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Struja T, Capraro J. Synchronous pituitary and pineal gland lesions presenting with panhypopituitarism in a patient with widespread colorectal cancer: a case report. Oxf Med Case Reports 2021; 2021:omab030. [PMID: 34055366 PMCID: PMC8143655 DOI: 10.1093/omcr/omab030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 12/28/2022] Open
Abstract
A 60-year-old man presented to our hospital because of febrile neutropenia due to chemotherapy for his metastasized colon cancer. During hospital stay, polyuria and polydipsia were noted. He reported that his thirst had become increasingly intolerable over the last weeks. Diabetes mellitus was diagnosed. Polyuria and polydipsia persisted despite euglycemia under insulin treatment. Because of thirst and high urine volumes during the night, diabetes insipidus was suspected. Endocrinological work up revealed complete panhypopituitarism with impairment of all anterior and posterior axes. After substitution with hydrocortisone, levothyroxine and desmopressin symptoms resolved. MRI of the brain revealed one round, contrast enhancing lesion in the pituitary stalk and one in the pineal gland. Because of extensive extracerebral metastasis and poor performance status, the patient opted for radiation therapy only. He died 2.5 months later due to non-cerebral manifestations of his cancer before cerebral radiotherapy could be initiated.
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Affiliation(s)
- Tristan Struja
- Department of Endocrinology and Diabetology, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland
| | - Joël Capraro
- Department of Endocrinology and Diabetology, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland
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Cuoco JA, Kortz MW, McCray E, Guilliams EL, Busch CM, Rogers CM, Jarrett RW, Mittal S. Case Report: Metastatic Bronchopulmonary Carcinoid Tumor to the Pineal Region. Front Endocrinol (Lausanne) 2021; 12:623756. [PMID: 33868166 PMCID: PMC8044440 DOI: 10.3389/fendo.2021.623756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/08/2021] [Indexed: 12/02/2022] Open
Abstract
Intracranial spread of a systemic malignancy is common in advanced staged cancers; however, metastasis specifically to the pineal gland is a relatively rare occurrence. A number of primary lesions have been reported to metastasize to the pineal gland, the most common of which is lung. However, metastasis of a bronchial neuroendocrine tumor to the pineal gland is a seldom-reported entity. Here, we present a 53-year-old female who presented with worsening headaches and drowsiness. MRI brain revealed a heterogeneously enhancing partially cystic mass in the pineal region. The patient had an extensive oncologic history consisting of remote stage IIA invasive breast ductal carcinoma as well as a more recently diagnosed atypical bronchopulmonary neuroendocrine tumor with lymph node metastases. She underwent microsurgical volumetric resection of the large pineal mass and a gross total removal of the tumor was achieved. Histopathology confirmed a metastatic tumor of neuroendocrine origin and the immunohistochemical profile was identical to the primary bronchopulmonary carcinoid tumor. Eight weeks after surgery, she underwent stereotactic radiosurgical treatment to the resection cavity. At 1-year follow-up, the patient remains clinically stable without any new focal neurological deficits and without any evidence of residual or recurrent disease on postoperative MRI. Metastatic neuroendocrine tumors should be considered in the differential diagnosis of pineal region tumors and aggressive surgical resection should be considered in selected patients. Gross total tumor resection may afford excellent local disease control. We discuss the relevant literature on neuroendocrine tumors and current treatment strategies for intracranial metastases of neuroendocrine origin.
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Affiliation(s)
- Joshua A. Cuoco
- Department of Neurosurgery, Carilion Clinic Neurosurgery, Roanoke, VA, United States
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- School of Neuroscience, Virginia Tech, Blacksburg, VA, United States
| | - Michael W. Kortz
- Department of Neurosurgery, University of Colorado, Aurora, CO, United States
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, United States
| | - Edwin McCray
- Department of Neurosurgery, Duke University, Durham, NC, United States
| | - Evin L. Guilliams
- Department of Neurosurgery, Carilion Clinic Neurosurgery, Roanoke, VA, United States
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- School of Neuroscience, Virginia Tech, Blacksburg, VA, United States
| | - Christopher M. Busch
- Department of Neurosurgery, Carilion Clinic Neurosurgery, Roanoke, VA, United States
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- School of Neuroscience, Virginia Tech, Blacksburg, VA, United States
| | - Cara M. Rogers
- Department of Neurosurgery, Carilion Clinic Neurosurgery, Roanoke, VA, United States
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- School of Neuroscience, Virginia Tech, Blacksburg, VA, United States
| | - Robert W. Jarrett
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- Carilion Clinic Pathology and Dominion Pathology Associates, Roanoke, VA, United States
| | - Sandeep Mittal
- Department of Neurosurgery, Carilion Clinic Neurosurgery, Roanoke, VA, United States
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- School of Neuroscience, Virginia Tech, Blacksburg, VA, United States
- Fralin Biomedical Research Institute, Roanoke, VA, United States
- *Correspondence: Sandeep Mittal,
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Cuoco JA, Kortz MW, Benko MJ, Jarrett RW, Rogers CM, Witcher MR, Marvin EA. Pineal Gland Metastasis From Poorly Differentiated Carcinoma of Unknown Primary Origin. Front Endocrinol (Lausanne) 2020; 11:597773. [PMID: 33193110 PMCID: PMC7644842 DOI: 10.3389/fendo.2020.597773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022] Open
Abstract
Pineal metastasis is an exceedingly rare finding in patients with systemic malignancies. Such lesions are typically the manifestation of a primary lung cancer; nonetheless, a variety of malignancies have been reported to disseminate to the pineal gland including gastrointestinal, endocrine, and skin cancers, among others. However, to our knowledge, pineal gland metastasis without a primary origin has yet to be described. Carcinoma of unknown primary origin is a heterogeneous group of cancers characterized by the presence of metastatic disease without an identifiable primary tumor on metastatic workup. Here, we present a case of a 65-year-old male found to have a heterogeneously enhancing lesion of the pineal gland as well as an enhancing lesion of the left cerebellar hemisphere. Comprehensive metastatic workup demonstrated multifocal metastatic adenopathy without an identifiable primary lesion. Stereotactic biopsy of the pineal lesion revealed poorly differentiated carcinoma with an immunophenotype most consistent with gastrointestinal origin. To our knowledge, this is the first case to describe a pineal gland metastasis without a primary origin. We discuss the relevant literature on pineal gland metastases as well as carcinoma of unknown primary origin.
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Affiliation(s)
- Joshua A. Cuoco
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Michael W. Kortz
- Department of Neurosurgery, University of Colorado, Aurora, CO, United States
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, United States
| | - Michael J. Benko
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Robert W. Jarrett
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- Department of Pathology, Carilion Clinic, Roanoke, VA, United States
| | - Cara M. Rogers
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Mark R. Witcher
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Eric A. Marvin
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
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