Pituitary Adenoma Neuronal CHoristoma – The PANCH syndrome

Figures & data

Figure 1.  A) Sagittal T1 weighted non-contrast MRI showing hypointense lesion in the pituitary; B) Conventional light microscopy (H & E) of the lesion showing pituitary epithelial cells admixed with bipolar ganglion cells in a glial background (×10); C) Photomicrograph showing synaptophysin positivity D) and background GFAP staining suggestive of glio-neuronal differentiation (×10)

Table I.  Literature review of glioneuronal differentiation of pituitary tumour (PANCH).

Author [ref]	Year	Patients	Comment
Puchner MJ [5]	1995	4	Chronic over-stimulation by hypothalamic releasing hormones produce hormone secreting pituitary adenomas
Saeger W [2]	1997	5	4 cases of GH secreting and 1 case of adenoma tissue with gangliocytoma
Baysefer A [4]	1997	3	PANCH with Cushing's disease
Sharma MC [6]	1999	2	Review of hypothesis of divergent differentiation
Kurosaki M [7]	2002	6	Ganglion cell lesions with synaptophysin, neurofilament and GHRH positivity. Hypothesized that intrasellar gangliocytoma promoted the growth of the pituitary adenoma
Kontogeorgos G [8]	2006	7	Neurofilament protein in pituitary adenomas suggests a common origin for neuronal and pituitary adenoma cell elements in gangliocytomas
Nasr C [9]	2006	1	Hypothalamic gangliocytomas producing GHRH associated with pituitary adenomas causing acromegaly
Serri O [10]	2008	1	Prolactin secretory adenoma with PANCH

Puchner MJ, Lüdecke DK, Saeger W, Riedel M, Asa SL. Gangliocytomas of the sellar region–a review. Exp Clin Endocrinol Diabetes 1995; 103: 129–49

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Saeger W, Lüdecke DK, Losa M. Combined neuronal and endocrine tumors of the sellar region. Pathologe 1997; 18: 419–24

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Baysefer A, Gezen F, Kayali H, Erdo(an E, Timurkaynak E, Celasun B. Intrasellar gangliocytoma resembling pituitary adenoma. Minim Invasive Neurosurg 1997; 40: 107–9

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Sharma MC, Karak AK, Mahapatra AK, Sarkar C. Pituitary adenoma with neuronal choristoma: A report of two rare cases. Clin Neurol Neurosurg 1999; 101: 128–32

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Kurosaki M, Saeger W, Lüdecke DK. Intrasellar gangliocytomas associated with acromegaly Brain Tumor Pathol 2002; 19: 63–7

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Kontogeorgos G, Mourouti G, Kyrodimou E, Liapi-Avgeri G, Parasi E. Ganglion cell containing pituitary adenomas: Signs of neuronal differentiation in adenoma cells. Acta Neuropathol 2006; 112: 21–8

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Nasr C, Mason A, Mayberg M, Staugaitis SM, Asa SL. Acromegaly and somatotroph hyperplasia with adenomatous transformation due to pituitary metastasis of a growth hormone-releasing hormone-secreting pulmonary endocrine carcinoma. J Clin Endocrinol Metab 2006; 91: 4776–80

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Serri O, Berthelet F, Bélair M, Vallette S, Asa SL. An unusual association of a sellar gangliocytoma with a prolactinoma. Pituitary 2008; 11: 85–7

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