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Balen AH, Tamblyn J, Skorupskaite K, Munro MG. A comprehensive review of the new FIGO classification of ovulatory disorders. Hum Reprod Update 2024; 30:355-382. [PMID: 38412452 DOI: 10.1093/humupd/dmae003] [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] [Received: 06/12/2023] [Revised: 01/23/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) system for the classification of disorders of ovulation was produced 50 years ago and, by international consensus, has been updated by the International Federation of Gynecology and Obstetrics (FIGO). OBJECTIVE AND RATIONALE This review outlines in detail each component of the FIGO HyPO-P (hypothalamic, pituitary, ovarian, PCOS) classification with a concise description of each cause, and thereby provides a systematic method for diagnosis and management. SEARCH METHODS We searched the published articles in the PubMed database in the English-language literature until October 2022, containing the keywords ovulatory disorders; ovulatory dysfunction; anovulation, and each subheading in the FIGO HyPO-P classification. We did not include abstracts or conference proceedings because the data are usually difficult to assess. OUTCOMES We present the most comprehensive review of all disorders of ovulation, published systematically according to the logical FIGO classification. WIDER IMPLICATIONS Improving the diagnosis of an individual's ovulatory dysfunction will significantly impact clinical practice by enabling healthcare practitioners to make a precise diagnosis and plan appropriate management.
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Affiliation(s)
- Adam H Balen
- Leeds Centre for Reproductive Medicine, The University of Leeds, Leeds, UK
| | - Jennifer Tamblyn
- Leeds Centre for Reproductive Medicine, The University of Leeds, Leeds, UK
| | | | - Malcolm G Munro
- Department of Obstetrics and Gynecology, The University of California, Los Angeles, Los Angeles, CA, USA
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2
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Haberbosch L, Schmid S, Hubertus V, Soll D, Acker G, Dottermusch M, Jensen M, Maurer L, Spranger J, Mai K, Vajkoczy P, Saeger W, Strasburger CJ. Metastases to the pituitary gland: insights from the German pituitary tumor registry. Pituitary 2023; 26:708-715. [PMID: 37899389 PMCID: PMC10665242 DOI: 10.1007/s11102-023-01361-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 10/31/2023]
Abstract
Metastatic involvement of the pituitary gland is a rare but clinically significant phenomenon, that often poses diagnostic and therapeutic challenges. The aim of this study was to provide a comprehensive analysis of the origin of pituitary metastases using data from the German Pituitary Tumor Registry, one of the globally largest collections of pituitary pathology specimens. Here, we report data from a retrospective analysis of patients with metastases to the pituitary registered between 1990 and 2022. Out of 17,896 pituitary cases in the registry during this period, a total of 96 metastases to the pituitary gland were identified, accounting for 0.5% of all pituitary tumors in the registry. The mean age of the patients was 64 years. Breast cancer was identified as the primary tumor in 25% of total cases (n = 24/96) and in 50% of female patients. The second most prevalent primary tumor was lung cancer (18.75%, n = 18/96), followed by renal cell carcinoma (14.58%, n = 14/96). In comparison to current meta-analyses, this cohort shows a higher prevalence of metastases originating from the kidney. Furthermore, in contrast to the existing literature, no case of primary thyroid tumor was identified. Our study highlights the importance of pituitary metastases as a differential diagnosis in patients presenting with pituitary tumors.
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Affiliation(s)
- Linus Haberbosch
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany.
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany.
- BIH Charité Junior Digital Clinician Scientist Program, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, Berlin, 10117, Germany.
| | - Simone Schmid
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
| | - Vanessa Hubertus
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, Berlin, 10117, Germany
| | - Dominik Soll
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
| | - Güliz Acker
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
| | - Matthias Dottermusch
- Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Marie Jensen
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Lukas Maurer
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Knut Mai
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Peter Vajkoczy
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
| | - Wolfgang Saeger
- Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Institute of Pathology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Christian J Strasburger
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, 10117, Germany
- Pituitary Tumor Center of Excellence, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
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3
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Alali I, Al-Sarraj A, Kabalan Y. Diabetes Insipidus due to Metastases of Undiagnosed Lung Cancer: A Case Report from Syria. Case Rep Endocrinol 2023; 2023:1482675. [PMID: 37731967 PMCID: PMC10508995 DOI: 10.1155/2023/1482675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023] Open
Abstract
Pituitary metastases (PM) are extremely uncommon, accounting for less than 1% of all intracranial metastases. PM of an undiagnosed malignancy can commonly present with symptoms of hormonal deficiencies, central diabetes insipidus, and/or visual symptoms. Lung and breast malignancies are the most common cancers associated with PM. Despite advances in diagnostic and therapeutic options, the prognosis remains poor and is influenced by primary malignancy and treatment methods. We report a case of a patient with PM from lung cancer who had polyuria, polydipsia, and nonspecific symptoms. A full evaluation confirmed central diabetes insipidus, hypogonadism, and metastatic lung cancer. We also discuss the current literature on PM diagnosis and management, emphasizing the need for a comprehensive evaluation of all available data. This is the first case of PM reported from Syria, to our knowledge.
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Affiliation(s)
- Ibrahim Alali
- Endocrinology Department, Al-Assad University Hospital, Damascus University, Damascus, Syria
| | - Alaa Al-Sarraj
- Endocrinology Department, Al-Assad University Hospital, Damascus University, Damascus, Syria
| | - Younes Kabalan
- Endocrinology Department, Al-Assad University Hospital, Damascus University, Damascus, Syria
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4
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Burman P, Casar-Borota O, Perez-Rivas LG, Dekkers OM. Aggressive Pituitary Tumors and Pituitary Carcinomas: From Pathology to Treatment. J Clin Endocrinol Metab 2023; 108:1585-1601. [PMID: 36856733 PMCID: PMC10271233 DOI: 10.1210/clinem/dgad098] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/13/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
Aggressive pituitary tumors (APTs) and pituitary carcinomas (PCs) are heterogeneous with regard to clinical presentation, proliferative markers, clinical course, and response to therapy. Half of them show an aggressive course only many years after the first apparently benign presentation. APTs and PCs share several properties, but a Ki67 index greater than or equal to 10% and extensive p53 expression are more prevalent in PCs. Mutations in TP53 and ATRX are the most common genetic alterations; their detection might be of value for early identification of aggressiveness. Treatment requires a multimodal approach including surgery, radiotherapy, and drugs. Temozolomide is the recommended first-line chemotherapy, with response rates of about 40%. Immune checkpoint inhibitors have emerged as second-line treatment in PCs, with currently no evidence for a superior effect of dual therapy compared to monotherapy with PD-1 blockers. Bevacizumab has resulted in partial response (PR) in few patients; tyrosine kinase inhibitors and everolimus have generally not been useful. The effect of peptide receptor radionuclide therapy is limited as well. Management of APT/PC is challenging and should be discussed within an expert team with consideration of clinical and pathological findings, age, and general condition of the patient. Considering that APT/PCs are rare, new therapies should preferably be evaluated in shared standardized protocols. Prognostic and predictive markers to guide treatment decisions are needed and are the scope of ongoing research.
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Affiliation(s)
- Pia Burman
- Department of Endocrinology, Skåne University Hospital, Lund
University, 205 02 Malmö, Sweden
| | - Olivera Casar-Borota
- Department of Immunology, Genetics, and Pathology; Uppsala
University, 751 85 Uppsala, Sweden
- Department of Clinical Pathology, Uppsala University
Hospital, 751 85 Uppsala, Sweden
| | - Luis Gustavo Perez-Rivas
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München,
Ludwig-Maximilians-Universität München, 80804
Munich, Germany
| | - Olaf M Dekkers
- Department of Internal Medicine (Section of Endocrinology & Clinical
Epidemiology), Leiden University Medical Centre, 2333 ZA
Leiden, The Netherlands
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5
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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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6
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Ugga L, Franca RA, Scaravilli A, Solari D, Cocozza S, Tortora F, Cavallo LM, De Caro MDB, Elefante A. Neoplasms and tumor-like lesions of the sellar region: imaging findings with correlation to pathology and 2021 WHO classification. Neuroradiology 2023; 65:675-699. [PMID: 36799985 PMCID: PMC10033642 DOI: 10.1007/s00234-023-03120-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/15/2023] [Indexed: 02/18/2023]
Abstract
The sellar region represents a complex anatomical area, composed of multiple structures of different embryological derivation, including the skull base and the pituitary gland, along with vascular, nervous, and meningeal structures. Masses arising in this region include benign and malignant lesions arising from the pituitary gland itself, but also from vestigial embryological residues or surrounding tissues, that may require different therapeutic approaches. While assessing sellar region masses, the combination of clinical presentation and imaging features is fundamental to define hypotheses about their nature. MR represents the imaging modality of choice, providing information about the site of the lesion, its imaging features, and relation with adjacent structures, while CT is useful to confirm the presence of lesion calcifications or to reveal tumor invasion of bony structures. The aim of this pictorial review is to provide an overview of the common neoplasms and tumor-like conditions of the sellar region, according to the 2021 WHO Classification of Tumors of the Central Nervous System (fifth edition), with an emphasis on the radiologic-pathologic correlation. After a brief introduction on the anatomy of this region and the imaging and pathological techniques currently used, the most relevant MRI characteristics, clinical findings, and pathological data, including histologic and molecular features, will be shown and discussed, with the aim of facilitating an appropriate differential diagnosis among these entities.
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Affiliation(s)
- Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Raduan Ahmed Franca
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Alessandra Scaravilli
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Domenico Solari
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Fabio Tortora
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Andrea Elefante
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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7
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Stereotactic radiosurgery for pituitary and cavernous sinus metastases. J Neurooncol 2023; 161:175-184. [PMID: 36617600 DOI: 10.1007/s11060-023-04236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
PURPOSE Metastases extending to the pituitary gland and cavernous sinus are extremely rare; however, advances in neuroimaging have increased the reported incidence. Stereotactic radiosurgery (SRS) affords the precise delivery of focused radiation to minimize adverse radiation effects. This study assessed the efficacy and safety of SRS in the treatment of pituitary and cavernous sinus metastases. METHODS Analysis was performed on 23 patients with pituitary and cavernous sinus metastases who underwent treatment using SRS between 1996 and 2021. The cohort was categorized into 2 groups in terms of metastasis location: pituitary involvement (Group 1, n = 11) and cavernous sinus involvement (Group 2, n = 12). Overall survival, local tumor control, and distal tumor control rates were compared between the two groups using Kaplan-Meier analysis. RESULTS The median age of the cohort was 52.2 years and the median tumor volume was 4.5 mL. Overall survival rates were as follows: 1 year (72.9%), 2 years (51.8%), and 3 years (45.3%). Local tumor control rates were as follows: 1 year (82.3%), 2 years (82.3%), and 3 years (65.9%). Visual deficit and hypopituitarism were the most common presentations in Group 1, whereas cranial nerve deficit was the most common presentation in Group 2. CONCLUSIONS SRS appears to be a safe and effective therapy for the treatment of pituitary and cavernous sinus metastases. GKRS is a relatively simple procedure, which places minimal stress on the patient, thereby facilitating further anti-cancer treatment. Considering the limited survival duration in cases of metastasis, it is very likely that post-GKRS complications (e.g., new onset cranial nerve deficit and hypopituitarism) would not become an issue before patient passes away.
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8
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Wei Z, Yavan S, Deng H, Mallela AN, Gersey ZC, Shariff RK, Fazeli PK, Niranjan A, Lunsford LD, Abou-Al-Shaar H. The role of stereotactic radiosurgery in the multidisciplinary management of pituitary metastases. Pituitary 2022; 25:948-958. [PMID: 36203008 DOI: 10.1007/s11102-022-01279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE This study evaluates the role and outcomes of Gamma Knife radiosurgery (GKRS) in the management of pituitary metastases. METHODS The records of brain metastases patients who underwent GKRS at the University of Pittsburgh Medical Center during the 10-year interval of 2010-2020 were systematically reviewed. Outcome measures included patient survival, tumor control rate, pituitary hormonal outcomes, visual outcomes, adverse radiation effects (AREs), and need for adjuvant therapy. RESULTS Eighteen patients with pituitary metastases (eight male; median age of 65.5 years) had sufficient clinical follow-up for analysis. The most common primary cancers were non-small cell lung cancer (n = 6) and breast cancer (n = 4). Patients presented with headache (n = 9) and visual difficulties (n = 6). One patient underwent resection before GKRS. The median tumor volume was 0.78 cc (range 0.04-6.42 cc). The median overall survival after GKRS was 6.5 months (range 0.5-58 months). The overall survival after GKRS at 3-, 6-, and 12-months were 72.2%, 50.0% and 38.9%, respectively. The tumor control rate was 94.4%. One patient had further progression that required additional GKRS. None of the patients developed AREs after GKRS. CONCLUSION GKRS is an effective treatment modality for the multidisciplinary management of patients with pituitary metastases. This minimally-invasive strategy is associated with optimal tumor control rate and low risk to adjacent optic nerves or neurovascular structures.
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Affiliation(s)
- Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - Sila Yavan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - Zachary C Gersey
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - Rimsha K Shariff
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Division of Endocrinology and Metabolism, Neuroendocrinology Unit, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Pouneh K Fazeli
- Division of Endocrinology and Metabolism, Neuroendocrinology Unit, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA.
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9
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Baiano C, Somma T, Franca RA, Di Costanzo M, Scala MR, Cretella P, Esposito F, Cavallo LM, Cappabianca P, Solari D. Evolution in endoscopic endonasal approach for the management of hypothalamic–pituitary region metastasis: A single-institution experience. Front Oncol 2022; 12:975738. [PMID: 35965539 PMCID: PMC9366217 DOI: 10.3389/fonc.2022.975738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionEndonasal endoscopic surgery has changed the treatment perspectives for different lesions of the hypothalamic–pituitary region. The metastases of the hypothalamic–pituitary region represent 0.4% of all intracranial metastatic tumors and account for only 1.8% of surgically managed pituitary lesions. The aim of tshis study is to describe a single-center institutional experience with 13 cases of hypothalamic–pituitary metastasis focused on presurgical workup, the evolution of the surgical technique, and postsurgical management according to our protocols, showing effects on progression-free and overall survival rates for this relatively uncommon location.Material and MethodsWe retrospectively reviewed the whole series of patients that received the endoscopic endonasal approach at the Division of Neurosurgery at the University of Naples “Federico II” undergoing surgery from January 1997 to December 2021. We identified 13 cases whose pathology reports revealed a metastatic lesion. Statistical analysis was performed to determine the Kaplan–Meier survival function and assess for log-rank differences in survival based on gender, surgical treatment, and postoperative therapy (p-value < 0.02*).ResultsThe pathology report disclosed lung adenocarcinoma (six cases, 46%), breast adenocarcinoma (two cases, 15.4%), clear cell renal carcinoma (one case, 7%), melanoma (one case, 7%), colorectal adenocarcinoma (one case, 7%), uterine cervix carcinoma (one case, 7%), and follicular thyroid carcinoma (one case, 7%). A standard endoscopic endonasal approach was performed in 10 patients (76.9%), while an extended endonasal procedure was performed in only three cases (23%). Biopsy was the surgical choice in five patients with infiltrative and invasive lesions and a poor performance status (38%), while in the cases where neurovascular decompression was necessary, a subtotal resection was achieved in five patients (38%) and partial resection in three patients (23%). Recovery of visual field defect was observed in six of seven patients with visual loss (85.7%), improvement of oculomotor nerve palsy occurred in four of seven patients with this defect (57.1%), while the impairment of oculomotor palsy was observed in three patients (42.9%). Visual function was stable in the other patients. The median progression-free survival and overall survival were 14 and 18 months, respectively. There were statistically significant differences in PFS and OS in patients who underwent adjuvant radiotherapy (p=0.019 is referred to OS and p=0.017 to PFS, respectively; p-value = 0.02).ConclusionsThe endoscopic endonasal approach is a viable approach for the management of hypothalamic–pituitary metastases as this surgery provides an adequate opportunity to obtain tissue sample and neurovascular decompression, both being crucial for continuing the integrated adjuvant therapy protocols.
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Affiliation(s)
- Cinzia Baiano
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
- *Correspondence: Cinzia Baiano,
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Raduan Ahmed Franca
- Pathology Section, Department of Advanced Biomedical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Marianna Di Costanzo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Maria Rosaria Scala
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Pasquale Cretella
- Pathology Section, Department of Advanced Biomedical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Felice Esposito
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
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10
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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] [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. Pituitary metastases are rare tumors mainly diagnosed in patients with multiple metastatic lesions. Diagnosis is difficult as clinical symptoms are nonspecific. Treatment mainly aims to improve the quality of life.
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Affiliation(s)
- Ghassen Gader
- Department of Neurosurgery Faculty of Medicine of Tunis Trauma and Burns Center University of Tunis‐El Manar Ben Arous Tunisia
| | - Skander Guediche
- Department of Neurosurgery Faculty of Medicine of Tunis Trauma and Burns Center University of Tunis‐El Manar Ben Arous Tunisia
| | - Mohamed Ben Hadj Yahya
- Department of Radiology Faculty of Medicine of Tunis National Institute of Neurology University of Tunis‐El Manar Tunis Tunisia
| | - Mohamed Zouaghi
- Department of Neurosurgery Faculty of Medicine of Tunis Trauma and Burns Center University of Tunis‐El Manar Ben Arous Tunisia
| | - Mouna Rkhami
- Department of Neurosurgery Faculty of Medicine of Tunis Trauma and Burns Center University of Tunis‐El Manar Ben Arous Tunisia
| | - Mohamed Badri
- Department of Neurosurgery Faculty of Medicine of Tunis Trauma and Burns Center University of Tunis‐El Manar Ben Arous Tunisia
| | - Ihsèn Zammel
- Department of Neurosurgery Faculty of Medicine of Tunis Trauma and Burns Center University of Tunis‐El Manar Ben Arous Tunisia
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11
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Hashimoto H, Maruo T, Nakamura M, Ushio Y, Hirata M, Kishima H. Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report. J Med Case Rep 2022; 16:12. [PMID: 35027091 PMCID: PMC8759158 DOI: 10.1186/s13256-021-03229-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023] Open
Abstract
Background Symptomatic pituitary metastasis is rare; furthermore, it can result in diabetes insipidus and panhypopituitarism. Since diabetes insipidus is masked by concurrent panhypopituitarism, it can impede the diagnosis of pituitary dysfunction. Case presentation A 68-year-old Japanese female suffering from pituitary and thalamic metastases caused by untreated breast cancer, underwent a biopsy targeting the thalamus, not the pituitary. She lacked prebiopsy pituitary dysfunction symptoms; however, these symptoms unexpectedly occurred after biopsy. Diabetes insipidus was masked by corticosteroid insufficiency, and she showed normal urinary output and plasma sodium levels. Upon commencement of glucocorticoid replacement therapy, the symptoms of diabetes insipidus appeared. Conclusions In this case, thalamic biopsy, as opposed to pituitary biopsy, was performed to preserve pituitary function. However, pituitary dysfunction could not be avoided. Caution is necessary for asymptomatic patients with pituitary metastases as invasive interventions, such as surgery, may induce pituitary dysfunction. Moreover, with respect to masked diabetes insipidus, there is a need to carefully consider pituitary dysfunction to avoid misdiagnosis and delayed treatment.
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Affiliation(s)
- Hiroaki Hashimoto
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540-0008, Japan. .,Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan.
| | - Tomoyuki Maruo
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540-0008, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Masami Nakamura
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540-0008, Japan
| | - Yukitaka Ushio
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540-0008, Japan
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
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12
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Parthasarathy S, Lee DH, Levitt AH, Manavalan A. Pituitary Metastasis Presenting With Central Diabetes Insipidus and Panhypopituitarism. AACE Clin Case Rep 2022; 8:15-18. [PMID: 35097195 PMCID: PMC8784703 DOI: 10.1016/j.aace.2021.06.006] [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: 04/12/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Abstract
Objective We report a case of pituitary metastasis (PM) presenting with acute anterior and posterior pituitary dysfunction following a two-decade-long oncologic course marked by disease progression. Case Report An elderly woman with a history of stage IIA invasive ductal carcinoma of the breast presented with confusion. Her laboratory evaluation was significant for panhypopituitarism and central diabetes insipidus, and magnetic resonance imaging findings were suggestive of PM. She was treated with hormone replacement, resulting in the reversal of her metabolic and cognitive derangements. Discussion PM is a rare complication of advanced malignancy. Although several malignancies may spread to the pituitary, the most common are breast cancer in women and lung cancer in men. Unlike pituitary adenomas, which predominantly involve the anterior pituitary, PM has a predilection for the posterior lobe and infundibulum due to direct access via systemic circulation. The clinical presentation of PM depends on the size of the metastatic deposit and other structures involved in the vicinity of the sella. Magnetic resonance imaging with gadolinium is the gold standard for the evaluation of sellar masses. The diagnosis of PM involves a thorough history, physical examination, biochemical evaluation of the hypothalamic-pituitary axis, and imaging studies. Conclusion Metastatic involvement of the pituitary is a rare condition seen in <2% of resected pituitary masses. The clinical presentation is heterogeneous and can include headache, visual impairment, and panhypopituitarism. Unfortunately, the presence of PM portends a poor prognosis, and the median survival rate after diagnosis is 6 to 13.6 months.
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Affiliation(s)
- Sahana Parthasarathy
- Department of Internal Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, New York
- Address correspondence to Dr Sahana Parthasarathy, Department of Internal Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, 1803 Haight Avenue, Bronx, NY 10461.
| | - Donna H. Lee
- Division of Diabetes, Endocrinology and Metabolism, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Alex H. Levitt
- Department of Neuroradiology, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, New York
| | - Anjali Manavalan
- Division of Diabetes, Endocrinology and Metabolism, Albert Einstein College of Medicine/Jacobi Medical Center/North Central Bronx, Bronx, New York
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13
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Han D, Zhao K, Yang Q, Zhang L, Fei S. Secondary mutant ALK-I1171s in pituitary metastases from a patient with ALK fusion-positive advanced lung adenocarcinoma: A case report and literature review. Front Oncol 2022; 12:1016320. [PMID: 36324562 PMCID: PMC9619101 DOI: 10.3389/fonc.2022.1016320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pituitary metastasis accounts for a very low percentage of cases of brain metastasis from lung cancer, and there are uncertainties and challenges in diagnosis and treatment. We hope to shed some light on the diagnosis and treatment by reporting a case of ALK fusion mutation-positive lung cancer pituitary metastasis. CASE PRESENTATION We report a 48-year-old female patient with an initial diagnosis of stage IVB lung adenocarcinoma with ALK fusion. The patient developed headache, dizziness, hypopituitarism and hyperprolactinemia one year after treatment with crizotinib. Later, the patient underwent neurosurgical resection of the pituitary tumor and then symptomatic relief. Postoperative pathology suggested pituitary metastasis, and the next-generation gene sequencing conducted on the pituitary metastasis indicated that secondary drug resistance mutation ALK-I1171s occurred after the ALK fusion gene. CONCLUSION In this article, we present a patient with suspected pituitary metastases with lung cancer. The progression to pituitary mass resection and next-generation gene sequencing of the pituitary metastasis are suggestive for further diagnosis and treatment.
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Affiliation(s)
| | | | | | | | - Shihong Fei
- *Correspondence: Shihong Fei, ; Liling Zhang,
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14
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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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15
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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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16
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Kleinschmidt-DeMasters BK. Metastases to the Pituitary Gland: Histological Patterns of Spread and Review of the Literature. J Neuropathol Exp Neurol 2021; 80:1033–1042. [PMID: 34559240 DOI: 10.1093/jnen/nlab096] [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: 11/13/2022] Open
Abstract
Few studies have focused on histological patterns of metastatic spread to the pituitary gland. We review our experience and that in the literature, 1970-present. Departmental cases, 1998-2021, were assessed for anterior versus posterior gland and/or capsular involvement and cohesive tumor obliterating underlying pituitary architecture versus metastatic cells filling pituitary acini with relative acinar preservation. Eleven autopsy/15 surgical cases, including 2 metastases to pituitary adenomas, were identified. Cohesive/obliterative patterns predominated histologically in both surgical and autopsy cases, but acinar filling by metastatic cells was extensive in 3/26 cases, focal in 5/26, and had resulted in initial erroneous impressions of atypical pituitary adenoma/pituitary carcinoma in 1 case and pituitary adenoma with apoplexy in another, likely due to focusing on necrotic areas in the specimen where the acinar pattern had been broken down and not appreciating nearby areas with acinar filling by metastatic cells. Although most pituitary metastases produce readily identifiable cohesive/obliterative patterns, diagnostic challenges remain with the less frequently seen "acinar filling" pattern. A dichotomy exists between patients with symptomatic pituitary metastases occurring early in the disease course and requiring surgical excision versus patients in whom asymptomatic small pituitary metastases are found incidentally at autopsy, the latter almost invariably in late disease stages, with widely disseminated metastatic disease.
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Affiliation(s)
- B K Kleinschmidt-DeMasters
- Department of Pathology, Department of Neurology, and Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA (B.K.K.-D.)
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17
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Dabbous Z, Mohamed M, Benjamin S, Green F, Salman H, Elhadd T. A tale of many tumors and one endocrine site: A case series of pituitary metastases. Qatar Med J 2021; 2021:38. [PMID: 34540600 PMCID: PMC8428511 DOI: 10.5339/qmj.2021.38] [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: 02/09/2021] [Accepted: 05/06/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Metastases to the pituitary gland are extremely rare with an incidence rate reported from an autopsy series of 1.8%-12%, and only 20% was diagnosed clinically. Tumors that commonly metastasize are breast and lung tumors. CASE SERIES We present a series of five cases, including four female patients and one male patient with metastatic cancer. Two women had metastatic small lung cancer and presented with diabetes insipidus (DI). Two women had metastatic breast cancer, of which one presented with DI and the other with panhypopituitarism. The male patient had bronchogenic adenocarcinoma and presented with DI. CONCLUSION Our case series confirmed earlier reports that DI is the most common presentation of metastases to the pituitary gland.
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Affiliation(s)
- Zeinab Dabbous
- Endocrine Department, Hamad Medical Corporation, Doha, Qatar
| | - Muna Mohamed
- Department of Medicine, Dumfries and Galloway Royal Infirmary, Dumfries, Scotland E-mail:
| | - Silas Benjamin
- Endocrine Department, Hamad Medical Corporation, Doha, Qatar
| | - Fiona Green
- Department of Medicine, Dumfries and Galloway Royal Infirmary, Dumfries, Scotland E-mail:
| | - Hassoun Salman
- Department of Medicine, Dumfries and Galloway Royal Infirmary, Dumfries, Scotland E-mail:
| | - Tarik Elhadd
- Endocrine Department, Hamad Medical Corporation, Doha, Qatar
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18
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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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19
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Darrat M, Binhussein M, Beausang A, Faul C, O’Reilly MW, Javadpour M, Agha A. A very rare case of pituitary metastasis infiltrating a non-secretory gonadotroph adenoma. Endocrinol Diabetes Metab Case Rep 2020. [PMCID: PMC7774744 DOI: 10.1530/edm-20-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pituitary adenomas are the commonest sellar tumours. Pituitary metastases are very rare, with the most common primaries being breast and lung cancers. We report the case of an 83-year-old man with a history of breast carcinoma who presented with recent-onset headaches and progressive deterioration of visual acuity. MRI brain showed a large sellar and suprasellar mass compressing the optic chiasm and involving the pituitary stalk. Transsphenoidal debulking resulted in symptomatic relief and visual recovery. Specimen examination revealed a combination of a gonadotroph pituitary adenoma that was infiltrated by metastatic breast carcinoma. He had no symptoms of diabetes insipidus. He was subsequently treated with pituitary radiotherapy. This is a very rare presentation of a pituitary mass with mixed pathology. To our knowledge, this is the third description of a breast carcinoma metastasis into a gonadotroph cell pituitary adenoma.
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Affiliation(s)
- Milad Darrat
- 1Deparments of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | | | | | - Clare Faul
- 3Radiation Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - Mohsen Javadpour
- 4Neurosurgery, Beaumont Hospital, Dublin, IrelandBeaumont Hospital, Dublin, Ireland
- 5School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Amar Agha
- 1Deparments of Endocrinology, Beaumont Hospital, Dublin, Ireland
- 5School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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20
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Watanabe M, Yasuda J, Ashida K, Matsuo Y, Nagayama A, Goto Y, Iwata S, Watanabe M, Sasaki J, Hoshino T, Nomura M. Masked Diabetes Insipidus Hidden by Severe Hyponatremia: A Case of Pituitary Metastasis of Lung Adenocarcinoma. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e928113. [PMID: 33335085 PMCID: PMC7755591 DOI: 10.12659/ajcr.928113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Male, 70-year-old Final Diagnosis: Adrenal insufficiency • diabetes insipidus • lung adenocarcinoma Symptoms: Anorexia • fatigue Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic • Neurosurgery • Oncology
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Affiliation(s)
- Miki Watanabe
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Junichi Yasuda
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kenji Ashida
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yuko Matsuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Ayako Nagayama
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yuka Goto
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shimpei Iwata
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masayuki Watanabe
- Division of Respiratory, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Jun Sasaki
- Division of Respiratory, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tomoaki Hoshino
- Division of Respiratory, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masatoshi Nomura
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Division of Respiratory, Neurology, and Rheumatology, Department of Internal Medicine, Kurume, Fukuoka, Japan
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21
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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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22
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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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23
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Lithgow K, Siqueira I, Senthil L, Chew HS, Chavda SV, Ayuk J, Toogood A, Gittoes N, Matthews T, Batra R, Meade S, Sanghera P, Khan N, Ahmed S, Paluzzi A, Tsermoulas G, Karavitaki N. Pituitary metastases: presentation and outcomes from a pituitary center over the last decade. Pituitary 2020; 23:258-265. [PMID: 32189207 PMCID: PMC7181548 DOI: 10.1007/s11102-020-01034-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Highlight and characterize manifestations, diagnostic/management approaches and outcomes in a contemporary cohort of patients with pituitary metastases (PM) from a large European pituitary center-over 10 years. METHODS Retrospective review of PM cases between 1/2009 and 12/2018. Clinical, laboratory, imaging data at PM detection and during follow-up were analysed. RESULTS 18 cases were identified (14 females; median age at diagnosis 61.5 years). Most common primary malignancies were lung (39%) and breast (32%). Most frequent presenting manifestation was visual dysfunction (50%). Gonadotrophin, ACTH, TSH deficiency were diagnosed in 85%, 67%, 46% of cases, respectively; diabetes insipidus (DI) was present in 17%. 33% of cases were detected during investigation for symptoms unrelated to PM. PM management included radiotherapy (44%), transsphenoidal surgery (17%), transsphenoidal surgery and radiotherapy (6%) or monitoring only (33%). One-year survival was 49% with median survival from PM detection 11 months (range 2-47). CONCLUSIONS In our contemporary series, clinical presentation of PM has evolved; we found increased prevalence of anterior hypopituitarism, decreased rates of DI and longer survival compared with older literature. Increased availability of diagnostic imaging, improvements in screening and recognition of pituitary disease and longer survival of patients with metastatic cancer may be contributing factors.
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Affiliation(s)
- K Lithgow
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - I Siqueira
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - L Senthil
- Department of Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H S Chew
- Department of Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S V Chavda
- Department of Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Ayuk
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Toogood
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Gittoes
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T Matthews
- Department of Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Batra
- Department of Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Meade
- Department of Oncology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Sanghera
- Department of Oncology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Khan
- Department of Ear, Nose & Throat, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Ahmed
- Department of Ear, Nose & Throat, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Paluzzi
- Department of Neurosugery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - G Tsermoulas
- Department of Neurosugery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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24
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Roncaroli F, Chatterjee D, Giannini C, Pereira M, La Rosa S, Brouland JP, Gnanalingham K, Galli C, Fernandes B, Lania A, Radotra B. Primary papillary epithelial tumour of the sella: expanding the spectrum of TTF-1-positive sellar lesions. Neuropathol Appl Neurobiol 2020; 46:493-505. [PMID: 32311761 DOI: 10.1111/nan.12622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 12/11/2022]
Abstract
AIM To describe four novel primary epithelial tumours of the sella with papillary architecture and Thyroid Transcription Factor 1 (TTF-1) expression. METHODS Paraffin-embedded tissue from the four cases and recurrence of patient 1 was investigated with haematoxylin-eosin, special histochemical stains, immunohistochemistry with a broad panel of antibodies and next-generation sequencing. The ultrastructure of one tumour was studied in tissue retrieved from paraffin. RESULTS The lesions occurred in three females aged 20, 26 and 42 years and a male aged 49 years. They presented with signs and symptoms secondary to pituitary stalk compression. Preoperative neuroimaging documented mixed solid and cystic, enhancing sellar masses with suprasellar extension. Histologically, the tumours showed thin papillae lined by a single layer of cytokeratin and TTF-1-positive cuboidal and cylindrical cells with mildly atypical nucleus. Next-generation sequencing performed in three cases did not identify any mutations. The main differential diagnosis included metastasis from lung or thyroid carcinoma, extraventricular choroid plexus papilloma and sellar ependymoma. CONCLUSION We suggest the descriptive term of primary papillary epithelial tumour of the sella (PPETS) for this entity and propose that it could represent the intracranial equivalent of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma. The cell of origin of PPETS remains undetermined although the intense and ubiquitous expression of TTF-1 may suggest a derivation from the infundibulum or ventricular recess. Our study expands the spectrum of sellar TTF-1-positive tumour and challenges the view that they all derive from pituicytes.
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Affiliation(s)
- F Roncaroli
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biology, University of Manchester, Manchester, UK
| | - D Chatterjee
- Deparment of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - C Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Pereira
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Division of Evolution and Genomic Science, University of Manchester, Manchester, UK
| | - S La Rosa
- Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - J P Brouland
- Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - K Gnanalingham
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Foundation Trust, Salford, Manchester, UK
| | - C Galli
- Department of Histopathology, Humanitas University, Milan, Italy
| | - B Fernandes
- Department of Histopathology, Humanitas University, Milan, Italy
| | - A Lania
- Department of Endocrinology, Humanitas University, Milan, Italy
| | - B Radotra
- Deparment of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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25
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Sheahan KH, Huffman GC, DeWitt JC, Gilbert MP. Metastatic Lung Cancer Presenting as Monocular Blindness and Panhypopituitarism Secondary to a Pituitary Metastasis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920948. [PMID: 32321907 PMCID: PMC7193223 DOI: 10.12659/ajcr.920948] [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] [Indexed: 11/18/2022]
Abstract
Patient: Female, 52-year-old Final Diagnosis: Metastatic lung adenocarcinoma Symptoms: Fatigue • vision loss Medication: — Clinical Procedure: — Specialty: Endocrinology and metabolic
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Affiliation(s)
- Kelsey H Sheahan
- Division of Endocrinology and Diabetes, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | | | - John C DeWitt
- Department of Laboratory Services, University of Vermont Medical Center, Burlington, VT, USA
| | - Matthew P Gilbert
- Division of Endocrinology and Diabetes, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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26
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Isolated pituitary fossa metastasis from a primary tonsillar squamous cell carcinoma: case report. The Journal of Laryngology & Otology 2020; 134:369-371. [PMID: 32234087 DOI: 10.1017/s0022215120000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This paper presents a case of an isolated pituitary fossa metastasis on a background of a previously treated tonsillar squamous cell carcinoma. CASE REPORT A 64-year-old male, diagnosed with a primary p16-negative squamous cell carcinoma in the right tonsil, was treated with a course of chemoradiotherapy with curative intent. Positron emission tomography/computed tomography, performed at six months post-treatment, revealed a good local response and no distant metastases. The patient was placed on routine follow up at two-monthly intervals. Two months into follow up, he presented with a right-sided oculomotor nerve palsy and partial Horner's syndrome. Imaging and biopsy revealed a pituitary fossa metastasis (p16-negative squamous cell carcinoma), and a further positron emission tomography/computed tomography visualised this lesion. He was deemed unsuitable for further intervention and underwent palliative radiotherapy for symptom control. CONCLUSION This case represents the first reported isolated pituitary fossa metastasis from a tonsillar squamous cell carcinoma. A high degree of clinical suspicion is recommended, along with a low threshold for biopsy and a cautioned use of positron emission tomography/computed tomography, when investigating such patients.
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27
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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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28
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Abstract
The pituitary fossa is an uncommon site for metastatic tumor spread. Metastatic lesions to the sellar area derived mostly from breast, lung, renal, prostate, and colon cancers, and rarely from other solid and hematologic malignancies. Almost every cancer has been reported as a source of pituitary metastasis. Pituitary metastasis can involve both the anterior and posterior lobes, but the neuro-hypophysis is mainly involved. Clinical manifestations include diabetes insipidus, hypopituitarism, headache, visual disturbances, ophthalmoplegia, and also compression of adjacent structures by aggressive tumor masses. Metastatic spread to the pituitary from a distant primary malignancy is commonly associated with metastases to other tissues and poor prognosis, unless efficient systemic targeted medical treatment is available for the primary cancer (melanoma, lymphoma).
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Affiliation(s)
- Ilan Shimon
- Institute of Endocrinology, Beilinson Hospital, Petach Tikva, and Sackler School of Medicine, Tel-Aviv University, Petach Tikva, Israel,
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29
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Patel KR, Zheng J, Tabar V, Cohen MA, Girotra M. Extended Survival After Surgical Resection for Pituitary Metastases: Clinical Features, Management, and Outcomes of Metastatic Disease to the Sella. Oncologist 2019; 25:e789-e797. [PMID: 31784491 DOI: 10.1634/theoncologist.2019-0520] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/18/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with pituitary metastasis (PM) have a relatively poor prognosis. We describe the presentation, management, and outcomes of patients with PM. SUBJECTS, MATERIALS, AND METHODS We performed a retrospective review of patients diagnosed with PM at a single institution from 1996 to 2015. Eighty-five patients diagnosed with metastasis to the pituitary or sella turcica by pathology or based on a combination of neuroimaging and clinical findings were included. Univariate and multivariable Cox regressions evaluated associations between clinical factors and overall survival. RESULTS The most frequent sites of primary malignancies resulting in PM were lung (26%) and breast (26%). Median age at diagnosis was 60 years (range, 18-95). The most common complaints at diagnosis included visual deficits (62%), headache (47%), and cranial nerve palsy (31%). Seventy percent of patients had pituitary insufficiency-adrenal insufficiency (59%), hypothyroidism (59%), or diabetes insipidus (28%). Management of PM included radiation therapy (76%), chemotherapy (68%), surgical resection (21%), or combination therapy (71%). Fifty percent and 52% of patients who received surgical treatment and irradiation, respectively, reported symptomatic improvement. Median overall survival (OS) was 16.5 months (95% confidence interval: 10.7-25.4). On multivariable analysis, a primary cancer site other than lung or breast (p = .020), age <60 years (p = .030), and surgical resection (p = .016) were associated with longer OS. CONCLUSION Patients <60 years of age, those with primary tumor sites other than lung or breast, and those who undergo surgical resection of the pituitary lesion may have prolonged survival. Surgical resection and radiation treatment resulted in symptomatic improvement in ~50% of patients. IMPLICATIONS FOR PRACTICE This study is the largest original series of patients with metastatic disease to the sella. In patients with pituitary metastasis, younger age, primary site other than lung or breast, and metastatic resection may prolong survival. Resection and radiation led to symptomatic improvement in ∼50% of patients. Seventy percent of patients had hypopituitarism. These hormonal deficiencies can be life threatening and can result in substantial morbidity if left untreated. Patients should be treated using a multimodality approach-including a potential role for surgery, radiation, chemotherapy, and hormone replacement-with the goal of improving survival and quality of life.
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Affiliation(s)
- Krupa R Patel
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Multidisciplinary Pituitary and Skull Base Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc A Cohen
- Multidisciplinary Pituitary and Skull Base Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Monica Girotra
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Multidisciplinary Pituitary and Skull Base Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
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30
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Vision Loss from Metastatic Colon Cancer to the Planum Sphenoidale and Optic Nerves. Can J Neurol Sci 2019; 47:233-234. [PMID: 31711554 DOI: 10.1017/cjn.2019.323] [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: 11/05/2022]
Abstract
An 80-year-old man was seen in urgent neuro-ophthalmology consultation for bilateral vision loss. He had a past medical history of hypertension and metastatic stage IV colorectal adenocarcinoma. Four months prior to presentation, he developed gradual onset, painless blurred vision in his right eye. He underwent cataract surgery in that eye, but his vision continued to decline to the point of no light perception. He developed new onset, painless, blurred vision in his left eye 3 weeks prior to presentation and woke up with no light perception in his left eye one day prior to presentation.
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31
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Mekki A, Dercle L, Lichtenstein P, Nasser G, Marabelle A, Champiat S, Chouzenoux E, Balleyguier C, Ammari S. Machine learning defined diagnostic criteria for differentiating pituitary metastasis from autoimmune hypophysitis in patients undergoing immune checkpoint blockade therapy. Eur J Cancer 2019; 119:44-56. [PMID: 31415986 DOI: 10.1016/j.ejca.2019.06.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/09/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE New-onset pituitary gland lesions are observed in up to 18% of cancer patients undergoing treatment with immune checkpoint blockers (ICB). We aimed to develop and validate an imaging-based decision-making algorithm for use by the clinician that helps differentiate pituitary metastasis (PM) from ICB-induced autoimmune hypophysitis (HP). MATERIALS AND METHODS A systematic search was performed in the MEDLINE and EMBASE databases up to October 2018 to identify studies concerning PM and HP in patients treated with cytotoxic T-lymphocyte-associated protein 4 and programmed cell death (ligand) 1. The reference standard for diagnosis was confirmation by histology or response on follow-up imaging. Patients from included studies were randomly assigned to the training set or the validation set. Using machine learning (random forest tree algorithm) with the most-described six imaging and three clinical features, a multivariable prediction model (the signature) was developed and validated for diagnosing PM. Signature performance was evaluated using area under a receiver operating characteristic curves (AUCs). RESULTS Out of 3174 screened articles, 65 were included totalising 122 patients (HP: 60 pts, PM: 62 pts). Complete radiological data were available in 82 pts (Training: 62 pts, Validation: 20 pts). The signature reached an AUC = 0.91 (0.82, 1.00), P < 10-8 in the training set and AUC = 0.94 (0.80, 1.00), P = 0.001 in the validation set. The signature predicted PM in lesions either ≥ 2 cm in size or < 2 cm if associated with heterogeneous contrast enhancement and cavernous extension. CONCLUSION An image-based signature was developed with machine learning and validated for differentiating PM from HP. This tool could be used by clinicians for enhanced decision-making in cancer patients undergoing ICB treatment with new-onset, concerning lesions of the pituitary gland.
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Affiliation(s)
- Ahmed Mekki
- Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris-Saclay, Paris, France; Department of Neuroradiology, C.H.U Bicêtre AP-HP, Le Kremlin-Bicêtre, France.
| | - Laurent Dercle
- Université Paris-Saclay, Paris, France; Gustave Roussy, Université Paris-Saclay, Institut National de La Santé et de La Recherche Médicale (INSERM), U1015, Equipe Labellisée Ligue Nationale Contre le Cancer, Villejuif, F-94805, France; Department of Radiology, Columbia University Medical Center, NYC, NY, USA.
| | | | - Ghaida Nasser
- Department of Neuroradiology, C.H.U Bicêtre AP-HP, Le Kremlin-Bicêtre, France
| | | | | | - Emilie Chouzenoux
- Center for Visual Computing, CentraleSupelec, INRIA Saclay, Gif-sur-Yvette, 91190, France
| | - Corinne Balleyguier
- Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris-Saclay, Paris, France
| | - Samy Ammari
- Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris-Saclay, Paris, France
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32
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Schill F, Nilsson M, Olsson DS, Ragnarsson O, Berinder K, Edén Engström B, Dahlqvist P, Wahlberg J, Englund E, Burman P. Pituitary Metastases: A Nationwide Study on Current Characteristics With Special Reference to Breast Cancer. J Clin Endocrinol Metab 2019; 104:3379-3388. [PMID: 30892659 DOI: 10.1210/jc.2019-00012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the contemporary presentation of pituitary metastases. PATIENTS Thirty-eight patients diagnosed with pituitary metastases from 1996 to 2018 in Sweden. METHODS Pituitary metastases were confirmed by histopathology (n = 27) or considered highly likely according to radiological findings, including rapid tumor progression (n = 11). Medical records were reviewed and sellar images reexamined centrally. RESULTS Breast and lung cancers were the most common primary tumors, in 45% and 21% of patients, respectively. Sixty-seven percent of breast cancers overexpressed human epidermal growth factor receptor 2 (HER2); 53% of pituitary metastases from breast cancers appeared ≥10 years after diagnosis of the primary tumor. At presentation, 71% appeared to have ACTH deficiency, 65% had TSH deficiency, and 26% had diabetes insipidus. Fatigue, nausea/vomiting, loss of appetite, weight loss, myalgia, and/or arthralgia were reported in 47% of patients with morning cortisol <100 nmol/L vs 23% with cortisol ≥200 nmol/L. Sixteen patients had visual field defects, and eight had diplopia. Intrasellar and suprasellar tumor growth was the most frequent finding. Initially, a pituitary adenoma was considered the etiology in 18% of patients.Radiotherapy, pituitary surgery, and chemotherapy were used in 68%, 68%, and 11% of patients, respectively. One and 2 years after diagnosis of pituitary metastases, 50% and 26% of patients were alive. CONCLUSION Pituitary metastases may be mistaken for pituitary adenomas and can appear late, especially in breast cancer. Breast cancers overexpressing HER2 seem prone to metastasize to the pituitary. Hypocortisolism may be misdiagnosed as cancer-related malaise. An increased awareness of pituitary metastases and undiagnosed pituitary failure can improve management in these patients.
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Affiliation(s)
- Fredrika Schill
- Department of Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Margareta Nilsson
- Centre for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Daniel S Olsson
- Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Berinder
- Institute of Molecular Medicine and Surgery, Karolinska Institute and Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Britt Edén Engström
- Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala, Sweden
| | - Per Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jeanette Wahlberg
- Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Elisabet Englund
- Department of Genetics and Pathology, Labmedicine, Medical Service, Skåne University Hospital, University of Lund, Lund, Sweden
| | - Pia Burman
- Department of Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden
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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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Castle-Kirszbaum M, Goldschlager T, Ho B, Wang YY, King J. Twelve cases of pituitary metastasis: a case series and review of the literature. Pituitary 2018; 21:463-473. [PMID: 29974330 DOI: 10.1007/s11102-018-0899-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The pituitary gland is an unusual site for metastatic spread, but as patients with metastatic malignancy are living longer, it may become more prevalent. Compression of important anatomy adjacent to the sella may produce disabling symptoms and endocrine derangement, leading to significant morbidity. METHODS An ambispective review of patient records between 2013 and 2017 from three neurosurgical centres was performed. After identifying cases, further investigation was performed to evaluate patient demographic, symptoms at presentation, radiological and histological findings, management, and outcome. RESULTS Our investigation identified 12 patients with pituitary metastasis. The average age of the cases was 63.4 years, with breast (n = 4) and lung (n = 4) being the most common primary cancers. In half the cases there was a history of metastatic disease, while in one-quarter of cases, pituitary symptoms were the first sign of malignancy. Adenohypophyseal dysfunction (83%), diabetes insipidus (DI) (75%), headache (67%) and visual field defects (67%) were the most common findings at presentation. Glucocorticoid replacement increased the sensitivity for diagnosis of DI. All cases were contrast enhancing on MRI and the endoscopic trans-sphenoidal approach was preferred for biopsy and debulking. CONCLUSIONS The pituitary should not be overlooked as a site of metastasis and sellar symptoms may be the first presentation of neoplastic disease. Any biochemical or clinical sign of pituitary pathology in a patient with known cancer should raise suspicion for sellar metastasis. Moreover, the development of DI or ophthalmoplegia from any pituitary lesion is suggestive of metastatic disease even in patients with no known primary.
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Affiliation(s)
- Mendel Castle-Kirszbaum
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Benjamin Ho
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Yi Yuen Wang
- Department of Neurosurgery, St Vincent's Hospital, Melbourne, Australia
| | - James King
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
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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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Pekic S, Popovic V. DIAGNOSIS OF ENDOCRINE DISEASE: Expanding the cause of hypopituitarism. Eur J Endocrinol 2017; 176:R269-R282. [PMID: 28258131 DOI: 10.1530/eje-16-1065] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/17/2017] [Accepted: 03/02/2017] [Indexed: 12/14/2022]
Abstract
Hypopituitarism is defined as one or more pituitary hormone deficits due to a lesion in the hypothalamic-pituitary region. By far, the most common cause of hypopituitarism associated with a sellar mass is a pituitary adenoma. A high index of suspicion is required for diagnosing hypopituitarism in several other conditions such as other massess in the sellar and parasellar region, brain damage caused by radiation and by traumatic brain injury, vascular lesions, infiltrative/immunological/inflammatory diseases (lymphocytic hypophysitis, sarcoidosis and hemochromatosis), infectious diseases and genetic disorders. Hypopituitarism may be permanent and progressive with sequential pattern of hormone deficiencies (radiation-induced hypopituitarism) or transient after traumatic brain injury with possible recovery occurring years from the initial event. In recent years, there is increased reporting of less common and less reported causes of hypopituitarism with its delayed diagnosis. The aim of this review is to summarize the published data and to allow earlier identification of populations at risk of hypopituitarism as optimal hormonal replacement may significantly improve their quality of life and life expectancy.
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Affiliation(s)
- Sandra Pekic
- School of MedicineUniversity of Belgrade, Belgrade, Serbia
- Clinic of EndocrinologyDiabetes and Metabolic Diseases, University Clinical Center Belgrade, Belgrade, Serbia
| | - Vera Popovic
- School of MedicineUniversity of Belgrade, Belgrade, Serbia
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Gulati S, Kiefer C, Karim NA. Diabetes Insipidus: An Unusual Presentation of Adenocarcinoma of the Lung in a Patient with no Identifiable Lung Mass. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:476-9. [PMID: 26713294 PMCID: PMC4677473 DOI: 10.4103/1947-2714.168677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Context: Lung cancers are known to metastasize to unusual sites. Despite this knowledge often times the diagnosis of a primary lung cancer gets delayed especially when the patient presents without respiratory symptoms. Case Report: The patient discussed in our review is a 47-year-old female, smoker who had presented to several hospitals with months of headache, nausea and intermittent episodes of vomiting. She was noted to have hypernatremia due to diabetes insipidus and a pituitary lesion on her magnetic resonance images. The pituitary mass on biopsy was found to represent a metastatic focus from a primary lung adenocarcinoma. Conclusion: Clinicians should be aware of malignancies that are well known to metastasize to the posterior pituitary. Conversely, since not every patient presents with symptoms of metastasis, there is a need to recognize the clinical syndromes (e. g., diabetes insipidus-like symptoms or more subtle symptoms like cranial nerve palsies) associated with potential metastasis to the pituitary.
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Affiliation(s)
- Shuchi Gulati
- Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio, United States
| | - Christoper Kiefer
- Division of Pathology and Lab Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - Nagla Abdel Karim
- Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio, United States
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Zacharia BE, Romero FR, Rapoport SK, Raza SM, Anand VK, Schwartz TH. Endoscopic Endonasal Management of Metastatic Lesions of the Anterior Skull Base: Case Series and Literature Review. World Neurosurg 2015; 84:1267-77. [PMID: 26079759 DOI: 10.1016/j.wneu.2015.05.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The anterior skull base is an uncommon site for brain metastases. A limited number of cases have been reported where a region of the skull base is accessed through an expanded/extended transsphenoidal route. In addition, reports of overall and progression-free survival rates are lacking. OBJECTIVE To report progression-free and overall survival rates for skull base metastases treated with aggressive endoscopic endonasal surgery and radiation therapy. METHODS We retrospectively review a prospective database of patients at New York Presbyterian Hospital undergoing expanded endoscopic endonasal surgery from 2004 to 2014. From this database, we identified all patients whose final pathology revealed a metastatic lesion in the midline skull base. RESULTS Seven hundred forty-nine patients underwent endonasal endoscopic surgery. Final pathology in 12 patients (1.6%) revealed metastasis to the sellar or parasellar region. Tumors were located in the sella, suprasellar cistern, clivus, ethmoid sinuses, sphenoid sinus, cavernous sinus, and craniovertebral junction. Breast and lung cancers were the most common primary diagnoses. Gross total resection was achieved in 41.6% of patients. There were no postoperative cerebrospinal fluid leaks. Adjuvant radiation therapy was used in 92% of cases. Median follow-up was 14 months (range, 1-55). Median progression-free and overall survival were 18 and 16 months, respectively. CONCLUSIONS The range of anterior skull base metastatic lesions that can be managed endonasally has increased with the advent of extended endonasal endoscopic surgical approaches. Favorable results can be obtained with this surgical approach as part of the overall management paradigm for patients with skull base metastases.
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Affiliation(s)
- Brad E Zacharia
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
| | - Flavio R Romero
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA
| | - Sarah K Rapoport
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Hospital, Washington, DC, USA
| | - Shaan M Raza
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA
| | - Vijay K Anand
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA; Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA; Department of Neuroscience, Weill Medical College of Cornell University, New York, New York, USA
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