1
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Wang XJ. Pituitary metastasis from lung adenocarcinoma. World J Clin Cases 2024; 12:6155-6158. [PMID: 39371557 PMCID: PMC11362882 DOI: 10.12998/wjcc.v12.i28.6155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/04/2024] [Accepted: 06/24/2024] [Indexed: 08/13/2024] Open
Abstract
Pituitary tumor is a common neuroendocrine tumor, but there are also rare clinical metastases at this site, which are generally transferred from extrabellar tumors. Although the clinical incidence is low, the prognosis is poor. The purpose of this editorial is to discuss further the relevant knowledge of pituitary metastases and remind clinicians to prevent missed diagnosis and improve the prognosis of these patients.
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Affiliation(s)
- Xue-Jian Wang
- Department of Neurosurgery, Affiliated Hospital 2 of Nantong University, Nantong 226000, Jiangsu Province, China
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2
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Avula S, Chauhan A, Clark HB, Alameddine H. Wrong Tissue at the Wrong Place: A Rare Case of Hypopituitarism Secondary to Metastatic Renal Cell Carcinoma. Cureus 2024; 16:e64172. [PMID: 39119418 PMCID: PMC11309516 DOI: 10.7759/cureus.64172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Metastasis to the pituitary gland is a very rare occurrence. The most common primary cancer that metastasizes to the pituitary are breast cancer and lung cancer. Most of the pituitary metastases are asymptomatic. The most commonly reported symptoms include anterior pituitary dysfunction, visual field defects, headaches, and diabetes insipidus. Metastasis from renal cell carcinoma (RCC) is very rare. Here, we present the case of a 59-year-old male who presented with vision changes, fatigue, low libido, a low appetite, and excessive thirst. The hormonal evaluation was consistent with panhypopituitarism, and he was started on hydrocortisone, levothyroxine, testosterone, and desmopressin. Brain MRI showed a suprasellar enhancing mass that progressively increased in size. He underwent endoscopic endonasal transplanum and transtuberculum approach for tumor removal. Biopsy of the tumor was reported as metastatic RCC. He was later scheduled for a gamma knife. Metastatic RCC to pituitary is rare, with most being asymptomatic, leading to a delay in diagnosis. Treatment of pituitary metastases is not standardized and should be tailored to patients' clinical conditions, histology, and the presence of extrapituitary metastases. More prospective studies are needed to formulate guidelines for the management of pituitary metastases.
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Affiliation(s)
- Sreekant Avula
- Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, USA
| | - Aditya Chauhan
- Diabetes, Endocrinology, and Metabolism, University of Minnesota School of Medicine, Minneapolis, USA
| | - H Brent Clark
- Pathology, University of Minnesota, Minneapolis, USA
| | - Hind Alameddine
- Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, USA
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3
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Wang Q, Liu XW, Chen KY. Pituitary metastasis from lung adenocarcinoma: A case report. World J Clin Cases 2024; 12:2597-2605. [PMID: 38817229 PMCID: PMC11135431 DOI: 10.12998/wjcc.v12.i15.2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/20/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Pituitary gland metastasis is an unusual event, and pituitary metastasis from lung adenocarcinoma is extremely rare and associated with poor prognosis. To date, approximately 15 cases have been reported. CASE SUMMARY Here, we present the case of a 64-year-old woman with pituitary metastasis derived from lung adenocarcinoma, which was difficult to distinguish from other sellar tumors. The patient presented to the neurosurgery clinic with blurred vision and intermittent headache. During hospitalization, brain computed tomography (CT) and magnetic resonance imaging revealed a pituitary macroadenoma. Chest CT revealed irregular nodules in the basal segment of the lower lobe of the left lung, which were likely lung cancer. Positron emission tomography-CT revealed a carbohydrate metabolism tumor in the lungs and sellar region, which was considered malignant. Postoperative pathological examination of the sellar tumor revealed lung adenocarcinoma. CONCLUSION Excision of pituitary metastases combined with radiotherapy and chemotherapy should be a priority treatment for patients with pituitary metastasis.
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Affiliation(s)
- Qing Wang
- Department of Critical Care Medicine, Chengdu First People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Xiao-Wei Liu
- Department of Neurosurgery, Chengdu Second People's Hospital, Chengdu 610017, Sichuan Province, China
- Department of the First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Ke-Yu Chen
- Department of Neurosurgery, Chengdu Second People's Hospital, Chengdu 610017, Sichuan Province, China
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4
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Wang H, Zhu M, Yan Y. Neuro-ophthalmological findings of pituitary metastasis: Case series from a single center and review of the literature. Heliyon 2024; 10:e26027. [PMID: 38379980 PMCID: PMC10877364 DOI: 10.1016/j.heliyon.2024.e26027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/10/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024] Open
Abstract
When pituitary metastasis (PM) invades the pituitary gland, it leads to impaired endocrine function and compression and infiltration of surrounding tissues, causing a series of clinical alterations. We presented seven patients with PM evaluated at neuro-ophthalmologic clinic and reviewed neuro-ophthalmological findings of 44 cases with PM in the English literature from 1979 to December 2022. The mean age at diagnosis was 58.1 years, and 45.1% were male. The mean latency period from primary cancer to the diagnosis of PM was 57.6 months. PM is the only presenting sign of malignancy in 11.8% of patients. The mean time from the visual disturbance to the diagnosis of PM was 96.3 days. Visual acuity decreased in 72.5% and 60.8% of cases with visual field defects. 74.2% exhibited a pattern of temporal field defect respecting the vertical meridian. Isolated ophthalmoplegia was found in 37.3% of patients. The most common ocular motor nerve palsy was unilateral III nerve palsy. Breast cancer was the most common primary malignancy. 84.6% entirely or partially relieved the neuro-ophthalmic symptoms after treatment. 51% of patients were alive during a mean follow-up period of 11 months. The mean survival duration was within six months in 65% of deceased patients. For elderly patients with a pituitary tumor, PM should be on the list of differential diagnoses for those with visual impairment, especially ocular motor nerve palsy, even if diabetic insipidus is not present, with or even without a history of malignancy, regardless of the primary tumor site.
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Affiliation(s)
- Hongliang Wang
- Department of Ophthalmology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Mingjie Zhu
- Department of Ophthalmology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Ottawa-Shanghai Joint School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Yan
- Department of Ophthalmology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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5
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Mazar‐Atabaki A, Mohamadzadeh O, Sadrehosseini SM, Tabari A, Zeinalizadeh M. Pituitary metastasis from renal cell carcinoma presenting with significant hyperprolactinemia, case report. Clin Case Rep 2023; 11:e7808. [PMID: 37636878 PMCID: PMC10457481 DOI: 10.1002/ccr3.7808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/09/2023] [Accepted: 06/19/2023] [Indexed: 08/29/2023] Open
Abstract
Key Clinical Message Kidney metastasis to the pituitary gland can cause hyperprolactinemia even above 250 ng/mL. Although the treatment of metastasis is palliative, surgical decompression could play a major role in the recovery of symptoms and improve quality of life. Pituitary metastasis should be considered in the evaluation of an unusual pituitary mass. Abstract Pituitary tumors are frequently encountered in the neurosurgical setting. Although the majority of them are pituitary adenomas, rare entities encompass pituitary metastasis. They should be differentiated from pituitary adenomas because their management and prognosis are different. We report a 53-year-old female who complained of headache and had remarkable hyperprolactinemia (271.1 ng/mL). Having considered macroprolactinoma as the initial diagnosis, medical treatment was initiated with Cabergoline. Subsequently, the patient's vision deteriorated which prompted us to perform endoscopic endonasal transsphenoidal surgery. Histologic examination of the resected tumor revealed metastatic renal cell carcinoma. Main treatment for these subjects is palliative; and unlike the pituitary adenoma, the prognosis is unfortunately poor. Pituitary metastasis should be considered in the evaluation of an unusual pituitary mass associated with hyperprolactinemia.
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Affiliation(s)
- Ali Mazar‐Atabaki
- Brain and Spinal Injury Research Center, Pituitary ClinicImam Khomeini Hospital Complex, Tehran University of Medical SciencesTehranIran
- Department of Neurological Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Omid Mohamadzadeh
- Brain and Spinal Injury Research Center, Pituitary ClinicImam Khomeini Hospital Complex, Tehran University of Medical SciencesTehranIran
- Department of Neurological Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Seyed Mousa Sadrehosseini
- Department of Otolaryngology‐Head and Neck Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Azin Tabari
- Department of Otolaryngology‐Head and Neck Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Mehdi Zeinalizadeh
- Department of Neurological Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
- Brain and Spinal Injury Research Center, Pituitary ClinicNeuroscience Institute, Tehran University of Medical SciencesTehranIran
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6
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Venkataramana NK, Madesh M, Venkat B, Gorur IM. Metastatic Tumor to Pituitary from Renal Cell Carcinoma: Case Report with Review of Literature. Neurol India 2023; 71:1063-1064. [PMID: 37929472 DOI: 10.4103/0028-3886.388113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- N K Venkataramana
- Department of Neurosurgery, Brains Hospital, Bangalore, Karnataka, India
| | - Mahendra Madesh
- Department of Neurosurgery, Brains Hospital, Bangalore, Karnataka, India
| | - Bharggavi Venkat
- Department of Neurosurgery, Brains Hospital, Bangalore, Karnataka, India
| | - Imran M Gorur
- Consultant Pathologist, Cytecare Hospitals, Bangalore, Karnataka, India
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7
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Cheng Y, Feng M. A rare case of pituitary metastasis from hepatocellular carcinoma: case report and literature review. Front Oncol 2023; 13:1227678. [PMID: 37576890 PMCID: PMC10413550 DOI: 10.3389/fonc.2023.1227678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Presence of pituitary metastases (PMs) is a relatively rare clinical situation, especially when originating from hepatocellular carcinoma (HCC). A 73-year-old man presented with headaches, diplopia, and soon impaired vision, as well as gastrointestinal symptoms. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain revealed a space-occupying mass in the sellar region. The patient had a history of hepatocellular carcinoma and recent abdominal ultrasound and positron emission tomography (PET) indicated recurrence and metastases. Endoscopic transnasal transsphenoidal tumor excision was performed, and postoperative pathological report confirmed the diagnosis of HCC PM. In the literature review, 17 published cases of HCC PMs were summarized. Both the diagnosis and management of HCC PMs are difficult. Patients who had HCC-related history and new-onset headaches or diplopia should be inspected with a suspicion of metastatic lesions. Surgical intervention with transnasal endoscope is only recommended to ameliorate the symptoms and improve the life quality.
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Affiliation(s)
- Yuanchen Cheng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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8
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Kahilogullari G, Bayatli E, Geyik M, Cabuk B, Beton S, Gunaldi O, Tanrıverdi O, Cetinalp NE, Tarkan O, Yıldırım AE, Guner YE, Nehir A, Goksu E, Akyuz M, Isikay İ, Duz B, Celtikci E, Kertmen H, Köktekir E, Camlar M, Bahçecioğlu Mutlu AB, Cansız Ersoz C, Bozdag SC, Berker M, Ceylan S. Endonasal endoscopic approach for sellar metastatic pathologies: a national observation. Br J Neurosurg 2023; 37:206-212. [PMID: 35582922 DOI: 10.1080/02688697.2022.2077310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE Sellar metastases are rare lesions. Recent improvements in diagnosis and treatment strategies have prolonged survival but increased the probability of metastatic tumors. Evaluation with clinical symptomatology and meticulous laboratory examination is crucial. We present our multicenter national study on sellar metastases to evaluate and underline the main clinical, endocrine, and radiological considerations regarding the diagnosis and endonasal endoscopic management of such rare lesions. METHODS A medical literature-based retrospective study was planned across 13 neurosurgical centers in Turkey, where a data survey was conducted to collect information regarding sellar metastases surgically treated using the endoscopic endonasal approach, including clinical presentation, radiographic features, primary tumor origin, histopathological confirmation, time to metastasis, treatment, and patient outcomes. RESULTS Between 2010 and 2020, 54 patients (22 women [40.7%] and 32 men [59.3%]) who underwent surgery with the endonasal endoscopic approach and had pathologically proven sellar metastases (overall incidence, 0.54%) were included. Of the patients, 59.3% had no known malignancy and presented with new-onset symptoms, 79.6% reported headache, 51.9% complained of some degree of visual deficits, and 50% had cranial nerve symptoms. Tissue biopsy was performed in 7.4% of the patients, whereas gross or subtotal resection was achieved in the remaining patients. CONCLUSION To our knowledge, this is the largest series of patients surgically treated with the endonasal endoscopic approach for sellar metastases. For these patients, the treatment focus should be on management modalities for increasing quality of life instead radical treatment options with survival benefit.
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Affiliation(s)
| | - Eyup Bayatli
- Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Murat Geyik
- Department of Neurosurgery, Gaziantep University, Gaziantep, Turkey
| | - Burak Cabuk
- Department of Neurosurgery, Kocaeli University, Kocaeli, Turkey
| | - Suha Beton
- Department of Otolaryngology, Ankara University, Ankara, Turkey
| | - Omur Gunaldi
- Department of Neurosurgery, Health Ministery University, Cam and Sakura City Hospital, İstanbul, Turkey
| | - Osman Tanrıverdi
- Department of Neurosurgery, Health Ministery University, Cam and Sakura City Hospital, İstanbul, Turkey
| | | | - Ozgur Tarkan
- Department of Otolaryngology, Cukurova University, Adana, Turkey
| | - Ali Erdem Yıldırım
- Department of Neurosurgery, Liv Hospital, İstinye University, Ankara, Turkey
| | - Yahya Efe Guner
- Department of Neurosurgery, Liv Hospital, İstinye University, Ankara, Turkey
| | - Ali Nehir
- Department of Neurosurgery, Gaziantep University, Gaziantep, Turkey
| | - Ethem Goksu
- Department of Neurosurgery, Antalya University, Antalya, Turkey
| | - Mahmut Akyuz
- Department of Neurosurgery, Antalya University, Antalya, Turkey
| | - İlkay Isikay
- Department of Neurosurgery, Hacettepe University, Ankara, Turkey
| | - Bulent Duz
- Department of Neurosurgery, Health Ministery University, Abdulhamit Han Hospital, İstanbul, Turkey
| | - Emrah Celtikci
- Department of Neurosurgery, Gazi University, Ankara, Turkey
| | - Hayri Kertmen
- Department of Neurosurgery, Health Ministery University, Yıldirim Beyazit Hospital, Ankara, Turkey
| | - Ender Köktekir
- Department of Neurosurgery, Selçuk University, Konya, Turkey
| | - Mahmut Camlar
- Department of Neurosurgery, Health Ministery University, Tepecik Hospital, Izmir, Turkey
| | | | | | | | - Mustafa Berker
- Department of Neurosurgery, Hacettepe University, Ankara, Turkey
| | - Savas Ceylan
- Department of Neurosurgery, Kocaeli University, Kocaeli, Turkey
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9
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Rasiah NP, Albakr A, Kosteniuk S, Starreveld Y. Early and isolated breast cancer metastasis to the pituitary: A case report and systematic review. Surg Neurol Int 2022; 13:462. [PMID: 36324911 PMCID: PMC9609953 DOI: 10.25259/sni_1053_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Pituitary metastases (PMs) arising from breast cancer tend to occur many years following initial diagnosis, and after other systemic metastasis have been identified. Survival is generally considered to be poor. However, there are cases where patients present with an isolated metastatic lesion in the pituitary. Survival in this subset of patients has not been evaluated. We present a case of isolated PM that presented two years after initial diagnosis of breast cancer. We performed a systematic review of 38 breast cancer patients with PM. We report presentation, treatment strategy, and outcomes of breast cancer metastasis to the pituitary and highlight cases of isolated PM. Case Description: A 39 year old female presented with complaints of headache and polydipsia two years after diagnosis with breast cancer. Systemic workup was unremarkable, but brain imaging identified an isolated PM. Transsphenoidal debulking was performed with adjuvant radiation therapy (RT) targeted to the sellar region. Unfortunately, she passed away 9 months later from systemic progression. Conclusion: A total of 38 patients were included systematic review. Of these, 13 had isolated PM. Prevalent signs/ symptoms included visual disturbance, diabetes insipidus (DI), and hypothalamic dysfunction. Patients treated with surgical resection and adjuvant chemotherapy (ChT), or RT had better survival than those treated with resection alone. Patients that receive treatment for isolated PM may survive for many years without progression or recurrence.
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Affiliation(s)
- Neilen P Rasiah
- Department of Neurosurgery, University of Calgary, Calgary, Canada
| | | | - Suzanne Kosteniuk
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Yves Starreveld
- Department of Neurosurgery, University of Calgary, Calgary, Canada
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10
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Aisner SC, Sharer L, Liu JK, Baisre de Leon A, Heller DS. Metastatic Pleomorphic Lobular Carcinoma of the Breast to the Hypothalamus Presenting as a Primary Pituitary Lesion Presenting 17 Years Later-Report of a Case and Review of the Literature. Int J Surg Pathol 2022; 30:789-791. [PMID: 35234082 DOI: 10.1177/10668969221081739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carcinomas metastatic to the brain are common, however, metastatic disease to the hypothalamic- pituitary region is uncommon and account for less than 3.6% of all resected malignant pituitary tumors. Most metastatic disease in that region derives from a lung or breast primary, with both ductal and lobular carcinoma reported. We report what we believe is the first case of pleomorphic lobular carcinoma metastatic to the hypothalamus. This case is also reaffirms that late metastasis from breast cancer should be considered in the differential diagnosis. It is important for the clinician to consider the clinical history of breast cancer, even when remote, in the differential diagnosis.
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Affiliation(s)
| | - Leroy Sharer
- 12286Rutgers-New Jersey Medical School, Newark NJ
| | - James K Liu
- 12286Rutgers-New Jersey Medical School, Newark NJ
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11
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Gader G, Guediche S, Ben Hadj Yahya M, Zouaghi M, Rkhami M, Badri M, Zammel I. Polyuria and polydipsia revealing a pituitary metastasis: Report of a rare case. Clin Case Rep 2022; 10:e6025. [PMID: 35846911 PMCID: PMC9272224 DOI: 10.1002/ccr3.6025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Sellar region is a rare localization for intracranial metastases. The diagnosis is frequently delayed as symptoms are generally non specific. Radiologic diagnosis may be difficult as these tumours present similiraities to other more frequent sellar tumours. There is still no consensus regarding therapeutic approach. Prognosis is related to several features.
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Affiliation(s)
- Ghassen Gader
- Department of NeurosurgeryFaculty of Medicine of TunisTrauma and Burns CenterUniversity of Tunis‐El ManarBen ArousTunisia
| | - Skander Guediche
- Department of NeurosurgeryFaculty of Medicine of TunisTrauma and Burns CenterUniversity of Tunis‐El ManarBen ArousTunisia
| | - Mohamed Ben Hadj Yahya
- Department of RadiologyFaculty of Medicine of TunisNational Institute of NeurologyUniversity of Tunis‐El ManarTunisTunisia
| | - Mohamed Zouaghi
- Department of NeurosurgeryFaculty of Medicine of TunisTrauma and Burns CenterUniversity of Tunis‐El ManarBen ArousTunisia
| | - Mouna Rkhami
- Department of NeurosurgeryFaculty of Medicine of TunisTrauma and Burns CenterUniversity of Tunis‐El ManarBen ArousTunisia
| | - Mohamed Badri
- Department of NeurosurgeryFaculty of Medicine of TunisTrauma and Burns CenterUniversity of Tunis‐El ManarBen ArousTunisia
| | - Ihsèn Zammel
- Department of NeurosurgeryFaculty of Medicine of TunisTrauma and Burns CenterUniversity of Tunis‐El ManarBen ArousTunisia
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12
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Dedeker C, Archibald H, Meares A, Mendez A, Hamlar D. Metastatic breast cancer masquerading as a pituitary macroadenoma: A case report. SAGE Open Med Case Rep 2022; 10:2050313X211073243. [PMID: 35096396 PMCID: PMC8793421 DOI: 10.1177/2050313x211073243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
The purpose of this manuscript is to report a case of symptomatic breast cancer metastasis to the pituitary gland, a described yet exceedingly rare phenomenon. A 52-year-old woman with a known history of stage-IV breast cancer treated 3 years prior with chemotherapy presented to the emergency department with 2 weeks of right-sided periorbital headache and 1 week of right-sided ptosis. Magnetic resonance imaging showed a 1.9 cm × 2.8 cm × 2.8 cm mass in the pituitary with mass effect on the right optic chiasm. Endocrine laboratory studies were largely normal, including prolactin, thyroid-stimulating hormone, insulin-like growth factor, and a minimally decreased cortisol. She underwent endoscopic transnasal transsphenoidal resection 4 days later to remove the mass without complication. Postoperative pathologic studies were positive for breast cancer metastasis, and she was subsequently started on adjuvant radiation and oral chemotherapy. While breast cancer metastases to the sella have been described in the literature before, symptomatic spread to the pituitary represents a small percentage of all breast cancer metastases, and we thus feel is worthy of further discussion.
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Affiliation(s)
- Connor Dedeker
- University of Minnesota Medical School Twin Cities, Minneapolis, MN, USA
| | - Hunter Archibald
- Department of Otolaryngology: Head and Neck Surgery, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Annie Meares
- Department of Pathology, Regions Hospital, St. Paul, MN, USA
| | | | - David Hamlar
- Department of Otolaryngology: Head and Neck Surgery, University of Minnesota Twin Cities, Minneapolis, MN, USA
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13
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Bailey D, Mau C, Zacharia B. Pituitary Metastasis From Urothelial Carcinoma: A Case Report and Review of the Diagnosis and Treatment of Pituitary Metastases. Cureus 2021; 13:e17574. [PMID: 34646629 PMCID: PMC8481102 DOI: 10.7759/cureus.17574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/05/2022] Open
Abstract
The sellar and parasellar regions are a rare site of brain metastasis, most commonly from breast and lung cancer. Pituitary metastasis (PM) often presents as the first sign of metastatic disease but may herald early disseminated cancer. The diagnosis of PM requires differentiation from a benign pituitary adenoma. Although this may be proven definitively via surgical biopsy, a constellation of clinical findings including oculomotor palsy, visual disturbances, retroorbital pain, and diabetes insipidus is more suggestive of PM. Imaging is neither sensitive nor specific for differentiation but may inform the broader clinical picture. Due to its rarity, treatment guidelines for PM lack consensus, often including a mixture of radiation and surgery. Gross resection is challenging because of the vascular, invasive nature of these lesions. Stereotactic radiosurgery may be used to good effect either alone or in addition to resection. Even with treatment, the prognosis is poor. In this article, we present the third reported case of urothelial carcinoma metastasis to the pituitary. In addition, we review the clinical presentation, diagnosis, and treatment options including surgical resection and radiosurgery.
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Affiliation(s)
- David Bailey
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Christine Mau
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Brad Zacharia
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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14
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Ragni A, Nervo A, Papotti M, Prencipe N, Retta F, Rosso D, Cacciani M, Zamboni G, Zenga F, Uccella S, Cassoni P, Gallo M, Piovesan A, Arvat E. Pituitary metastases from neuroendocrine neoplasms: case report and narrative review. Pituitary 2021; 24:828-837. [PMID: 34342837 PMCID: PMC8416815 DOI: 10.1007/s11102-021-01178-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/04/2022]
Abstract
PURPOSE Pituitary metastases (PM) are uncommon findings and are mainly derived from breast and lung cancers. No extensive review of PM from neuroendocrine neoplasms (NENs) is on record. Here we describe a clinical case of PM from pancreatic NEN and review the clinical features of PM from NENs reported in the literature. METHODS A case of PM from a pancreatic NEN followed at our institution is described. We also reviewed the 43 cases of PM from NENs reported in the literature. RESULTS A 59-year old female patient, previously submitted to duodeno-cephalo-pancreasectomy for a well-differentiated pancreatic NEN, with known hepatic metastases, underwent a 68 Ga-DOTATOC PET/CT that revealed an uptake in the pituitary gland. A subsequent MRI displayed a pituitary lesion, with suprasellar extension. After a hormonal and genetic diagnostic workup that excluded the diagnosis of MEN 1, the worsening of headache and visual impairment and the growth of the lesion lead to its surgical removal. A pituitary localization of the pancreatic NEN was identified. Regarding the published cases of PM from NENs, the most common tumour type was small cell lung cancer (SCLC), accounting for nearly half of the cases, followed by bronchial and pancreatic well differentiated NENs. The most frequent symptom was a variable degree of visual impairment, while headache was reported in half of the cases. Partial or total anterior hypopituitarism was present in approximately three quarters of the cases, while diabetes insipidus was less common. The most frequent treatment for PM was surgical resection, followed by radiotherapy and chemotherapy. The clinical outcome was in line with previous reports of PM from solid tumours, with a median survival of 14 months. Surgery of PM was associated with prolonged survival. CONCLUSIONS PM from NENs have clinical features similar to metastases derived from other solid tumours, albeit the involvement of the anterior pituitary seems more frequent; a thorough pituitary hormonal evaluation is mandatory, after focused radiological studies, particularly if a surgical approach is considered. The optimal management of PM remains disputed and seems mainly driven by the aggressiveness of the primary tumour and the presence of symptoms. In well-differentiated NENs, particularly in the case of symptomatic PM, surgical removal may be a reasonable approach.
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Affiliation(s)
- Alberto Ragni
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- Endocrine and Metabolic Diseases Unit, SS. Antonio E Biagio E Cesare Arrigo Hospital, Alessandria, Italy
| | - Alice Nervo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mauro Papotti
- Pathology Division, Department of Oncology, University of Turin, Turin, Italy
| | - Nunzia Prencipe
- Endocrinology and Metabolism Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesca Retta
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Daniela Rosso
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marta Cacciani
- Endocrinology Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Zamboni
- Pathology Division, Ospedale Sacro Cuore Don Calabria, Negrar and University of Verona, Verona, Italy
| | - Francesco Zenga
- Neurosurgery Unit, Department of Neurosciences and Mental Health, University of Turin, Turin, Italy
| | - Silvia Uccella
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paola Cassoni
- Pathology Division, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marco Gallo
- Endocrine and Metabolic Diseases Unit, SS. Antonio E Biagio E Cesare Arrigo Hospital, Alessandria, Italy
| | - Alessandro Piovesan
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
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15
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Liu CY, Wang YB, Zhu HQ, You JL, Liu Z, Zhang XF. Hyperprolactinemia due to pituitary metastasis: A case report. World J Clin Cases 2021; 9:190-196. [PMID: 33511184 PMCID: PMC7809681 DOI: 10.12998/wjcc.v9.i1.190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/17/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pituitary metastasis is an uncommon manifestation of systemic malignant tumors. Moreover, hyperprolactinemia and overall hypopituitarism caused by metastatic spread leading to the initial symptoms are rare.
CASE SUMMARY A 53-year-old male patient was admitted to our hospital with complaints of bilateral blurred vision, dizziness, polyuria, nocturia, severe fatigue and somnolence, decreased libido, and intermittent nausea and vomiting for more than 6 mo. During the last 7 d, the dizziness had worsened. Laboratory investigations revealed overall hypofunction of the pituitary gland, but the patient had an elevated serum prolactin level (703.35 mg/mL). Preoperative magnetic resonance imaging revealed a tumor in the sellar region, accompanied by intratumoral hemorrhage and calcification. Thus, transnasal subtotal resection of the lesion in the sellar region was performed. The histopathological and immunohistochemical examinations of the resected lesion revealed metastasis of lung adenocarcinoma to the pituitary gland. Oral hydrocortisone (30 mg/d) and levothyroxine (25 mg/d) were given both pre- and postoperatively. Post-operatively, the clinical symptoms were significantly improved. However, 4 mo following the surgery, the patient succumbed due to multiple organ failure.
CONCLUSION Hyperprolactinemia is one of the markers of poor prognosis in patients with carcinoma that metastasizes to the pituitary gland. Exogenous hormone supplementation plays a positive role in relieving the symptoms of patients and improving quality of life.
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Affiliation(s)
- Chun-Yang Liu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yu-Bo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hui-Qin Zhu
- Department of Respiratory medicine, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Jin-Liang You
- Department of Neurosurgery, Linyi Cancer Hospital, Linyi 276000, Shandong Province, China
| | - Zhuang Liu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xian-Feng Zhang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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16
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Liu X, Wang R, Li M, Chen G. Pituitary Metastasis of Lung Neuroendocrine Carcinoma Mimicking Pituitary Adenoma:Case Report and Literature Review. Front Endocrinol (Lausanne) 2021; 12:678947. [PMID: 34335467 PMCID: PMC8317059 DOI: 10.3389/fendo.2021.678947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 12/02/2022] Open
Abstract
Pituitary metastasis is an unusual situation in clinical practice, while the incidence is increasing with age. Breast cancer for women and lung cancer for men were the most frequent primary origins of pituitary metastasis. Diagnosing asymptomatic patients with unknown primary malignant origin is difficult, thus pituitary metastasis may be diagnosed as primary pituitary adenoma. Here, we report a case of a 65-year-old patient with visual changes and diabetes insipidus, showing an extensive mass in the sellar region which was initially thought to be a primary pituitary adenoma. Patient corticotropic deficits were corrected, and transnasal transsphenoidal surgery was adopted, leading to total tumor resection. Tumor texture during surgical procedure was similar to that of pituitary adenoma. However, the histopathological and immunohistochemistry results suggested it as a pituitary metastasis from lung neuroendocrine tumor. Postoperative chest CT scan confirmed a pulmonary mass consistent with primary neoplasm. Abdominal CT further detected multiple metastases in liver, pancreas, and colon. Despite intensive treatment, the patient continued to show decreased level of consciousness due to cachexia, resulting in death 1 week after surgery. This case highlights the importance of differential diagnosis of invasive lesions of the sellar region, especially in individuals over 60 years of age with diabetes insipidus.
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Affiliation(s)
- Xiaohai Liu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Chinese Pituitary Specialists Congress, Beijing, China
| | - Renzhi Wang
- Chinese Pituitary Specialists Congress, Beijing, China
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Chinese Pituitary Specialists Congress, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Chinese Pituitary Specialists Congress, Beijing, China
- *Correspondence: Ge Chen,
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17
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Moon RDC, Singleton WGB, Smith P, Urankar K, Evans A, Williams AP. Slow-Growing Pituitary Metastasis from Renal Cell Carcinoma: Literature Review. World Neurosurg 2020; 145:416-425. [PMID: 32891842 DOI: 10.1016/j.wneu.2020.08.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Tumor metastasis to the pituitary is rare, most commonly reported with either breast or lung cancer metastasizing to the neurohypophysis. Pituitary metastases of renal cell carcinoma (RCC) are by contrast infrequently described even within this scarce literature. We present an illustrative case of RCC pituitary metastasis 15 years after radical nephrectomy for primary disease and a review of the published literature. CASE DESCRIPTION A 69-year-old female was diagnosed with a large sellar mass with suprasellar extension. The initial radiologic diagnosis was most in keeping with pituitary macroadenoma, although prominent vascular flow voids were noted. Endoscopic endonasal transsphenoidal adenectomy was challenging on account of significant intraoperative hemorrhage from an unusually vascular tumor. Pathologic examination supported a diagnosis of metastatic clear cell renal carcinoma. Literature review identified 41 cases of RCC pituitary metastasis since 1984. The mean age at time of diagnosis with pituitary metastasis was 59.5 years (range 35-81 years, 73% male). Pituitary metastasis was the initial presentation of RCC in 10 patients. The median time from RCC diagnosis to pituitary metastasis was 1 year (range 0-27 years). Surgical resection was performed for 30 patients, of which 47% reported a highly vascular tumor. CONCLUSIONS We highlight the potential for delayed metastasis to the pituitary to masquerade as a macroadenoma. Imaging consistent with rich vascularity should bring the diagnosis of RCC metastasis into the differential and is important to note when planning surgical resection in such cases.
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Affiliation(s)
- Richard D C Moon
- Department of Neurosurgery, North Bristol NHS Trust, Bristol, UK.
| | | | - Paul Smith
- Department of Neuroradiology, North Bristol NHS Trust, Bristol, UK
| | - Kathryn Urankar
- Department of Neuropathology, North Bristol NHS Trust, Bristol, UK
| | - Alison Evans
- Department of Endocrinology and Metabolic Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Adam P Williams
- Department of Neurosurgery, North Bristol NHS Trust, Bristol, UK
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18
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Gandhi GY, Fung R, Natter PE, Makary R, Balaji KC. Symptomatic Pituitary Metastasis as Initial Manifestation of Renal Cell Carcinoma: Case Report and Review of Literature. Case Rep Endocrinol 2020; 2020:8883864. [PMID: 32908722 PMCID: PMC7450332 DOI: 10.1155/2020/8883864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 02/07/2023] Open
Abstract
Metastasis to the pituitary gland is extremely rare (∼2% of sellar masses). Clinical, biochemical, and radiologic characteristics of pituitary metastasis are poorly defined and can be difficult to diagnose before surgery. We present an unusual case with pituitary metastasis as the first manifestation of renal cell carcinoma (RCC). A 70-year-old male presented with acute onset of weakness, dizziness, diplopia, and progressively worsening headache. The initial CT head revealed a heterogeneous sellar mass measuring 2.8 × 1.9 × 1.7 cm. A follow-up MRI showed the sellar mass invading the right cavernous sinus. The presumptive diagnosis was a pituitary macroadenoma. Physical examination revealed bilateral 6th cranial nerve palsy and episodes of intermittent binocular horizontal diplopia. Hormonal testing noted possible secondary adrenal insufficiency (AM serum cortisol: 3.3 mcg/dL, ACTH: 8 pg/mL), secondary hypothyroidism (TSH: <0.01 mIU/L, FT4: 0.7 ng/dL), secondary hypogonadism (testosterone: 47 ng/dL, LH: 1.3 mIU/mL, and FSH: 2.3 mIU/mL), and elevated serum prolactin (prolactin: 56.8 ng/ml, normal: 4.0-15.2 ng/ml). IGF-1 level was normal at 110 ng/mL (47-192 ng/mL). The patient was discharged on levothyroxine and hydrocortisone therapy with plans for close surveillance. However, his condition worsened over the next three months, and he was subsequently readmitted with nausea, vomiting, and hypernatremia secondary to diabetes insipidus. Repeat MRI pituitary showed an interval increase in the size of the sellar mass with suprasellar extension and a new mass effect on the optic chiasm. The sellar mass was urgently resected via a trans-sphenoidal approach. The tumor was negative for neuroendocrine markers and pituitary hormone panel, ruling out the diagnosis of pituitary adenoma and triggered workup for metastatic renal cell carcinoma, clear cell type. The diagnosis of renal cell carcinoma was confirmed by the diffuse and strong staining for renal cell carcinoma markers (Pax-8, RCC-1, and CD10). A follow-up CT scan noted large right renal mass measuring 11 × 10 × 11 cm. The patient underwent a cytoreductive robotic right radical nephrectomy for WHO/ISUP histologic grade II clear cell RCC, stage pT2b pNX pM1. He subsequently received fractionated stereotactic radiotherapy to the pituitary gland. He is presently stable with no radiological evidence of progression or new intracranial disease on subsequent imaging. Pituitary metastasis most commonly occurs from breast, lung, or gastrointestinal tumors but also rarely from renal cell carcinoma. Biochemical findings such as panhypopituitarism, acute clinical signs such as headache, visual symptoms, and diabetes insipidus and interval increase in sellar mass in a short time interval should raise suspicion for sellar metastasis.
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Affiliation(s)
- Gunjan Y. Gandhi
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Russell Fung
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Patrick E. Natter
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Raafat Makary
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - K. C. Balaji
- Department of Urology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
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19
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Pituitary metastasis of malignant melanoma misdiagnosed as pituitary adenoma: A case report and systematic review of the literature. Neurochirurgie 2020; 66:383-390. [PMID: 32777231 DOI: 10.1016/j.neuchi.2020.06.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/17/2020] [Accepted: 06/13/2020] [Indexed: 11/21/2022]
Abstract
We report a case of malignant melanoma revealed by a metastasis to the pituitary gland. The tumor was misdiagnosed as a pituitary adenoma and aggressive transsphenoidal surgery was complicated by a cerebrospinal fluid fistula. Nine weeks later, the patient presented multiple leptomeningeal and brain metastases spreading from the sellar region. Regarding these observations, we conducted a systematic review of the literature in order to investigate clinicoradiological features that should lead clinicians to suspect pituitary metastasis and how it should impact the surgical management.
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20
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Alhashem A, Taha M, Almomen A. Pituitary metastasis of lung adenocarcinoma: Case report and literature review. Int J Surg Case Rep 2020; 67:98-101. [PMID: 32058309 PMCID: PMC7016037 DOI: 10.1016/j.ijscr.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 11/26/2022] Open
Abstract
Pituitary metastasis is rare, and it is the least common intracranial site of metastases. Majority of cases of pituitary metastasis the patient is known to have a primary malignancy. The clinical presentation and radiological features of pituitary metastasis are not specific making diagnosis difficult. Management may include endoscopic trans-sphenoidal resection, chemotherapy, radiotherapy and hormone replacement. Definitive diagnosis can be achieved through surgical resection.
Introduction Pituitary metastasis is rare, and it is the least common site of intracranial metastases. It is mostly asymptomatic but can present with diabetes insipidus, headache, ophthalmoplegia, visual disturbance and anterior pituitary dysfunction and in majority of cases patients known to have a primary malignancy. Case Presentation This study presents a 54-year-old male presented with a few months history of headache and drooping of both eyelids and after proper investigations and endoscopic resection of the sellar mass the diagnosis was confirmed to be pituitary metastasis of lung adenocarcinoma. Conclusion Diagnosis and management of pituitary metastases are complex and depend on many factors. Endoscopic surgical resection and debulking alleviates symptoms and provides the definitive diagnosis which has great importance in cases with clinical presentation that does not strongly point to pituitary metastasis to avoid unnecessary radiotherapy and chemotherapy when possible.
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Affiliation(s)
| | - Mahmoud Taha
- Department of Neurosurgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ali Almomen
- Department of Otorhinolaryngology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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21
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Current status and treatment modalities in metastases to the pituitary: a systematic review. J Neurooncol 2020; 146:219-227. [PMID: 31933258 DOI: 10.1007/s11060-020-03396-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Metastases to the pituitary (MP) are uncommon, accounting for 0.4% of intracranial metastases. Through advances in neuroimaging and oncological therapies, patients with metastatic cancers are living longer and MP may be more frequent. This review aimed to investigate clinical and oncological features, treatment modalities and their effect on survival. METHODS A systematic review was performed according to PRISMA recommendations. All cases of MP were included, excepted primary pituitary neoplasms and autopsy reports. Descriptive and survival analyses were then conducted. RESULTS The search identified 2143 records, of which 157 were included. A total of 657 cases of MP were reported, including 334 females (50.8%). The mean ± standard deviation age was 59.1 ± 11.9 years. Lung cancer was the most frequent primary site (31.0%), followed by breast (26.2%) and kidney cancers (8.1%). Median survival from MP diagnosis was 14 months. Overall survival was significantly different between lung, breast and kidney cancers (P < .0001). Survival was impacted by radiotherapy (hazard ratio (HR) 0.49; 95% confidence interval (CI) 0.35-0.67; P < .0001) and chemotherapy (HR 0.58; 95% CI 0.36-0.92; P = .013) but not by surgery. Stereotactic radiotherapy tended to improve survival over conventional radiotherapy (HR 0.66; 95% CI 0.39-1.12; P = .065). Patients from recent studies (≥ 2010) had longer survival than others (HR 1.36; 95% CI 1.05-1.76; P = .0019). CONCLUSION This systematic review based on 657 cases helped to better identify clinical features, oncological characteristics and the effect of current therapies in patients with MP. Survival patterns were conditioned upon primary cancer histologies, the use of local radiotherapy and systemic chemotherapy, but not by surgery.
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22
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Abushamat LA, Kerr JM, Lopes MBS, Kleinschmidt-DeMasters BK. Very Unusual Sellar/Suprasellar Region Masses: A Review. J Neuropathol Exp Neurol 2019; 78:673-684. [PMID: 31233145 DOI: 10.1093/jnen/nlz044] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/15/2019] [Accepted: 05/10/2019] [Indexed: 12/18/2022] Open
Abstract
The cause of sellar region masses in large retrospective series is overwhelmingly pituitary adenomas (84.6%), followed by craniopharyngiomas (3.2%), cystic nonneoplastic lesions (2.8%), inflammatory lesions (1.1%), meningiomas (0.94%), metastases (0.6%), and chordomas (0.5%) (1). While other rare lesions were also identified (collectively 6.0%), single unusual entities in the above-cited series numbered <1-2 examples each out of the 4122 cases, underscoring their rarity. We searched our joint files for rare, often singular, sellar/suprasellar masses that we had encountered over the past several decades in our own specialty, tertiary care specialty pituitary center practices. Cases for this review were subjectively selected for their challenging clinical and/or histological features as well as teaching value based on the senior authors' (MBSL, BKD) collective experience with over 7000 examples. We excluded entities deemed to be already well-appreciated by neuropathologists such as mixed adenoma-gangliocytoma, posterior pituitary tumors, metastases, and hypophysitis. We identified examples that, in our judgment, were sufficiently unusual enough to warrant further reporting. Herein, we present 3 diffuse large cell B cell pituitary lymphomas confined to the sellar region with first presentation at that site, 2 sarcomas primary to sella in nonirradiated patients, and 1 case each of granulomatosis with polyangiitis and neurosarcoidosis with first presentations as a sellar/suprasellar mass. Other cases included 1 of chronic lymphocytic leukemia within a gonadotroph adenoma and 1 of ectopic nerve fascicles embedded within a somatotroph adenoma, neither of which impacted patient care. Our objective was to share these examples and review the relevant literature.
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Affiliation(s)
- Layla A Abushamat
- Department of Endocrinology, University of Colorado Health Sciences Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Janice M Kerr
- Department of Endocrinology, University of Colorado Health Sciences Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - M Beatriz S Lopes
- Department of Pathology (Neuropathology) and Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Bette K Kleinschmidt-DeMasters
- Department of Pathology
- Department of Neurology
- Department of Neurosurgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
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23
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Cai H, Liu W, Feng T, Li Z, Liu Y. Clinical Presentation and Pathologic Characteristics of Pituitary Metastasis from Breast Carcinoma: Cases and a Systematic Review of the Literature. World Neurosurg 2019; 124:445-451.e2. [PMID: 30630045 DOI: 10.1016/j.wneu.2018.12.126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is rare for breast carcinoma to metastasize to the pituitary gland; this finding indicates extensive metastasis of the primary tumor. CASE DESCRIPTION Herein, we present a 57-year-old patient with pituitary gland metastasis from breast cancer that was treated with extensive radical mastectomy 16 years prior. The pituitary was the sole site of metastasis. The patient was admitted with the chief complaint of blurred vision for 1 year and episodic headaches for 1 month. Magnetic resonance imaging revealed a solid mass in the sellar region with heterogenous contrast enhancement. The preoperative diagnosis was a pituitary adenoma. Neuroendoscopy-assisted tumor resection was conducted through a single-nostril sphenoid sinus approach. A pinkish-white, firm neoplasm was found, with an abundant blood supply and an indistinct boundary between the neoplasm and normal pituitary tissue; complete resection was achieved. The results of immunohistochemical analysis were positive for cytokeratin, Ki-67antigen, estrogen receptors, progesterone receptors, and prolactin-induced protein. The neoplasm was negative for spalt-like transcription factor 4, mammaglobin, and the alpha subunit of the glycoprotein hormones. These results were used to reach a final diagnosis of pituitary gland metastasis from a primary breast carcinoma. The patient's vision improved significantly after surgery, and no recurrence was detected during 1 year of follow-up. CONCLUSIONS Pituitary gland metastasis is rare and difficult to differentiate from a pituitary adenoma without a pathologic diagnosis. Surgery is the first choice for treatment. Surgery, radiotherapy, and chemotherapy are combined with endocrine therapy to tailor treatment to the results of immunohistochemistry.
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Affiliation(s)
- Heng Cai
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wenjing Liu
- Department of Geriatrics, First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Tianda Feng
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhen Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yunhui Liu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
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24
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Abstract
RATIONALE Sellar metastasis is a rare and complex disease whose clinical features are strongly associated with the primary malignancy. Here, we present a rare case of giant sellar metastasis spread from renal cell carcinoma (RCC). PATIENT CONCERNS A 30-year-old Chinese woman was admitted to our Hospital, reporting headache, nasal congestion, nausea, vomiting, and a sharp decline in her right eye vision. DIAGNOSES Brain magnetic resonance imaging (MRI) revealed an invasive sellar mass with cavernous sinus and nasal cavity extension. Additionally, the patient had a medical history of right radical nephrectomy for clear-cell RCC. INTERVENTIONS The patient underwent a successful subtotal resection of the tumor. Final pathological diagnosis confirmed sellar metastasis from RCC. After surgery, the patient was referred to our medical oncology department and received further systemic therapy. OUTCOMES No light perception remained in her right eye even after prompt surgical decompression. Follow-up MRI showed subtotal resection of the giant sellar metastasis. LESSON Sellar metastasis, although rare, should be particularly considered for elderly patients with deteriorating visual function and medical histories of cancer.
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25
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Javanbakht A, D'Apuzzo M, Badie B, Salehian B. Pituitary metastasis: a rare condition. Endocr Connect 2018; 7:EC-18-0338. [PMID: 30139817 PMCID: PMC6198191 DOI: 10.1530/ec-18-0338] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/20/2018] [Indexed: 01/31/2023]
Abstract
Tumor metastasis to the pituitary gland is a life-threatening condition associated with short life span. Pituitary metastasis is rare, however, and not well-documented. A better understanding of its clinical manifestations could lead to earlier diagnosis, appropriate therapy, and potentially improving quality of life. Therefore, we retrospectively studied the charts of patients with pituitary metastases who were treated at the City of Hope National Medical Center in Duarte, California, from 1984 to 2018. We reviewed and analyzed tumor origin, primary pituitary clinical manifestation, duration between primary tumor diagnosis and pituitary metastasis, type of treatment, and patient survival. A total 11 patients with a mean age of 59.2 years and median survival of 50.33 months were identified. Breast cancer and lymphoma were the most common primary origins in these cases, and diabetes insipidus and panhypopituitarism were the most common primary manifestations of their metastasis. We also compared our results with reports in the literature published between 1957 and 2018. A total 289 patients with pituitary metastasis have been reported in the literature. Breast cancer was the most frequent primary origin of the metastasis, and visual involvement was the most common primary manifestation. The posterior part of the pituitary is more susceptible than the anterior to metastasis. Pituitary metastasis may occur as a consequence of successful primary tumor treatment prolonging the chance of seeding. Future studies are needed to determine the molecular mechanism of metastasis to the pituitary.
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Affiliation(s)
- Aida Javanbakht
- A Javanbakht, Department of Diabetes, Endocrinology and Metabolism, Beckman Research Institute, Duarte, United States
| | - Massimo D'Apuzzo
- M D'Apuzzo, Department of Pathology, Beckman Research Institute, Duarte, United States
| | - Behnam Badie
- B Badie, Department of Neurosurgery, Beckman Research Institute, Duarte, United States
| | - Behrouz Salehian
- B Salehian, Endocrinology, City of Hope National Medical Center, Duarte, 91010, United States
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Wendel C, Campitiello M, Plastino F, Eid N, Hennequin L, Quétin P, Longo R. Pituitary Metastasis from Renal Cell Carcinoma: Description of a Case Report. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:7-11. [PMID: 28044054 PMCID: PMC5223779 DOI: 10.12659/ajcr.901032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pituitary metastasis is uncommon, breast and lung cancers being the most frequent primary tumors. Renal cell carcinoma (RCC) is a rare cause of pituitary metastases, with only a few cases described to date. CASE REPORT We report a case of a 61-year-old man who presented with a progressive deterioration of visual acuity and field associated with a bitemporal hemianopsia. Two years ago, he underwent radical right nephrectomy for a clear cell RCC (ccRCC). The biological tests showed pan-hypopituitarism and diabetes insipidus. Brain MRI revealed a large sellar tumor lesion bilaterally infiltrating the cavernous sinuses, which was surgically resected. Histology confirmed a ccRCC pituitary metastasis. The patient received post-surgical radiotherapy. Considering the presence of concomitant extra-pituitary metastases, treatment with sunitinib was started, followed by several lines of therapy with axitinib, everolimus, and sorafenib because of tumor progression. The patient also presented with a pituitary tumor recurrence, which was treated by stereotaxic radiotherapy. He died five years after the initial diagnosis of RCC and 30 months after the diagnosis of the pituitary metastasis. CONCLUSIONS There are no standardized treatment guidelines for management of pituitary metastases. Pituitary surgery plays a role in symptom palliation, and it does not have any relevant impact on survival. Exclusive radiotherapy or stereotaxic radiotherapy could be an alternative to surgery in patients whose general condition is poor or who have concomitant extra-pituitary metastases.
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Affiliation(s)
- Chloé Wendel
- Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Marco Campitiello
- Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Francesca Plastino
- Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Nada Eid
- Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Laurent Hennequin
- Division of Radiology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Philippe Quétin
- Division of Radiotherapy, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Raffaele Longo
- Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
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