ACTA ENDOCRINOLOGICA (BUC)

Background. Null cell adenoma (NCA) of the pituitary gland, once considered a distinct subtype of nonfunctioning pituitary tumors, has been substantially redefined with the advent of transcription factor (TF) immunostaining. The updated WHO classifications emphasize cell lineage differentiation, significantly narrowing the true spectrum of NCAs. Objective. To underscore the diagnostic challenges and potential misclassification of NCAs by presenting two illustrative cases and reviewing the evolving diagnostic approach. Methods. We describe two diagnostically complex cases initially classified as NCAs due to negative anterior pituitary hormone and TF immunostaining. Both demonstrated atypical clinical features, such as rapid progression and elevated Ki-67 indices, prompting further pathological reassessment. Results. In the first case, follow-up surgeries and additional immunohistochemistry revealed a posterior pituitary tumor—spindle cell oncocytoma. In the second, reevaluation identified hepatocellular carcinoma (HCC) metastasis to the pituitary. These findings highlight the necessity of considering posterior pituitary tumors and metastases in the differential diagnosis of NCAs, especially when clinical or imaging findings suggest alternative etiologies. Conclusion. NCAs must be regarded as a diagnosis of exclusion. Accurate classification depends on thorough clinicopathological correlation, multidisciplinary collaboration, and the use of expanded immunohistochemical panels. Recognition of rare mimickers is crucial for guiding appropriate treatment and improving outcomes.

Context. In patients undergoing thyroidectomy for malignant disease, lower quality of life scores were observed in the early postoperative period compared to those undergoing thyroidectomy for benign causes. Objective. Thyroid gland diseases are commonly encountered in society. This study presents health-related quality of life differences in thyroidectomies performed for benign and malignant diseases and the factors affecting this. Design. Patients who underwent thyroidectomy for thyroid disease between January 2021 and January 2022 were evaluated prospectively. Subjects and Methods. The SF 36 questionnaire was applied and interpreted at the 1st and 6th months after thyroidectomy in patients over the age of 18 who did not have a history of previous thyroid surgery. Results. The study included a total of 228 patients. Among them, 171 (75%) were female (male/female: 57/171). Multinodular goiter in benign cases and papillary carcinoma in malignant cases were predominant (68.3% and 90.6%, respectively). SF-36 scores were found to be worse in the malignant group. Conclusion. In patients undergoing thyroidectomy for malignant disease, lower quality of life scores were observed in the early postoperative period compared to those undergoing thyroidectomy for benign causes.