Mixed gangliocytoma-pituitary adenoma of dual lineage: A case report

Worldwide, the simultaneous occurrence of sellar gangliocytoma with pituitary adenoma is rarely reported. Herein, we describe a unique case of mixed gangliocytoma-pituitary adenoma of dual lineage. A 45-year-old male presented with transient ischemic attack, right sided numbness and decreased vision. Endocrinological examination found prolactin level to be elevated. Imaging studies revealed a 2.8 cm sellar/suprasellar lesion with superior displacement of optic chiasm. The patient underwent tumor resection via endoscopic endonasal transsphenoidal approach. Histologic sections show a biphasic tumor with two populations of cells, mature ganglion cells and prolactin secreting neuroendocrine cells. The tumor has unique dual lineage with one dominant expression of pituitary-specific transcription factor (PIT1) in all cell components which matched closely to prolactin positivity. By Immunohistochemistry, a less prominent but obvious component of scattered steroidogenic factor 1 (SF1) positive cells were identified, although follicle stimulating hormone (FSH) and luteinizing hormone (LH) were negative. T-box transcription factor (TPIT) stain was negative. Accordingly, the diagnosis of mixed gangliocytoma-pituitary adenoma of dual lineage was established.