Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc
Journal website

Case Report

Volume 8, Number 5, October 2018, pages 113-118

A Case of Pituitary Germinoma Misdiagnosed as Lymphocytic Hypophysitis


Figure 1.
Figure 1. Cranial magnetic resonance imaging (MRI). Post-contrast images of sellar mass at the diagnosis (a and b) and after radiotherapy (c).
Figure 2.
Figure 2. Pituitary histopathology. Heavy infiltrate of B lymphocytes compatible with lymphicytic hypophysitis (a); immunohistochemistry staining for c-kit (b) and PALP (c) highlighting germinoma’s cell.


Table 1. Cases of Germinoma Misdiagnosed Pathologically as Lymphocytic Hypophysitis
Case reportAgeSexClinical presentationHormonal evaluationFirst MRI findingFirst Bx lymphocitic infiltration ± granulomatous change or fibrosisTumor markersIHCInitial treatmentTime to final diagnosis
Panhypo: panhypopituitarism; DI: diabetes insipidus; Wt: weight; Bx: biopsy; IHC: immunohistochemistry; PLAP: placental alkaline phosphatase; GC: glucocorticoid; NK: not known; Nd: not described. *In this case, the diagnosis of germinoma was confirmed by the first biopsy using IHC study.
Mikami-Terao et al (2006) [9]13FemalePolyuria, polydipsia, headache, pubertal arrestPanhypo DIEnlarged pituitary, mass lesion in the stalkYesNegativeFirst Bx: CD20, CD79, CD3, CD5, CD45
Second Bx: PLAP
GC> 24 months
Terasaka et al (2012) [28]40FemalePolyuria, polydipsia, amenorrhea, headache, double vision, Wt loss, nerve palsyPanhypo DIIntrasellar mass, stalk thickeningYes (fibrosis)NegativeFirst Bx: CD3, CD20
Second Bx: PLAP, c-kit
GC84 months
Fehn et al (1999) [29]12FemalePolyuria, polydipsia, growth retardation, headache, visual lossPanhypo DINormalYes (fibrosis)NegativeSecond Bx: CD43, CD45, CD20
Third Bx: PLAP
GC72 months
Gutenberg et al (2011) [33]11FemaleBlurred vision, fatigue, polyuria, polydipsiaPanhypo DIIntra- and suprasellar massYesNegativeFirst Bx: CD79, CD3
Second Bx: c-kit, Oct4
GC30 months
Endo et al (2002) [30]12MalePolyuria, polydipsia, fatigue, loss of appetitePanhypo DIIntrasellar mass with suprasellar extension and right cavernous invasionYes (granulomatous change)NegativeFirst Bx: Nd
Second Bx: PLAP
GC30 months
Bettendorf et al (1999) [31]8FemalePolyuria, polydipsia, short staturePanhypo DINormalYesNegativeNdGC77 months
Amat Madramany et al (2015) [32]10MalePolyuria, polydipsiaPanhypo DINormalDiagnosis: lymphocytic hypophysitisNegativeNKNK36 months
Houdouin* et al (2003) [12]13MalePolyuria, polydipsia, visual field defectPanhypo DINormalDiagnosis: lymphocytic hypophysitisNKFirst Bx: PLAP, c-kitNKNK
Houdouin* et al (2003) [12]21MalePolyuria, polydipsia, visual field defectPanhypo DIStalk thickeningDiagnosis: lymphocytic hypophysitisNKFirst Bx: PLAP, c-kitNKNK