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Dedeker C, Archibald H, Meares A, Mendez A, Hamlar D. Metastatic breast cancer masquerading as a pituitary macroadenoma: A case report. SAGE Open Med Case Rep 2022; 10:2050313X211073243. [PMID: 35096396 PMCID: PMC8793421 DOI: 10.1177/2050313x211073243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
The purpose of this manuscript is to report a case of symptomatic breast cancer metastasis to the pituitary gland, a described yet exceedingly rare phenomenon. A 52-year-old woman with a known history of stage-IV breast cancer treated 3 years prior with chemotherapy presented to the emergency department with 2 weeks of right-sided periorbital headache and 1 week of right-sided ptosis. Magnetic resonance imaging showed a 1.9 cm × 2.8 cm × 2.8 cm mass in the pituitary with mass effect on the right optic chiasm. Endocrine laboratory studies were largely normal, including prolactin, thyroid-stimulating hormone, insulin-like growth factor, and a minimally decreased cortisol. She underwent endoscopic transnasal transsphenoidal resection 4 days later to remove the mass without complication. Postoperative pathologic studies were positive for breast cancer metastasis, and she was subsequently started on adjuvant radiation and oral chemotherapy. While breast cancer metastases to the sella have been described in the literature before, symptomatic spread to the pituitary represents a small percentage of all breast cancer metastases, and we thus feel is worthy of further discussion.
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Affiliation(s)
- Connor Dedeker
- University of Minnesota Medical School Twin Cities, Minneapolis, MN, USA
| | - Hunter Archibald
- Department of Otolaryngology: Head and Neck Surgery, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Annie Meares
- Department of Pathology, Regions Hospital, St. Paul, MN, USA
| | | | - David Hamlar
- Department of Otolaryngology: Head and Neck Surgery, University of Minnesota Twin Cities, Minneapolis, MN, USA
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2
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Sahel OA, Benameur Y, Nabih SO, Biyi A, Doudouh A. A rare case of pituitary metastasis from breast cancer detected on fluorodeoxyglucose positron emission tomography/computed tomography that presented as insipid diabetes. World J Nucl Med 2021; 20:211-214. [PMID: 34321980 PMCID: PMC8286001 DOI: 10.4103/wjnm.wjnm_88_20] [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: 06/22/2020] [Revised: 07/28/2020] [Accepted: 08/14/2020] [Indexed: 11/08/2022] Open
Abstract
Pituitary metastases are rare, are generally asymptomatic, and often remain undiagnosed. Breast cancer is the most common primary cancer metastasizing to hypophysis in women. However, it is difficult to clinically and radiologically differentiate pituitary metastases from pituitary adenomas. We report a case of pituitary metastases diagnosed on magnetic resonance imaging and positron emission tomography/computed tomography, which was the prime manifestation of a breast cancer in a 46-year-old female. This cancer was revealed by insipid diabetes.
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Affiliation(s)
- Omar Ait Sahel
- Department of Nuclear Medicine, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Yassir Benameur
- Department of Nuclear Medicine, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Salah Oueriagli Nabih
- Department of Nuclear Medicine, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Abdelhamid Biyi
- Department of Nuclear Medicine, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Abderrahim Doudouh
- Department of Nuclear Medicine, Military Hospital of Instruction Mohamed V, Rabat, Morocco
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3
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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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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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Marmouch H, Arfa S, Mohamed SC, Slim T, Khochtali I. An acute adrenal insufficiency revealing pituitary metastases of lung cancer in an elderly patient. Pan Afr Med J 2016; 23:34. [PMID: 27200139 PMCID: PMC4856488 DOI: 10.11604/pamj.2016.23.34.8905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/28/2016] [Indexed: 12/03/2022] Open
Abstract
Metastases of solid tumors to the pituitary gland are often asymptomatic or appereas as with diabetes insipid us. Pituitary metastases more commonly affect the posterior lobe and the infundibulum than the anterior lobe. The presentation with an acute adrenal insufficiency is a rare event. A 69-year-old men presented with vomiting, low blood pressure and hypoglycemia. Hormonal exploration confirmed a hypopituitarism. Appropriate therapy was initiated urgently. The hypothalamic-pituitary MRI showed a pituitary hypertrophy, a nodular thickening of the pituitary stalk. The chest X Rays revealed pulmonary opacity. Computed tomography scan of the chest showed a multiples tumors with mediastinal lymphadenopathy. Bronchoscopy and biopsy demonstrated a pulmonary adenocarcinoma. Hence we concluded to a lung cancer with multiple pituitary and adrenal gland metastases. This case emphasizes the need for an etiological investigation of acute adrenal insufficiency after treatment of acute phase.
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Affiliation(s)
- Hela Marmouch
- Department of Endocrinology and Internal Medecine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Sondes Arfa
- Department of Endocrinology and Internal Medecine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | - Tensim Slim
- Department of Endocrinology and Internal Medecine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Ines Khochtali
- Department of Endocrinology and Internal Medecine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
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Jebasingh FK, Mahesh DM, Sathyakumar S, Sigamani E, Paul TV. An Uncommon Cause for Polyuria. J Clin Diagn Res 2016; 9:OJ01-2. [PMID: 26814359 DOI: 10.7860/jcdr/2015/15775.7005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/15/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Felix K Jebasingh
- Senior Registrar, Department of Endocrinology, Diabetes & Metabolism, Christian Medical College , Vellore, India
| | - D M Mahesh
- Assistant Professor, Department of Endocrinology, Diabetes & Metabolism, Christian Medical College , Vellore, India
| | - Samantha Sathyakumar
- Senior Registrar, Department of Endocrinology, Diabetes & Metabolism, Christian Medical College , Vellore, India
| | - Elanthenral Sigamani
- Assistant Professor, Department of Pathology, Christian Medical College , Vellore, India
| | - Thomas V Paul
- Professor, Department of Endocrinology, Diabetes & Metabolism, Christian Medical College , Vellore, India
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Gilard V, Alexandru C, Proust F, Derrey S, Hannequin P, Langlois O. Pituitary metastasis: is there still a place for neurosurgical treatment? J Neurooncol 2015; 126:219-24. [PMID: 26514360 DOI: 10.1007/s11060-015-1967-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 10/24/2015] [Indexed: 12/13/2022]
Abstract
Pituitary metastases are uncommon, ranging from 1 to 5 % of all metastases. Between 10 and 30 % of pituitary lesions are symptomatic responsible for diabetes insipidus, visual field defect or cranial nerve palsy. Primary sites are lung or breast in two-thirds of cases. There is no current reference concerning treatment of such lesions. Overall survival is poor and depends on primary site. Although the role of surgery is currently limited, discussion is warranted in several indications for diagnostic or symptomatic purposes. We report two cases of symptomatic pituitary metastases in a context of breast cancer and review the litterature concerning the role of surgery and other treatment modalities.
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Affiliation(s)
- V Gilard
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031, Rouen Cedex, France.
| | - C Alexandru
- Department of Oncology, Henri Becquerel Cancer Center, Rouen, France
| | - F Proust
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - S Derrey
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031, Rouen Cedex, France
| | - P Hannequin
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031, Rouen Cedex, France
| | - O Langlois
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031, Rouen Cedex, France
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Al-Aridi R, El Sibai K, Fu P, Khan M, Selman WR, Arafah BM. Clinical and biochemical characteristic features of metastatic cancer to the sella turcica: an analytical review. Pituitary 2014; 17:575-87. [PMID: 24337713 DOI: 10.1007/s11102-013-0542-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Sellar metastasis is uncommon and poorly characterized as published data include small series of subjects. This study's goal is to identify unique features that differentiate this entity from other sellar masses such as pituitary macroadenomas. METHODS Published cases of pathologically-confirmed sellar metastasis along with our experience in such patients over a 6-years period were reviewed (total = 129). As a control group, we reviewed similar data on 55 patients with pituitary macroadenomas managed over the same time-period. Presenting symptoms, pituitary dysfunction were analyzed using univariate, multivariate and receiver operating characteristic (ROC) analyses. RESULTS Sellar metastasis has equal gender distribution with a median patient-age of 56 years. The most common primary malignancy was breast cancer (29%) in women and lung cancer (30%) in men. Sellar metastasis was the first manifestation of cancer in over 40% of patients. Common presenting symptoms included headaches, visual field deficits, abnormal eye motility and diabetes insipidus. These symptoms were less frequent among patients with pituitary macroadenomas. Univariate regression analyses showed that headaches, abnormal eye motility, visual field deficits and diabetes insipidus were each predictive of metastatic disease. ROC analysis combining all 4 features revealed an AUC of 0.953 with a sensitivity of 0.818 and a specificity of 0.935. Using the multivariate regression, abnormal eye motility and/or diabetes insipidus independently predicted metastatic disease. CONCLUSIONS Sellar metastasis should be suspected in patients presenting with sellar masses, abnormal eye motility and/or diabetes insipidus even those without known malignancy since pituitary metastasis can often be the first manifestation of cancer.
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Affiliation(s)
- Ribal Al-Aridi
- Division of Clinical and Molecular Endocrinology, University Hospitals/Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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McCutcheon IE. Pituitary adenomas: Surgery and radiotherapy in the age of molecular diagnostics and pathology. Curr Probl Cancer 2013; 37:6-37. [PMID: 23391140 DOI: 10.1016/j.currproblcancer.2012.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ian E McCutcheon
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA
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10
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Guijarro de Armas MG, Torán Ranero CE, Pavón de Paz I, Merino Viveros M, Iglesias Bolaños P, Monereo Megías S. Panhypopituitarism and lung neoplasm: a case study. ACTA ACUST UNITED AC 2013; 60:e35-6. [PMID: 23769487 DOI: 10.1016/j.endonu.2013.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 11/18/2022]
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11
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Lachhab L, Fikri M, Aitbenhaddou E, Arkha Y, Regragui W, Jiddane M, Benomar A, Yahyaoui M. Localisations métastatiques inhabituelles d’adénocarcinome pulmonaire. J Fr Ophtalmol 2013; 36:e23-6. [DOI: 10.1016/j.jfo.2012.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 03/01/2012] [Indexed: 12/17/2022]
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12
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Lin BH, Lin HY, Hung SK, Lee MS, Chiou WY. Hypopituitarism, a very rare manifestation of rectal cancer metastases: case report and a review of the literature. Clin Res Hepatol Gastroenterol 2011; 35:329-31. [PMID: 21474419 DOI: 10.1016/j.clinre.2011.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Accepted: 01/07/2011] [Indexed: 02/04/2023]
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Marsh JC, Garg S, Wendt JA, Gielda BT, Turian JV, Herskovic AM. Intracranial metastatic disease rarely involves the pituitary: retrospective analysis of 935 metastases in 155 patients and review of the literature. Pituitary 2010; 13:260-5. [PMID: 20405323 DOI: 10.1007/s11102-010-0229-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We present a case report of a patient recently treated at our institution for an isolated non-small cell lung cancer metastatic lesion to the sella, report the lack of involvement of the pituitary gland in a large single-institution series of treated intracranial parenchymal metastases, and review the pertinent literature. We reviewed cranial imaging studies (CT and MRI) for 935 metastases in 155 patients treated at our institution over the previous 3 years for intracranial metastatic disease. Special attention was paid to the skull base to document the presence of any metastatic disease involving the pituitary gland, infundibular stalk, sella turcica (including anterior and posterior clinoids), or diaphragm sellae. We found no other involvement of the pituitary gland or other sellar structures by metastatic disease in this series. Intracranial metastatic disease rarely involves the pituitary gland and infundibular stalk parenchyma, suggesting that this structure may be safely omitted from the treatment field during WBRT and prophylactic cranial irradiation (PCI). This treatment approach should reduce the late sequelae of treatment to this critical organ.
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Affiliation(s)
- James C Marsh
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA.
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Gutenberg A, Landek-Salgado M, Tzou SC, Lupi I, Geis A, Kimura H, Caturegli P. Autoimmune hypophysitis: expanding the differential diagnosis to CTLA-4 blockade. Expert Rev Endocrinol Metab 2009; 4:681-698. [PMID: 30780785 DOI: 10.1586/eem.09.37] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Autoimmune hypophysitis is an increasingly recognized disorder that enters in the differential diagnosis of nonfunctioning pituitary masses. The differential diagnosis of these conditions is challenging because of similar clinical presentations and radiological signs. This review describes the essential features of hypophysitis and the other nonfunctioning pituitary masses. It also emphasizes a recently described feature of hypophysitis: its appearance with unexpectedly high frequency in patients receiving treatments that abrogate the function of cytotoxic T lymphocyte antigen 4.
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Affiliation(s)
- Angelika Gutenberg
- a Department of Neurosurgery, Georg-August University, Goettingen, Germany.
| | - Melissa Landek-Salgado
- b Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Shey-Cherng Tzou
- c Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Isabella Lupi
- d Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy.
| | - Abby Geis
- e Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Hiroaki Kimura
- f Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Patrizio Caturegli
- g Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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