Virtual Microscope
A 60 year-old man with hepatic failure and a yellowish pituitary
Jiang Qian, M.D., Ph.D.
Department of Pathology, Albany Medical College, Albany, NY.
Last updated: January 31, 2007
Clinical Information: The patient was a 60 year-old man who presented to the Emergency Department with altered mental status.
His medical history included hepatitis C, alcohol abuse, end-stage liver disease, hepatic encephalopathy, chronic pancreatitis, diabetes mellitus, chronic obstructive pulmonary disease (COPD), anemia because of chronic disease, and paranoid schizophrenia.
On admission, he was found to have high ammonia level which was felt to be responsible for his mental status changes. His white blood cell (WBC) count was also elevated. The patient was admitted to the intensive care unit and treated with Zosyn in addition to other medications as judged medically necessary. He developed sepsis and shock later and died later despite all therapeutic efforts.
On autopsy, the brain was 1,360 grams and grossly unremarkable. The pituitary gland appeared soft with slight yellowish discoloration but without significant enlargement. The following virtual microscope image is obtained from the pituitary gland.
General Autopsy Findings:
- Liver with hepatocellular carcinoma in a background of cirrhosis.
- Ascites: 4000 ml, and splenomegaly: 500 grams.
- Bronchopneumonia.
- Cardiovascular atherosclerotic disease.
- Coronary artery disease (CAD):
- Left anterior descending artery- 60% stenosis.
- Left circumflex artery- 50% stenosis.
- Aortic moderate atherosclerosis.
- Coronary artery disease (CAD):
The brain was 1,360 grams and grossly unremarkable. The pituitary gland appeared soft with slight yellowish discoloration but without significant enlargement. Images from the pituitary gland are illustrated below.
Diagnosis: Metastatic hepatocellular carcinoma.
Pathology: This is a rather interesting case. The entire pituitary is replaced by solid sheets of cells with glandular formation and focal necrosis. On high magnification, brownish yellow secretion highly suspicious of bile pigment is present in many of the glands. The diagnosis of metastatic hepatocellular is quite obvious.