J Korean Soc Endocrinol.  2006 Jun;21(3):245-250. 10.3803/jkes.2006.21.3.245.

A Case of Pituitary Mucormycosis in Diabetic Patient with Acromegaly and Gastric Cancer

• Choi PR
• Yu HJ
• Yang SW
• Kim GJ
• Rim H
• Kim YR
• Choi YS
• Park YH
• Chun BK

• KMID: 2200737
• DOI: http://doi.org/10.3803/jkes.2006.21.3.245

Abstract

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon, acute, and aggressive fungal infection occurring in several immunocompromised states including poorly controlled diabetes. ROCM causes a very high residual morbidity and mortality due to the angioinvasion property of the fungus. Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone, generally from pituitary adenoma. Although it has been demonstrated that acromegalic patients have an increased risk of neoplasm, gastric cancer with acromegaly is very rare. We experienced a case of pituitary mucormycosis in the diabetic patient with acromegaly and gastric cancer. The patient was treated successfully with subtotal gastrectomy for early gastric cancer, transsphenoidal surgery for pituitary adenoma, and a systemic application of amphotericin B for the mucormycosis.

MeSH Terms

Acromegaly*
Amphotericin B
Fungi
Gastrectomy
Growth Hormone
Humans
Mortality
Mucormycosis*
Pituitary Neoplasms
Stomach Neoplasms*
Amphotericin B
Growth Hormone

Figure

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  Fig. 1 A. Caldwell view shows no air fluid level in sinus. B. Sella MRI shows 0.3×0.5 cm sized mass (arrow) at the right side of pituitary gland. C. Sella MRI after transsphenoidal surgery.

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  Fig. 2 Endoscopic finding. An irregular and hyperemic depression with a small ulceration on center and abnormalities of the surrounding folds, such as interruption and clubbing are noted on the lesser curvature side of the proximal antrum (arrow).

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  Fig. 3 Microscopic features of resected stomach. Signet ring cell type of gastric adenocarcinoma confined within the mucosa in gastrectomy specimen (H&E stain, ×200)

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  Fig. 4 A microscopic finding of the pituitary adenoma, with acidophilic cells arranged in clusters or in trabecular pattern and some hyphae (arrow) (H&E stain, ×400).

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  Fig. 5 Microscopic features of removed pituitary adenoma. A, pituitary gland parenchyme (H&E stain, ×200); B, mucormycosis with broad, non-septated hyphae (H&E stain, ×400); C and D, well defined hyphae contour (PAS stain, ×400 and GMS stain, ×400, respectively).

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