Cryohypophysectomy: Postmortem Findings in 16 Cases

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One of us (L.W.C.) has described a technique for cryohypophysectomy using the 4.76 mm cryoprobe to obtain complete hypophyseal destruction.4 This paper reports the autopsy findings in 16 of the 104 patients in whom this technique was used. It emphasizes findings in the contents of the sella turcica and surrounding neurovascular structures, as correlated with this technique of cryohypophysectomy.

<bold>Patient Material</bold>

Table 1 summarizes the 16 cases, the technique for producing the lesion, and the interval between hypophysectomy and death. All but two cryohypophysectomies were performed for carcinoma of the breast. Of the

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    Case 1. Left: A section of the neurohypophysis typical of all cases. There was destruction of neurohypophyseal tissue and replacement with prominent capillary proliferation and gliosis. H. & E., × 250. Right: A section through the midsagittal plane of the pituitary gland. Colloid-containing spaces lined by well-differentiated cylindrical epithelium are seen in an area appropriate for the pars intermedia. H. & E., × 250.

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    Case 2. Nests of poorly-differentiated carcinoma cells surrounded by fibroblastic elements are seen in the region of the adenohypophysis, 6 months following cryohypophysectomy. Such metastases were seen in 7 of 16 cases. H. & E., × 250.

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    Case 8. A low-power photograph of the left side of the pituitary gland. The capsule and a portion of the wall of the cavernous sinus are visible at the extreme left. In the immediate subcapsular region, the dark area represents surviving and relatively normal pituitary tissue, 1 month after cryohypophysectomy. The remainder of the histological field consists of necrotic tissue with an early fibroblastic and histiocytic reaction. The darker structures deep within the gland are vessels filled with red blood cells and areas of hemorrhage. The entire pituitary remnant was in the immediate subcapsular region adjacent to the cavernous sinus on the left side, the side on which the cryoprobe was centered 1.5 mm from the midline. H. & E., × 25.

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