989

    • Search Google Scholar
    • Export Citation
  • 22

    Laws ETranssphenoidal approach to pituitary tumors. Schmidek HHSweet WH: Operative Neurosurgical Techniques: Indications Methods and Results ed 3 PhiladelphiaWB Saunders1995. Vol 1:283292

    • Search Google Scholar
    • Export Citation
  • 23

    Laws ERSheehan JPSheehan JMJagnathan JJane JA JrOskouian R: Stereotactic radiosurgery for pituitary adenomas: a review of the literature. J Neurooncol 69:2572722004

    • Search Google Scholar
    • Export Citation
  • 24

    Lyons JLandis CAHarsh GVallar LGrunewald KFeichtinger H: Two G protein oncogenes in human endocrine tumors. Science 249:6556591990

    • Search Google Scholar
    • Export Citation
  • 25

    Mason RBNieman LKDoppman JLOldfield EH: Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function. J Neurosurg 87:3433511997

    • Search Google Scholar
    • Export Citation
  • 26

    Oldfield EHChrousos GPSchulte HMSchaaf MMcKeever PEKrudy AG: Preoperative lateralization of ACTH-secreting pituitary microadenomas by bilateral and simultaneous inferior petrosal venous sinus sampling. N Engl J Med 312:1001031985

    • Search Google Scholar
    • Export Citation
  • 27

    Schulte HMOldfield EHAllolio BKatz DABerkman RAAli IU: Clonal composition of pituitary adenomas in patients with Cushing’s disease: determination by X-chromosome inactivation analysis. J Clin Endocrinol Metab 73:130213081991

    • Search Google Scholar
    • Export Citation
  • 28

    Thapar KKovacs KHorvath EAsa SLClassification and pathology of pituitary tumors. Wilkins RHRengachary SS: Neurosurgery ed 2 New YorkMcGraw-Hill1996. Vol 1:12731289

    • Search Google Scholar
    • Export Citation
  • 29

    Thapar KLaws ER JrPituitary tumors: Functioning and non-functioning. Winn H: Youmans Neurological Surgery ed 5 PhiladelphiaSaunders2003. Vol 1:11691206

    • Search Google Scholar
    • Export Citation
  • 30

    Tindall GTHerring CJClark RVAdams DAWatts NB: Cushing’s disease: results of transsphenoidal microsurgery with emphasis on surgical failures. J Neurosurg 72:3633691990

    • Search Google Scholar
    • Export Citation
  • 31

    Watson JCShawker THNieman LKDeVroom HLDoppman JLOldfield EH: Localization of pituitary adenomas by using intraoperative ultrasound in patients with Cushing’s disease and no demonstrable pituitary tumor on magnetic resonance imaging. J Neurosurg 89:9279321998

    • Search Google Scholar
    • Export Citation
  • 32

    Wrightson P: Conservative removal of small pituitary tumours: is it justified by the pathological findings?. J Neurol Neurosurg Psychiatry 41:2832891978

    • Search Google Scholar
    • Export Citation
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