Pathology slides. (A) Cyst lining with ciliated columnar epithelium (arrow). (B) Surgical specimen with colloidal cyst contents (star). (C) Dense lymphoplasmacyticinfiltrateswithfibrosiswithsomenormal adenohypophysial acinar cells. (D) Plasma cells with IgG4 immunoreactivity using diaminobenzedine-peroxidase detection. Scale barsforA,C,D = 50μm,B = 100μm.

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... hemorrhage, a trans-sphenoidal resection of the sellar mass was performed. In the perioperative period, she was started on intravenous hydrocortisone 100 mg every 8 h, which was eventually tapered to a daily 30 mg oral replacement dose by the third day. Postoperative histopathology revealed an RCC lined by partially ciliated columnar epithelium ( Fig. 2A). Eosinophilic colloidal material, consistent with cyst contents, was admixed with the specimen (Fig. 2B), most of which was composed of adjacent chronic inflammatory infiltrates containing dense collections of lymphocytes and plasma cells (Fig. 2C). The inflammatory changes involved the adenohypophysis as well as areas surrounding the ...

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... she was started on intravenous hydrocortisone 100 mg every 8 h, which was eventually tapered to a daily 30 mg oral replacement dose by the third day. Postoperative histopathology revealed an RCC lined by partially ciliated columnar epithelium ( Fig. 2A). Eosinophilic colloidal material, consistent with cyst contents, was admixed with the specimen (Fig. 2B), most of which was composed of adjacent chronic inflammatory infiltrates containing dense collections of lymphocytes and plasma cells (Fig. 2C). The inflammatory changes involved the adenohypophysis as well as areas surrounding the cyst wall. The plasma cells were largely IgG4 immunoreactive with 40-50/400× microscopic field (Fig. ...

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... day. Postoperative histopathology revealed an RCC lined by partially ciliated columnar epithelium ( Fig. 2A). Eosinophilic colloidal material, consistent with cyst contents, was admixed with the specimen (Fig. 2B), most of which was composed of adjacent chronic inflammatory infiltrates containing dense collections of lymphocytes and plasma cells (Fig. 2C). The inflammatory changes involved the adenohypophysis as well as areas surrounding the cyst wall. The plasma cells were largely IgG4 immunoreactive with 40-50/400× microscopic field (Fig. 2D). Because of the colloidal material within the inflammatory specimen, it was thought that there was likely to have been leakage of the cyst ...

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... specimen (Fig. 2B), most of which was composed of adjacent chronic inflammatory infiltrates containing dense collections of lymphocytes and plasma cells (Fig. 2C). The inflammatory changes involved the adenohypophysis as well as areas surrounding the cyst wall. The plasma cells were largely IgG4 immunoreactive with 40-50/400× microscopic field (Fig. 2D). Because of the colloidal material within the inflammatory specimen, it was thought that there was likely to have been leakage of the cyst contents prior to the resection. Based on the criteria proposed by Leporati et al. (3), the patient was diagnosed with IgG4 hypophysitis. With this diagnosis, we measured a serum IgG4 level which ...

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... initially mistaken for neurosarcoidosis proved a litmus test for the failure of high-dose steroid therapy and methotrexate as a tool for managing IgG4 hypophysitis and RCC (8). Surgical intervention was eventually required. Our reported case was histopathologically diagnosed as IgG4-related hypophysitis concomitant with leakage of RCC contents (Fig. 2). Plasma cells with IgG4 reactivity were detected in the absence of a foreign body reaction. This is a rare phenomenon, with only 4 other cases, to our knowledge, having been described in the literature thus far (Table 2). The association of isolated IgG4 hypophysitis and RCC is nebulous. One postulated mechanism of association is that ...