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Gariépy C, Champagne PO. Metastatic Seeding From a Gastrointestinal Neoplasia in a Pituitary Adenoma: A Case Report and Literature Review. Cureus 2023; 15:e34676. [PMID: 36909111 PMCID: PMC9993799 DOI: 10.7759/cureus.34676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Pituitary composite tumors consisting of metastasis within an adenoma are rare and aggressive entities. We present a case of esophageal adenocarcinoma metastasis at a prolactinoma presenting in a unique fashion and highlight how this case could contribute to a better understanding and early recognition of this condition. The patient was a 65-year-old male who presented with partial palsy of the third and sixth cranial nerves. He had a history of treated esophageal adenocarcinoma. He also had a known small parasellar lesion, with an elevated prolactin. Investigations showed a rapid progression of the parasellar lesion and normalization of prolactin. Partial surgical resection was performed, and pathology confirmed metastasis of the known digestive tract neoplasia. Although extremely rare, dual pathology of pituitary metastasis within adenomas should be considered in the differential diagnosis of sellar masses. Atypical behavior of benign adenomas, including rapid growth, spontaneous normalization of prolactin, or progression despite medical treatment should prompt medical teams to reconsider their diagnosis.
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Adenoma Replacement due to Invasion of a Metastatic Mass: A Case Report and Literature Review. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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Hani U, Tariq Q, Bari A, Anis SB, Diwan A. Benign pituitary adenoma with multiple intracranial metastases-a case report and review of the literature. J Surg Case Rep 2022; 2022:rjab382. [PMID: 35665399 PMCID: PMC9155169 DOI: 10.1093/jscr/rjab382] [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: 06/20/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022] Open
Abstract
Metastatic benign pituitary adenomas (PAs), also known as pituitary carcinomas (PCs), represent 0.1-0.2% of all intracranial lesions. They are rare and challenging pathologies. We present the case of a 34-year-old female, who presented to the clinic with headache and visual loss. She was diagnosed with PA with multiple extra-axial metastases. Debulking and biopsy of the lesions was done. Postoperatively, there was gross residual disease, and the patient's visual disturbances did not improve. Only 165 cases of PCs have been reported in the current literature. Existing consensus on management of these uncommon lesions is based on trial and previously published case reports and surgery appears to be the only definitive treatment. Further research regarding any non-surgical expectant management is warranted.
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Affiliation(s)
- Ummey Hani
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Quratulain Tariq
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Amman Bari
- University of Western Australia, School of Medicine, Perth, Australia
| | - Saad Bin Anis
- Department of Surgery, Section of Neurosurgery, Shaukat Khanum Hospital, Lahore, Pakistan
| | - Asad Diwan
- Department of Histopathology, The Aga Khan University Hospital, Karachi, Pakistan
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Recurrent Macroprolactinoma with Malignant Conversion to Carcinoma with Spinal Metastasis. Case Rep Endocrinol 2021; 2021:7488236. [PMID: 34804615 PMCID: PMC8601832 DOI: 10.1155/2021/7488236] [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: 05/27/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
In contrast to pituitary adenomas, pituitary carcinomas represent a rare malignant neoplasm with a remarkable high mortality. Pituitary carcinomas can arise from any pituitary tumor cell line and are determined to be carcinomas when there is distant metastasis or central nervous system dissemination. In this case vignette, we describe a rare case of malignant prolactinoma with intraspinal metastasis, and we also provide a review of relevant literature and treatment.
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Incandela F, Feraco P, Putortì V, Geraci L, Salvaggio G, Sarno C, La Tona G, Lasio G, Gagliardo C. Malignancy course of pituitary adenoma in MEN1 syndrome: Clinical-Neuroradiological signs. Eur J Radiol Open 2020; 7:100242. [PMID: 32695849 PMCID: PMC7365899 DOI: 10.1016/j.ejro.2020.100242] [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: 05/05/2020] [Accepted: 06/06/2020] [Indexed: 11/08/2022] Open
Abstract
Pituitary carcinomas (PCa) are extremely rare, indistinguishable from pituitary adenomas on histopathological grounds and have a poor prognosis. Most PCa start as PRL or ACTH secreting tumors in males, with relapsing invasive behaviour, refractoriness to medical and radiotherapy and increasing hormonal levels. The presence of distant metastases is still required for the diagnosis of PCa. The association with genetic endocrine diseases must be taken into account, since it adds further risk of evolution towards malignancy. Intradural spinal metastases have also been reported, so a complete craniospinal MR evaluation is recommended, when clinically indicated. We report a case of PCa, associated with MEN1 syndrome, with evidence of meningeal spread to the tentorium cerebelli, clival dura and spinal drop metastases mimicking spinal nerves schwannomas.
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Affiliation(s)
- Francesca Incandela
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Paola Feraco
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.,Department of Neuroradiology, Ospedale S. Chiara, Azienda Provinciale Per i Servizi Sanitari, Trento, Italy
| | - Valeria Putortì
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Laura Geraci
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Giuseppe Salvaggio
- Department of Diagnostic Imaging and Interventional Neurosciences, University-Hospital P. Giaccone of Palermo, Palermo, Italy
| | - Caterina Sarno
- Department of Diagnostic Imaging and Interventional Neurosciences, University-Hospital P. Giaccone of Palermo, Palermo, Italy
| | - Giuseppe La Tona
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Giovanni Lasio
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, (MI), Italy
| | - Cesare Gagliardo
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
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Moscote-Salazar LR, Satyarthee GD, Calderon-Miranda WG, Matus JA, Pacheco-Hernandez A, Puac-Polanco PC, Agrawal A. Prolactin Secreting Pituitary Carcinoma with Extracranial Spread Presenting with Pathological Fracture of Femur. J Neurosci Rural Pract 2019; 9:170-173. [PMID: 29456370 PMCID: PMC5812151 DOI: 10.4103/jnrp.jnrp_325_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Guru Dutta Satyarthee
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Jorge Aquino Matus
- Department of Radiology, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico
| | | | | | - Amit Agrawal
- Department of Neurosurgery, Narayna Medical College and Hospital, Nellore, Andhra Pradesh, India
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Abstract
Prolactinomas are the most common functional pituitary adenoma. Many prolactinomas can be treated with medication, but all patients should be evaluated at a neuroendocrine center including experienced neurosurgeons trained in transsphenoidal surgery. Surgery for prolactinomas is feasible and can be performed with low morbidity. Patients never previously treated with dopamine agonists should be considered for surgery if they have neurologic deficits, pituitary apoplexy, an uncertain diagnosis, or a significantly cystic prolactinoma. Patients previously treated with dopamine agonists should be considered for surgery in cases of intolerance or resistance. Recurrent and aggressive prolactinomas often require multimodal therapy.
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Affiliation(s)
- Daniel A Donoho
- Department of Neurosurgery, Brigham and Women's Hospital, BTM 4, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Edward R Laws
- Department of Neurosurgery, Brigham and Women's Hospital, BTM 4, 60 Fenwood Road, Boston, MA 02115, USA
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Zhao Y, Lian W, Xing B, Feng M, Liu X, Wang R, Zhou W. Diagnosis, Therapy, and Therapeutic Effects in Cases of Pituitary Metastasis. World Neurosurg 2018; 117:122-128. [PMID: 29883826 DOI: 10.1016/j.wneu.2018.05.205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 05/27/2018] [Accepted: 05/28/2018] [Indexed: 02/09/2023]
Abstract
OBJECTIVE This study aimed to summarize the diagnosis, therapy, and prognosis of pituitary metastasis. METHODS Ten patients from the Department of Neurosurgery of the Peking Union Medical College Hospital from April 1997 to August 2014 were retrospectively analyzed. RESULTS The participants included 7 males (70%) and 3 females (30%), with an average age of 60.4 years. The most common initial clinical feature was visual disability (50%). The postoperative pathology reports indicated 1 case (10%) of metastatic large-cell pulmonary carcinoma, 2 cases (20%) of metastatic small cell pulmonary carcinoma, 2 cases (20%) of clear cell renal carcinoma metastasis, and 5 cases (50%) of metastasis of adenocarcinomas from different areas. All the patients underwent a thorough follow-up, and the average survival was 144 days. CONCLUSIONS Pituitary metastasis is a rare disease. Its diagnosis depends on the clinical manifestations and radiologic results. The primary therapeutic method is surgery and subsequent radiotherapy and chemotherapy; however, the prognosis of this disease is poor.
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Affiliation(s)
- Yi Zhao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Wei Lian
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xiaohai Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Weixun Zhou
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
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Joehlin-Price AS, Hardesty DA, Arnold CA, Kirschner LS, Prevedello DM, Lehman NL. Case report: ACTH-secreting pituitary carcinoma metastatic to the liver in a patient with a history of atypical pituitary adenoma and Cushing's disease. Diagn Pathol 2017; 12:34. [PMID: 28420444 PMCID: PMC5395789 DOI: 10.1186/s13000-017-0624-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/30/2017] [Indexed: 02/07/2023] Open
Abstract
Background Pituitary carcinoma is a rare entity requiring the presence of metastasis to confirm its malignant potential. We report a case of pituitary carcinoma and discuss the diagnosis and management of this lesion in relation to the existing literature. Case presentation The patient is a 51-year-old woman with Cushing’s disease and intact adrenal glands who was diagnosed with metastatic pituitary carcinoma to the liver, 29 months after initial resection of an ACTH-secreting primary atypical pituitary adenoma (APA). Prior to detection of this metastasis the patient underwent repeat resection and radiotherapy for residual cavernous sinus disease. The metastatic lesion was detected by interval surveillance of serum ACTH and 24-hour urine cortisol, which despite stable pituitary MRI, were significantly elevated. These abnormalities prompted a PET scan that demonstrated hypermetabolic liver parenchyma, which was suspicious for metastasis on abdominal MRI. An ultrasound-guided liver biopsy demonstrated nests of moderately-differentiated cells with intermediate-sized, monotonous nuclei, distinct nucleoli, and abundant basophilic cytoplasm, confirmed by immunohistochemistry to represent metastatic pituitary carcinoma. The liver lesion was subsequently successfully removed by wedge resection. One year later, the patient’s residual cavernous sinus disease grew markedly, and she was placed on dual-agent chemotherapy consisting of oral temozolomide and capecitabine, with stabilization of her intracranial disease to present, although liver metastases recurred. Conclusions Pituitary carcinoma is a rare entity impossible to recognize as a primary tumor because its diagnosis by definition requires the presence of metastasis. Maintaining awareness of the entity and its precursor lesion APA is essential for its accurate pathologic diagnosis and appropriate management.
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Affiliation(s)
- Amy S Joehlin-Price
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Douglas A Hardesty
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Christina A Arnold
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Lawrence S Kirschner
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Norman L Lehman
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, 43210, USA.
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Nagy Z, Szabó PM, Grolmusz VK, Perge P, Igaz I, Patócs A, Igaz P. MEN1 and microRNAs: The link between sporadic pituitary, parathyroid and adrenocortical tumors? Med Hypotheses 2016; 99:40-44. [PMID: 28110695 DOI: 10.1016/j.mehy.2016.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 12/17/2016] [Indexed: 01/12/2023]
Abstract
Sporadic tumors of the pituitary, parathyroids and adrenal cortex are unique, as their benign forms are very common, but malignant forms are exceptionally rare. Hereditary forms of these tumors occur in multiple endocrine neoplasia syndrome type 1 (MEN1). We hypothesize that the pathogenic link among the sporadic tumors of these organs of different germ layers might be represented by common molecular pathways involving the MEN1 gene and microRNAs (miR). miR-24 might be a microRNA linking the three tumor entities, but other candidates such as miR-142-3p and microRNAs forming the DLK1-MEG3 miRNA cluster might also be of importance.
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Affiliation(s)
- Z Nagy
- 2nd Department of Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi str. 46, H-1088 Budapest, Hungary
| | - P M Szabó
- National Institutes of Health/NCI/DCTD/BRP, 9609 Medical Center Dr Bethesda MD, USA
| | - V K Grolmusz
- 2nd Department of Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi str. 46, H-1088 Budapest, Hungary; "Lendület-2013" Research Group, Hungarian Academy of Sciences and Semmelweis University, Szentkirályi str. 46, H-1088 Budapest, Hungary
| | - P Perge
- 2nd Department of Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi str. 46, H-1088 Budapest, Hungary
| | - I Igaz
- Department of Gastroenterology, Szt Imre Teaching Hospital Budapest, Budapest, Hungary
| | - A Patócs
- "Lendület-2013" Research Group, Hungarian Academy of Sciences and Semmelweis University, Szentkirályi str. 46, H-1088 Budapest, Hungary; Department of Laboratory Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi str. 46, H-1088 Budapest, Hungary
| | - P Igaz
- 2nd Department of Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi str. 46, H-1088 Budapest, Hungary.
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