case_images: PMC10762640_01
case_images: Clinical course of the patient. ACTH, adrenocorticotropic hormone; SOX, S-1 + oxaliplatin; CAPOX, capecitabine + oxaliplatin; HbA1c, hemoglobin A1c; AE, adverse event; irAE, immune-related AE.
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case_images: PMC10762640_01_fonc-13-1264281-g001.jpg
case_images: f1
case_images: Despite attempting cardiopulmonary resuscitation, his heartbeat did not resume and he died (Figure 1).
case_images: Pathological findings at autopsy. (A) Anterior pituitary gland. Histopathological findings showing focal lymphocytic infiltration comprising CD3+ T cells, suggesting cellular damage to the anterior pituitary gland. The number of infiltrating cells was 1, 0 and 1 per three high power fields (HPFs) for CD4+ T-cells and 62, 44, and 57 three HPFs for CD8+ T-cells. In addition, the negative periodic acid-Schiff (PAS) staining and negative T-Pit expression suggested that the number of ACTH-producing cells was reduced. (B) Pancreas. The pancreas showing marked interstitial fibrosis and moderate CD3+ T-cell infiltration (CD4<CD8), suggesting cellular damage to the pancreas. The number of infiltrating cells was 28, 14, and 13 per three HPFs for CD4+ T-cells and 107, 52 and 71 per three HPFs for CD8+ T-cells. Moreover, there were no synaptophysin- and insulin-positive cells, and the islets of Langerhans were completely absent. ACTH, adrenocorticotropic hormone; HE, hematoxylin and eosin staining.
case_images: fonc-13-1264281-g002.jpg
case_images: PMC10762640_01_fonc-13-1264281-g002.jpg
case_images: f2
case_images: Hence, the diagnosis of hypopituitarism due to selective disruption of ACTH-producing cells, an irAE induced by nivolumab, was established (Figure 2A). The pancreas exhibited marked interstitial fibrosis, moderate CD3+ T-cell infiltration, with a similar pattern to that of the pituitary gland (CD4<CD8), and absence of synaptophysin- and insulin-positive cells and the islets of Langerhans (Figure 2B).