1
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Wang H, Zhu M, Yan Y. Neuro-ophthalmological findings of pituitary metastasis: Case series from a single center and review of the literature. Heliyon 2024; 10:e26027. [PMID: 38379980 PMCID: PMC10877364 DOI: 10.1016/j.heliyon.2024.e26027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/10/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024] Open
Abstract
When pituitary metastasis (PM) invades the pituitary gland, it leads to impaired endocrine function and compression and infiltration of surrounding tissues, causing a series of clinical alterations. We presented seven patients with PM evaluated at neuro-ophthalmologic clinic and reviewed neuro-ophthalmological findings of 44 cases with PM in the English literature from 1979 to December 2022. The mean age at diagnosis was 58.1 years, and 45.1% were male. The mean latency period from primary cancer to the diagnosis of PM was 57.6 months. PM is the only presenting sign of malignancy in 11.8% of patients. The mean time from the visual disturbance to the diagnosis of PM was 96.3 days. Visual acuity decreased in 72.5% and 60.8% of cases with visual field defects. 74.2% exhibited a pattern of temporal field defect respecting the vertical meridian. Isolated ophthalmoplegia was found in 37.3% of patients. The most common ocular motor nerve palsy was unilateral III nerve palsy. Breast cancer was the most common primary malignancy. 84.6% entirely or partially relieved the neuro-ophthalmic symptoms after treatment. 51% of patients were alive during a mean follow-up period of 11 months. The mean survival duration was within six months in 65% of deceased patients. For elderly patients with a pituitary tumor, PM should be on the list of differential diagnoses for those with visual impairment, especially ocular motor nerve palsy, even if diabetic insipidus is not present, with or even without a history of malignancy, regardless of the primary tumor site.
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Affiliation(s)
- Hongliang Wang
- Department of Ophthalmology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Mingjie Zhu
- Department of Ophthalmology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Ottawa-Shanghai Joint School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Yan
- Department of Ophthalmology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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2
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Yang K, Begley SL, Lynch D, Ye V, Saini J, Gutierrez E, Vialet J, Millar BA, Conrad T, Laperriere N, Bernstein M, Zadeh G, Shultz DB, Kongkham PN. Pituitary metastases: a case series and scoping review. Pituitary 2023; 26:538-550. [PMID: 37698666 DOI: 10.1007/s11102-023-01349-w] [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: 08/16/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To understand the natural history and optimal treatment strategy for pituitary gland metastasis. METHODS We performed both a retrospective chart review of patients treated at our institution and a scoping review of the topic. RESULTS The retrospective review identified seven patients with an average age of 59.6 years. Primary histologies included breast cancer (4), melanoma (1), renal cell carcinoma (1), and sarcoma (1). Two patients had anterior pituitary endocrine dysfunction, one of whom was the only patient with visual symptoms. All patients were treated with radiosurgery and two also underwent surgical resection. Overall survival ranged from 6.5 to 117 months. Literature review identified 166 patients from 71 studies. The most common primary cancer was lung (27.7%), followed by breast (18.7%) and renal (14.5%) cancer. 107 presented with endocrine dysfunction, including 41 cases of diabetes insipidus and 55 cases of hypopituitarism. 110 presented with visual compromise. 107 patients received radiotherapy, 96 underwent surgical resection and 44 received systemic chemotherapy/immunotherapy. Surgery was significantly associated with an increased likelihood of vision improvement and a decreased likelihood of endocrine normalization. Radiographic regression predicted visual improvement. Median overall survival was 9.9 months (range: 0.2-96). CONCLUSIONS This scoping review showed that both radiosurgery and surgical resection have been frequently used to treat pituitary metastases with good response. Vision improvement is more likely to happen following surgical resection, likely at the expense of endocrine dysfunction. Despite treatment and radiographic response, patient survival remains less than a year.
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Affiliation(s)
- Kaiyun Yang
- Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Sabrina L Begley
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Daniel Lynch
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Vincent Ye
- Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Jasleen Saini
- Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Enrique Gutierrez
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Jaclyn Vialet
- Medical Library, North Shore University Hospital, Manhasset, NY, USA
| | - Barbara-Ann Millar
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Tatianna Conrad
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Normand Laperriere
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Mark Bernstein
- Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Gelareh Zadeh
- Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - David B Shultz
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Paul N Kongkham
- Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
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3
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Mazar‐Atabaki A, Mohamadzadeh O, Sadrehosseini SM, Tabari A, Zeinalizadeh M. Pituitary metastasis from renal cell carcinoma presenting with significant hyperprolactinemia, case report. Clin Case Rep 2023; 11:e7808. [PMID: 37636878 PMCID: PMC10457481 DOI: 10.1002/ccr3.7808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/09/2023] [Accepted: 06/19/2023] [Indexed: 08/29/2023] Open
Abstract
Key Clinical Message Kidney metastasis to the pituitary gland can cause hyperprolactinemia even above 250 ng/mL. Although the treatment of metastasis is palliative, surgical decompression could play a major role in the recovery of symptoms and improve quality of life. Pituitary metastasis should be considered in the evaluation of an unusual pituitary mass. Abstract Pituitary tumors are frequently encountered in the neurosurgical setting. Although the majority of them are pituitary adenomas, rare entities encompass pituitary metastasis. They should be differentiated from pituitary adenomas because their management and prognosis are different. We report a 53-year-old female who complained of headache and had remarkable hyperprolactinemia (271.1 ng/mL). Having considered macroprolactinoma as the initial diagnosis, medical treatment was initiated with Cabergoline. Subsequently, the patient's vision deteriorated which prompted us to perform endoscopic endonasal transsphenoidal surgery. Histologic examination of the resected tumor revealed metastatic renal cell carcinoma. Main treatment for these subjects is palliative; and unlike the pituitary adenoma, the prognosis is unfortunately poor. Pituitary metastasis should be considered in the evaluation of an unusual pituitary mass associated with hyperprolactinemia.
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Affiliation(s)
- Ali Mazar‐Atabaki
- Brain and Spinal Injury Research Center, Pituitary ClinicImam Khomeini Hospital Complex, Tehran University of Medical SciencesTehranIran
- Department of Neurological Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Omid Mohamadzadeh
- Brain and Spinal Injury Research Center, Pituitary ClinicImam Khomeini Hospital Complex, Tehran University of Medical SciencesTehranIran
- Department of Neurological Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Seyed Mousa Sadrehosseini
- Department of Otolaryngology‐Head and Neck Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Azin Tabari
- Department of Otolaryngology‐Head and Neck Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Mehdi Zeinalizadeh
- Department of Neurological Surgery, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
- Brain and Spinal Injury Research Center, Pituitary ClinicNeuroscience Institute, Tehran University of Medical SciencesTehranIran
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4
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Tovar-Méndez VH, Cuenca D, Gómez-Pérez FJ, Cuevas-Ramos D. Pituitary Infiltration by Lymphoma. J Endocr Soc 2022; 6:bvac161. [PMID: 36397777 PMCID: PMC9664974 DOI: 10.1210/jendso/bvac161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Lymphoma infiltration to the pituitary is rare. It represents less than 0.5% of all reported pituitary metastases (PMs). Here we present a case series of 3 patients with PMs from a systemic lymphoma. Also, we performed a literature review of the cases reported. We identified additional 31 cases in which non-Hodgkin lymphoma (NHL) was the most common (n = 28, 90%), with large B-cell NHL the most frequent histological subtype (n = 14, 45%). Central hypothyroidism (n = 21, 67%) was the most frequent pituitary deficiency followed by adrenal insufficiency (n = 19, 61%) and diabetes insipidus (DI; n = 18, 58%). Full endocrine recovery was found in only 12% (n = 4) of patients after treatment, and magnetic resonance imaging showed tumor regression in 22% of them. In our series, 2 patients were diagnosed with diffuse large B-cell lymphoma, and 1 had mixed cellularity of classic Hodgkin lymphoma. The mean age was 54 ± 6.92 years. Hypopituitarism and DI were present in all of them, with 100% of mortality because of advanced systemic disease.
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Affiliation(s)
- Víctor Hugo Tovar-Méndez
- Department of Endocrinology, Neuroendocrinology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , 14080, Mexico City, Tlalpan , Mexico
| | - Dalia Cuenca
- Department of Endocrinology, Neuroendocrinology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , 14080, Mexico City, Tlalpan , Mexico
| | - Francisco J Gómez-Pérez
- Department of Endocrinology, Neuroendocrinology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , 14080, Mexico City, Tlalpan , Mexico
| | - Daniel Cuevas-Ramos
- Department of Endocrinology, Neuroendocrinology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , 14080, Mexico City, Tlalpan , Mexico
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5
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Rasiah NP, Albakr A, Kosteniuk S, Starreveld Y. Early and isolated breast cancer metastasis to the pituitary: A case report and systematic review. Surg Neurol Int 2022; 13:462. [PMID: 36324911 PMCID: PMC9609953 DOI: 10.25259/sni_1053_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Pituitary metastases (PMs) arising from breast cancer tend to occur many years following initial diagnosis, and after other systemic metastasis have been identified. Survival is generally considered to be poor. However, there are cases where patients present with an isolated metastatic lesion in the pituitary. Survival in this subset of patients has not been evaluated. We present a case of isolated PM that presented two years after initial diagnosis of breast cancer. We performed a systematic review of 38 breast cancer patients with PM. We report presentation, treatment strategy, and outcomes of breast cancer metastasis to the pituitary and highlight cases of isolated PM. Case Description: A 39 year old female presented with complaints of headache and polydipsia two years after diagnosis with breast cancer. Systemic workup was unremarkable, but brain imaging identified an isolated PM. Transsphenoidal debulking was performed with adjuvant radiation therapy (RT) targeted to the sellar region. Unfortunately, she passed away 9 months later from systemic progression. Conclusion: A total of 38 patients were included systematic review. Of these, 13 had isolated PM. Prevalent signs/ symptoms included visual disturbance, diabetes insipidus (DI), and hypothalamic dysfunction. Patients treated with surgical resection and adjuvant chemotherapy (ChT), or RT had better survival than those treated with resection alone. Patients that receive treatment for isolated PM may survive for many years without progression or recurrence.
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Affiliation(s)
- Neilen P Rasiah
- Department of Neurosurgery, University of Calgary, Calgary, Canada
| | | | - Suzanne Kosteniuk
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Yves Starreveld
- Department of Neurosurgery, University of Calgary, Calgary, Canada
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6
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Oueslati I, Ayari S, Yazidi M, Bouali S, Khessairi N, Chihaoui M. Hypopituitarism secondary to a pituitary metastasis in a young woman with an invasive breast carcinoma. Clin Case Rep 2021; 9:e04175. [PMID: 34194769 PMCID: PMC8222757 DOI: 10.1002/ccr3.4175] [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: 09/21/2020] [Accepted: 03/29/2021] [Indexed: 11/26/2022] Open
Abstract
Hypopituitarism secondary to a pituitary metastasis is rare and difficult to diagnose since its symptoms are nonspecific. The presence of visual deficits and nerve palsies should suggest the presence of a pituitary metastasis in a cancer patient.
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Affiliation(s)
- Ibtissem Oueslati
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Sabrina Ayari
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Meriem Yazidi
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Sofiene Bouali
- Department of neurosurgeryNational Institute of NeurologyFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Nadia Khessairi
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Melika Chihaoui
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
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7
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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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8
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Li B, Cheng JH, Zhu HB, Li CZ, Zhang YZ, Zhao P. Pituitary metastasis from renal cell carcinoma: case report and review of the literature. Int J Neurosci 2020; 131:199-205. [PMID: 32098537 DOI: 10.1080/00207454.2020.1734599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pituitary metastasis(PM) from renal cell carcinoma(RCC) is rare, and is easy to be misdiagnosed. Here, we present a case of pituitary metastasis from clear-cell renal cell carcinoma(ccRCC) which was difficult to distinguish from other sellar region tumors. In addition, we systematically review the literature to find the characteristics of different tumors of the sellar region. It provides a new idea for the diagnosis of sellar region tumors in the clinic.
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Affiliation(s)
- Bin Li
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Hua Cheng
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hai-Bo Zhu
- Department of Cell and Biology, Beijing Neurosurgical Institute, Beijing, China
| | - Chu-Zhong Li
- Department of Cell and Biology, Beijing Neurosurgical Institute, Beijing, China
| | - Ya-Zhuo Zhang
- Department of Cell and Biology, Beijing Neurosurgical Institute, Beijing, China
| | - Peng Zhao
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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9
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Alexandraki KI, Grossman AB. Management of Hypopituitarism. J Clin Med 2019; 8:jcm8122153. [PMID: 31817511 PMCID: PMC6947162 DOI: 10.3390/jcm8122153] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
Hypopituitarism includes all clinical conditions that result in partial or complete failure of the anterior and posterior lobe of the pituitary gland’s ability to secrete hormones. The aim of management is usually to replace the target-hormone of hypothalamo-pituitary-endocrine gland axis with the exceptions of secondary hypogonadism when fertility is required, and growth hormone deficiency (GHD), and to safely minimise both symptoms and clinical signs. Adrenocorticotropic hormone deficiency replacement is best performed with the immediate-release oral glucocorticoid hydrocortisone (HC) in 2–3 divided doses. However, novel once-daily modified-release HC targets a more physiological exposure of glucocorticoids. GHD is treated currently with daily subcutaneous GH, but current research is focusing on the development of once-weekly administration of recombinant GH. Hypogonadism is targeted with testosterone replacement in men and on estrogen replacement therapy in women; when fertility is wanted, replacement targets secondary or tertiary levels of hormonal settings. Thyroid-stimulating hormone replacement therapy follows the rules of primary thyroid gland failure with L-thyroxine replacement. Central diabetes insipidus is nowadays replaced by desmopressin. Certain clinical scenarios may have to be promptly managed to avoid short-term or long-term sequelae such as pregnancy in patients with hypopituitarism, pituitary apoplexy, adrenal crisis, and pituitary metastases.
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Affiliation(s)
- Krystallenia I. Alexandraki
- Endocrine Unit, 1st Department of Propaedeutic Medicine, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Ashley B. Grossman
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford OX3 7LE, UK
- Centre for Endocrinology, Barts and the London School of Medicine, London EC1M 6BQ, UK
- Correspondence:
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10
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Clinical management of a pituitary gland metastasis from clear cell renal cell carcinoma. Anticancer Drugs 2019; 29:710-715. [PMID: 29846249 DOI: 10.1097/cad.0000000000000644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In very few years, several treatments have significantly improved the prognosis of patients with metastatic renal cell carcinoma (RCC). Despite this, the clinical outcomes of specific subgroups of patients including those with central nervous metastases still remain poor. In this population, a very infrequent and poorly described site of metastases is the pituitary gland. Because of the important endocrinal function and the anatomic site of this specific organ, clinical management of this complication requires several additional precautions compared with other central nervous metastases. Here, we describe a case of a single pituitary metastasis from clear cell RCC in a patient who showed a surprising progression-free survival and overall survival to sunitinib first-line treatment. Because of the uncommon clinical course of the disease of our patient and the atypical site of metastases, we want also to underline the importance of further investigation of molecular pathways associated with a favorable prognosis in patients with metastatic clear cell RCC.
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11
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Chang MH, Kuo YJ, Ho CY, Kuan EC, Lan MY. Metastatic Tumors of the Sinonasal Cavity: A 15-Year Review of 17 Cases. J Clin Med 2019; 8:jcm8040539. [PMID: 31010194 PMCID: PMC6517969 DOI: 10.3390/jcm8040539] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/22/2019] [Accepted: 04/16/2019] [Indexed: 12/13/2022] Open
Abstract
Extranasal cancers that metastasize to the sinonasal cavity are very rare. To date, there are only limited reports regarding this rare condition within the literature. Therefore, we retrospectively reviewed all patients diagnosed with metastatic cancer of the sinonasal tract from 2003 to 2018 at a tertiary academic medical center. Patient demographic data, clinical presentation, treatment modalities, and outcomes were investigated. There were a total of 17 patients (9 males and 8 females) included in the analysis. The mean age was 56.8 years (range 27–80). The most common primary malignancies were hepatocellular carcinoma (n = 3) and gastrointestinal tract adenocarcinoma (n = 3). The most common site of metastasis was the nasal cavity (n = 8). Five patients received radical tumor resection and the others underwent radiotherapy, chemotherapy, or combined chemoradiotherapy. The 2-year survival was 28%. In summary, metastasis to the sinonasal cavity remains extremely rare. A high degree of suspicion regarding the possibility of metastatic spread to the sinonasal region is necessary for patients with a previous history of malignancy who present with new sinonasal symptoms. The treatment strategy of sinonasal metastatic cancer is usually palliative therapy and the prognosis remains poor. However, early detection and diagnosis, coupled with aggressive treatment, may improve patient quality of life.
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Affiliation(s)
- Miao-Hsu Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
| | - Ying-Ju Kuo
- Department of Pathology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Ching-Yin Ho
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Department of Otolaryngology, Cheng Hsin Hospital, Taipei 11220, Taiwan.
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA 92868, USA.
| | - Ming-Ying Lan
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
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12
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Cai H, Liu W, Feng T, Li Z, Liu Y. Clinical Presentation and Pathologic Characteristics of Pituitary Metastasis from Breast Carcinoma: Cases and a Systematic Review of the Literature. World Neurosurg 2019; 124:445-451.e2. [PMID: 30630045 DOI: 10.1016/j.wneu.2018.12.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is rare for breast carcinoma to metastasize to the pituitary gland; this finding indicates extensive metastasis of the primary tumor. CASE DESCRIPTION Herein, we present a 57-year-old patient with pituitary gland metastasis from breast cancer that was treated with extensive radical mastectomy 16 years prior. The pituitary was the sole site of metastasis. The patient was admitted with the chief complaint of blurred vision for 1 year and episodic headaches for 1 month. Magnetic resonance imaging revealed a solid mass in the sellar region with heterogenous contrast enhancement. The preoperative diagnosis was a pituitary adenoma. Neuroendoscopy-assisted tumor resection was conducted through a single-nostril sphenoid sinus approach. A pinkish-white, firm neoplasm was found, with an abundant blood supply and an indistinct boundary between the neoplasm and normal pituitary tissue; complete resection was achieved. The results of immunohistochemical analysis were positive for cytokeratin, Ki-67antigen, estrogen receptors, progesterone receptors, and prolactin-induced protein. The neoplasm was negative for spalt-like transcription factor 4, mammaglobin, and the alpha subunit of the glycoprotein hormones. These results were used to reach a final diagnosis of pituitary gland metastasis from a primary breast carcinoma. The patient's vision improved significantly after surgery, and no recurrence was detected during 1 year of follow-up. CONCLUSIONS Pituitary gland metastasis is rare and difficult to differentiate from a pituitary adenoma without a pathologic diagnosis. Surgery is the first choice for treatment. Surgery, radiotherapy, and chemotherapy are combined with endocrine therapy to tailor treatment to the results of immunohistochemistry.
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Affiliation(s)
- Heng Cai
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wenjing Liu
- Department of Geriatrics, First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Tianda Feng
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhen Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yunhui Liu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
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13
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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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14
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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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15
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Mercado M, Melgar V, Salame L, Cuenca D. Clinically non-functioning pituitary adenomas: Pathogenic, diagnostic and therapeutic aspects. ACTA ACUST UNITED AC 2017; 64:384-395. [PMID: 28745610 DOI: 10.1016/j.endinu.2017.05.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/15/2022]
Abstract
Clinically non-functioning pituitary adenomas (NFPAs) are among the most common tumors in the sellar region. These lesions do not cause a hormonal hypersecretion syndrome, and are therefore found incidentally (particularly microadenomas) or diagnosed based on compressive symptoms such as headache and visual field defects, as well as clinical signs of pituitary hormone deficiencies. Immunohistochemically, more than 45% of these adenomas stain for gonadotropins or their subunits and are therefore called gonadotropinomas, while 30% of them show no immunostaining for any hormone and are known as null cell adenomas. The diagnostic approach to NFPAs should include visual field examination, an assessment of the integrity of all anterior pituitary hormone systems, and magnetic resonance imaging of the sellar region to define tumor size and extension. The treatment of choice is transsphenoidal resection of the adenoma, which in many instances cannot be completely accomplished. The recurrence rate after surgery may be up to 30%. Persistent or recurrent adenomas are usually treated with radiation therapy. In a small proportion of these cases, drug treatment with dopamine agonists and, to a lesser extent, somatostatin analogs may achieve reduction or at least stabilization of the tumor.
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Affiliation(s)
- Moises Mercado
- Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico; Neurological Center, American British Cowdray Medical Center, Mexico City, Mexico.
| | - Virgilio Melgar
- Neurological Center, American British Cowdray Medical Center, Mexico City, Mexico
| | - Latife Salame
- Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico
| | - Dalia Cuenca
- Department of Medicine, American British Cowdray Medical Center, Mexico City, Mexico
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16
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Taschner CA, Sankowski R, Shah JM, Urbach H, Hartmann R, Prinz M. Freiburg Neuropathology Case Conference : A Pituitary Mass Lesion. Clin Neuroradiol 2016; 26:493-497. [PMID: 27830265 DOI: 10.1007/s00062-016-0549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Medical Centre Freiburg, Freiburg, Germany.
| | - R Sankowski
- Department of Neuropathology, University Medical Centre Freiburg, Freiburg, Germany
| | - J M Shah
- Department of Neurosurgery, University Medical Centre Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, University Medical Centre Freiburg, Freiburg, Germany
| | - R Hartmann
- Department of Neuroradiology, University Medical Centre Freiburg, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, University Medical Centre Freiburg, Freiburg, Germany
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